Psychotherapy Finances

We’re preparing a new report on therapist opportunities to consult with schools. It’s often cash work and there’s no hassling over getting paid. But working with children can lead to insurance business as well if a family decides they need some extra help.

Helping a school, or school district, create and organize an anti-bullying policy is one example of how to incorporate education work into your practice. (This applies to both public and private schools.)

This week, the Wall Street Journal took a timely look at another area that is ripe for therapist intervention – school “refusal” issues among students.

Most kids don’t want to return to school in the fall, but for some it’s a traumatic ordeal. As a result, they’re absent for many days or even weeks. In two-thirds of the cases the cause is a psychological problem like anxiety, researchers tell the WSJ.

The longer the problem festers, the harder it is to address.

School refusal isn’t an isolated problem these days, either. Between 5% and 28% of kids will struggle with these issues at some point in their school career, according to University of Nevada, Las Vegas researcher Christopher Kearney, who was interviewed for the report.

Unresolved school refusal issues can affect a person’s behavior when they reach adulthood as well. Cognitive Behavioral Therapy is the preferred method of treatment, although medication is sometimes recommended – a controversial solution.

Just something else to ponder while you’re looking for ways to expand and stabilize your practice income. And obviously, the demand for these services is particularly high in fall.

Speaking with clinicians in private practice around the country over the past couple of years, we’ve usually asked how the recession was affecting their client flow. Not surprisingly, some practitioners in very depressed areas, such as southern Michigan, have reported significant drops in income.

But not all are suffering the same fate. And obviously, therapists with the best marketing programs have fared better than their less business savvy competitors.

Royal Oak, MI therapist and practice consultant Joe Bavonese put things into further perspective recently when he added that people who were relying on an all-cash practice before the recession seem to be hardest hit.

But therapists who also had at least some insurance business tended to better weather the storm.

It’s additional evidence that maintaining a mix of income sources for your practice is the best way to proceed. Those clinicians who were emphasizing cash niches, but held positions with at least a few insurance companies, could begin falling back a bit more on managed care.

Hopefully, an approaching economic recovery will bring more cash clients back into the mix.

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The new National Survey on Drug Use and Health (NSDUH) released yesterday by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that substance abuse increased from 2008 to 2009.

The rate of illegal drug use jumped from 8% of the population aged 12 and older in 2008 to 8.7% in 2009. The increase was largely driven by an increase in marijuana use, but prescription drug abuse and ecstasy use were also up.

“Although the rate of overall illicit drug use among young people in 2009 remained below 2002 levels, youth use was higher in 2009 compared to 2008 (10% of youth in 2009, versus 9.3% in 2008, versus 11.6% in 2002),” SAMHSA reported.

“The rate of marijuana use in this age group followed a similar pattern, declining from 8.2% of young people in 2002, to 6.7% in 2006, remaining level until 2008, and then increasing to 7.3% in 2009.”

We often publish articles on niche markets at Psychotherapy Finances, and we’re in the middle of preparing a new one for an issue this fall. It’ll be a comprehensive look at some of the standard niches for therapists, with a focus on specialties that have gained traction because of their timeliness.

In our research we stumbled upon a rather interesting issue that is being called to the attention of more and more EAP providers – adults being bullied at work.

We’ve featured articles about therapists who work with children being bullied at school (and there are also some consulting possibilities here, as most schools have anti-bullying programs.)

But now the managed care giant ValueOptions reports that employees who are being bullied on the job are seeking help through their EAP.

“When you see it on the playground, it’s clear,” Rich Paul, vice president of Health & Performance Solutions at ValueOptions, said in a news release earlier this week. “At work, bullying can be less obvious and occur over a long period of time, resulting in extreme stress and anxiety for the employee.”

And as he also notes: “Workplace bullying doesn’t just affect the person being bullied. It divides work teams, distracts from the job and causes untold hours and days of lost productivity for the employer.”

It can take different forms, including falsely accusing co-workers of errors, giving another employee “the silent treatment,” or ridiculing someone’s point made at a staff meeting.

In addition to EAP work, this could be worked into a private practice mini-niche. It would seem to offer additional opportunities for consulting as well – and businesses tend to pay better than schools.

As an addendum to an upcoming article in Psychotherapy Finances about Medicaid, we recently spoke with Roger Smith, a senior attorney for the American Association of Marriage and Family Therapists (AAMFT). Smith tells us that 38 states allow MFTs to work with Medicaid patients “in some capacity.” So we would expect the discipline to benefit from the additional 16 million Medicaid patients who may be added to the rolls under the new health care reform law.

Some of these states allow MFTs to see Medicaid patients in private practice, while others require them to be seen in a clinic setting, according to Smith. (MFTs have been lobbying the feds to treat Medicare patients, but their efforts have fallen short so far.)

But Smith is hopeful that the Medicaid expansion could spur changes on the state level to allow more MFT participation. The remaining 12 states, for example, may need additional providers.

The problem is, as Smith points out, MFTs aren’t all that eager to see Medicaid clients with rates as low as $35 per session. And analysts for other provider organizations have told us that budget-squeezed states might actually try to cut rates further, despite an infusion of federal Medicaid money.

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In California, average MFT income is down 6% from 2008, according to a survey by the California Association of Marriage and Family Therapists (CAMFT). That’s $55,890 to $52,886. The survey was quoted by the online publication, MFT Progress Notes on August. 16.

Over the last eight years, MFT incomes in California have risen only slightly from $47,851 to $50,689 among those with master’s degrees. However, those with doctoral degrees have seen their incomes jump from $62,885 in 2004 to $72,165 in 2010.

One caveat: The CAMFT survey was based on a 16% response rate. But that was consistent with past CAMFT surveys, Progress Notes said.