Community behavioral health clinics are a lifeline for the communities they serve and often provide mental health and substance abuse services at affordable rates to populations that might not otherwise have access. Many well-established clinics have been operating for decades, delivering treatment in the form of talk therapy, groups, youth services, psycho-educations, medication management and more. Yet these organizations face multiple concurrent challenges including chronic underfunding, low reimbursement rates, high caseloads, and a workforce shortage, with 97% reporting that they are having difficulty recruiting and retaining employees. Additionally, clinics are subject to high-levels of external oversight from multiple agencies as well as payer organizations. The demand for mental health services is greater than ever, and shows no sign of slowing down. Given these headwinds, it is crucial that clinics find novel ways to maintain therapists’ wellbeing and motivation. They should also embrace innovative strategies to operate with as much efficiency as is possible, especially in light of the human intervention that is at the heart of their offerings.
Andrew Schmitt, LCSW, Corporate OP Operations Director, Gaudenzia
Ultimately, core services are provided by clinicians, counselors, or certified recovery specialists, among others, overseen by trained supervisors who help them manage their workload and weigh in on treatment practices and client progress. These teams are driven by a desire to work closely with the people they serve, and are dedicated to helping others.
So the question becomes how to create operational efficiencies that allow clinicians and supervisors to focus on client needs, and serve more community members, without simply requiring the teams to work longer hours. For many community clinics, modernizing their technology is a crucial step in becoming more efficient.
But new technologies don’t work well unless everyone adopts them, including clinicians who might be reluctant. So within the clinics supervisors have become important advocates and teachers, encouraging clinicians to embrace the new tools at their disposal, as clinics transition increasingly to the digital era.
Supervisory Roles
To understand how supervisors at behavioral health clinics have become crucial to new technology adoption, it’s useful to look at what supervisors actually do. Supervisory roles have always been multifaceted jobs that include overseeing clinical teams to help them deliver quality care, by ensuring that clinicians are using the best therapeutic approaches and have the mental bandwidth to engage with patients, despite large caseloads and often with acute symptomology.
And, while the specialized training that most supervisors receive is focused on clinical care issues, evidence based practices, ethical issues and other aspects of treatment, the reality of what supervisors do is much more complex. They have to manage clinician schedules, complex client issues, administrative tasks such as chart audits and ensuring that documentation has all of the latest and necessary language including Stages of Change, or American Society of Addiction Medicine language for regulators and other oversight bodies.
In the past, much of the paperwork for these tasks was completely manual, and the shift to more automation has historically been slow, although today it is speeding up considerably. Clinical supervisors who want to work with clinicians more on care issues, are often frustrated by the amount of administrative work that is part of their purview and generally welcome technological changes that help streamline processes.
Technology and a New Role for Supervisors
What we have seen at our treatment center, as well as others, is that an increase in the demand for our services is supercharging our adoption of new technologies that allow us to scale our services. The pandemic dramatically increased the pace of change. For example, telehealth, previously viewed as potentially not as effective as in-person care, became an acceptable practice as we worked to keep serving our clients during the crisis and in fact has highlighted that technological advances are not just an opportunity to improve but an essential component of successful behavioral health service delivery
Other examples of digital transformation include greater automation of documentation, for example, creation of progress notes that must accompany every client or group meeting. Creating progress notes is a time-intensive process that can eat up hours of a clinician’s time over the course of a week, so automation is crucial. Additionally, accurate progress notes allow supervisors to better understand how treatment is being administered and whether the clinician is using the best, most up-to-date evidence based practices, or if they would benefit from increased training opportunities. Digital platforms that collect data on client’s progress offer an ability to practice measurement-based care, which makes treatment more relevant and timely for clients, and thereby more satisfying to therapists.
Other automation technologies can pull crucial reports from the EHR that can help supervisors understand client treatment plans, progress, and more. With better technologies, supervisors are equipped with unprecedented visibility into each member of their team’s activity, caseloads and performance, and can use that data to create tailored professional growth and development programs for clinicians, all in real time.
New technologies are also making the supervisors jobs easier by automating administrative tasks, saving time and giving them new opportunities to help clinicians focus on the interesting and rewarding aspects of the work: helping their clients live better lives. This enables quality management on a scale that had not been possible before.
Yet we have also found these innovations have been a two-edged sword, as experienced clinicians and supervisors are challenged to manage the changes in their workflow. Bringing clinicians along, teaching them the value of the new systems, and demonstrating that the end result will allow them more time to focus on work with clients and less on administrative burdens has become a key part of the supervisor’s responsibility.
Managing Across Experiences
Clinicians are a diverse group, with a variety of professional experiences, and at different stages in their careers. This creates an additional challenge for supervisors as they work to accommodate a variety of skill sets when it comes to technology.
One key is to help clinicians understand that technology can help with the administrative aspects of the job, which most of them dislike since they went into the profession to help people with direct interventions. As clinics move more quickly to modernize technology, bringing some clinicians into the newer practices can be a challenge, even if they ultimately understand the benefits. Some clinicians have stuck doggedly to manual/paper processes long after those techniques have outlived their usefulness, and supervisors find that they are often combatting preconceived ideas while they show clinicians how new technologies will ultimately help provide better care to clients.
Supervisors have found that they need all of their skills to change some clinicians’ minds about the new technologies. One technique we use, is to remind clinicians is that we are often helping our clients understand that nothing is certain and that change is an inevitable, albeit uncomfortable, part of life. Behavioral health care treatments often include explorations and discussions on the topics of change, adjustment, kindness, patience and tolerance, all of which are useful as supervisors help clinicians adjust to the new pace of change.
Scaling Services
Behavioral health clinics are modernizing and adopting new methods to enable scaling, while supporting quality management by helping supervisors do their jobs. This is crucial as the demand for services continues to increase while recruiting remains difficult, and burnout a risk among the clinicians. In this rapidly changing environment, supervisors are the advocates for the new ways of doing business, as they focus on helping clinics run efficiently and meet their main objective to serve their communities.
Andrew Schmitt, LCSW, is the Director Of Outpatient Services at Gaudenzia, Inc. and may be reached at aschmitt@gaudenzia.org. Melanie A. Irwin is the Division Director at Gaudenzia, Inc. and may be reached at mirwin@gaudenzia.org. Shiri Sadeh-Sharvit, PhD, is the Chief Clinical Officer at Eleos Health and may be reached at shiri@eleos.health.
