[ALISON PIDGEON]
You are listening to the Grow a Group Practice podcast. Whether you were thinking about starting a group practice or in the beginning stages, or want to learn how to scale up your already existing group practice, you are in the right place. I’m Alison Pidgeon, your host, a serial entrepreneur with four businesses, one of which is a large group practice that I started in 2015. Each week, I feature a guest or topic that is relevant to group practice owners. Let’s get started.

Hi, I’m Alison Pidgeon, your host. Thank you so much for joining me today. I hope going to you are having a great December. So just a little window into my world, my family celebrates Christmas and my husband is so excited about Christmas every year. He loves to decorate the house. Each room has a different theme and we moved into a new house a couple years ago. So now there’s just more space for him to decorate. So he started decorating in November and our house is fully decorated now. The Christmas music is definitely on much of the time so I am living in Christmas land but because that makes my husband happy, I just go along with it and I get out of having to decorate the house. So that works for me.

So I’m really excited to share this interview with you today. I interviewed Lisa Savage. She is the owner of the Center for Child Development, which is one of the country’s largest black-owned practices. She started her practice by providing school-based mental health counseling. She also co-founded an organization called Clinicians of Color, which is an online platform that provides support for private practice and clinical needs of BIPOC mental health providers. So she’s definitely doing many amazing things. She has 60 employees now so we talk a lot about how she’s scaled up her practice and how she kind of grew into her CEO role. So if you are aspiring to grow a larger group practice, this is a great interview for you to listen to.
[ALISON]
Hi, Lisa, welcome to the podcast.
[LISA SAVAGE]
Hi, thank you very much for having me.
[ALISON]
I’m excited to talk with you today. Can you give us an introduction of yourself and your practice?
[LISA]
Yes, absolutely. My name is Lisa Savage, as you just said, I’m an LCSW. I’m licensed in Delaware although I live in Maryland. That happened because I got married several years ago and Marilyn was kind of the midpoint between my husband and myself. He has a business in DC, so I’ve been living here in Baltimore for about five years. Before the pandemic, I was commuting back and forth to Delaware. I can say I do not miss that commute at all although it’s probably happen again. I’ve built a huge practice called the Center for Child Development. I currently have 60 employees and growing, so it is a huge practice that requires a great deal of my time and attention.
[ALISON]
That’s actually the reason that I wanted to have you on the podcast because it’s not common to find somebody who has a practice that large. So I thought it’d be cool to talk about kind of how you built it and what the different kind of points were which you had to maybe change the structure of things, to support the growth and all of that kind of thing. So do you want to kind of tell us how you got started with the group practice?
[LISA]
Yes, so I hired my very first associate, been with me now for 11 years. She started, she had just had a baby, so she wanted to kind of ease her way into the private practice world. So it really worked out quite well for both of us. She started as a contractor and she was my very first person that I had ever hired and she was pretty amazing and she’s still with me which is great. I think that says a lot about how we’ve been able to form this relationship over the years.

So after I hired Rebecca the very next year, I hired three more associates and it just seems to have grown with that kind of pattern over time. My practice is built on school-based mental health. So what I did was back in 2007, I went to a district in the state of Delaware and said to them, listen, you have no mental health services for children in middle or elementary school. There were high schools that had mental health services, but the middle and elementary schools did not have mental health services. So the district said Lisa, that’s a really good idea. So they said, hey, we’ll put you in four middle schools and let’s see how it all works out.

So this is before I hired Rebecca. So the four middle schools, I serviced them myself, I went to the school, created a process and procedures for getting kids referred. Then the second year is when the school district said, we want to expand this to our elementary schools. That’s when I brought on Rebecca. What didn’t I know at the time was the need for child mental health services. So I looked around the area where I practiced in Delaware and realized there were not a lot of people who worked with kids. There were a handful of people who worked with kids.

So I thought, hmm, I might be onto something here. Nobody else is doing this. Certainly nobody else was doing it in schools. So I started creating an infrastructure for my practice. I started fine-tuning my procedures and I started heavily promoting the importance of school-based mental health services, showing up where kids are and it started to take off. So while we started off with four, then it went to eight, we are now in close to 100 schools in the state of Delaware, which is why their practice has grown to be as big as it is. Honestly, never saw it growing that big.

I thought I had created something that was kind of cool, really nice. It worked out well for my practice model, but here we are in 2021 and I am hiring, I’ve hired up to, I have 60 people and literally my text messages are blowing up from my directors saying, we need to hire more people. So it’s, especially post pandemic, or I don’t think we’re post pandemic, but even during the pandemic mental health services for children and families has grown tremendously.
[ALISON]
Congratulations. That’s amazing.
[LISA]
Thank you. Thank you. I feel good about the work that we do. In all honesty, a lot of the children that we see, because either they live in the inner city or they live in rural areas, getting mental health services would be very challenging for the them. A lot of agencies have wait lists. We pride ourselves on never having a wait list, which does put a lot of pressure on us to get kids seen. But because we’re in the school, we can make accommodations to making sure a kid gets seen. So if we get a referral and that kid’s in acute distress, I know a therapist is be there today. That therapist can get that kid consented and get that kid assessed and make sure that that child is safe.
[ALISON]
That’s great. So let’s talk for a minute about kind of the business structure of the practice. So if you are doing school-based counseling, I’m assuming then you don’t have any physical offices for the therapists. They’re all just in the schools or how does that look?
[LISA]
So we do have an office and we’ve always had an office. We actually are in the same building that I started in many, many years ago, but we just moved to a bigger office. So coincidentally, we signed a lease for a 5,000 square foot office, six months before the pandemic hit. So for the past 18, 19 months, this beautiful office sits there, but we’re not using it. So we do still see quite a few people in our office. Surprisingly, we see a lot of adults as well. I think the point that I’d like to make is that when you become known for one area of specialty other people seek out your services.

So people get afraid about niching down, but it doesn’t preclude you from being able to see other people. So as I’ve grown, I’ve been able to hire people who have a variety of expertise, skills, and experience. So that’s helped me to expand my brand even more. So we’re known for school-based mental health, but we get tons of phone calls for the office. We’re all working virtually now, but we get tons of services for couples and men and women. So it’s kind of nice. Again, what I saw from my business perspective was we are very well known in the state for what we do, but to expand my brand, I started looking at therapists who had different types of expertise to enhance the work that we’re doing.

Kids belong to families. If here’s a marriage that’s not doing really well and there are children, those kids are going to be impacted. So why not help the couple, the parent to feel better and to be able to interact better and have a happier marriage? So that’s another, I think important business take-away too, for mental health professionals who are looking, who are listening is to think about once you’ve established your niche, now, how can you expand it to provide even more services?
[ALISON]
I’m really glad you made that point because I think that’s one thing, a lot of group practice owners don’t think about, is you may have that specialty of working with children, but then people are going to learn about you or services and the good work you’re doing. Then other types of referrals are come your way as well. So it makes sense to be able to accommodate them rather than me referring them out all the time.
[LISA]
Correct. Exactly, exactly. I mean, even now, as a business owner, I had to cut back on the number of clients that I was seeing. I knew that early on. Think I was probably three years into a group practice and really trying to juggle it all. I was doing payroll. I remember one Thursday night I was doing payroll and literally fell asleep on my couch, woke up at two o’clock in the morning and was like, wait a second, Lisa, there’s a better way to do this. So I knew that I had to add some other systems in place because I was burning out. I started to decrease my caseload. I now have, I now see maybe about five clients a week, which sometimes feels like a lot.

But what I’ve learned is that as a CEO of a business, you can’t work in your business and on your business at the same time. Something is going to give and typically it’s you as a human being that is going to give because you can’t do it all. So creating systems, adding in other people who can help you grow the business and of course maintain your own good mental health is really, really important. So that’s what I did. I have an awesome team that helps me. I wouldn’t be able to do this without them. It took some time to create and I’m continuously cultivating my team as we grow. There are different challenges that we all meet, but having a team being surrounded by people who have a particular skillset is also extremely important as well.
[ALISON]
Absolutely. So I’m curious as you grew and obviously realized you had to let go of more and more things and delegate them out, what were the things that you decided to keep? Like what do you spend your time doing now?
[LISA]
That’s an excellent question. So I spend my time now being super creative. So I do a lot of work online on social media, in our Facebook page that we have. I do a lot of talking in the community about mental health, particularly mental health that affects black and brown community. So I spend a lot of time doing that. Then I feel like I do a lot of time, I spend a lot of time helping my team to be able to reach our goals. So I set the goal. So I might set a goal of, I don’t know, we need to have X amount of billable hours in a week. And my team who surrounds me, I support them am in helping us to be able to reach that goal.

This year, this is really funny, this year because of the pandemic I took, we always go on a retreat, my leadership team. This year, we’d gone on two retreats because there were so many changes that every time we were doing a virtual meeting, I was like, guys, we just need to be in person. So last summer we went to the beach and then in August we went to a little resort on on the Eastern shore here in Baltimore. So we did a lot of planning and we did a lot of team building things because things have shifted so dramatically. We didn’t know what the school year was look like coming up. There was a lot of anxiety about, are we be in school out of school or school’s let us in. So part of my role now is really helping my team to be able to continue to meet the challenges that we’re constantly facing and to be able to meet the goals that we set for ourselves.
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[ALISON]
I think that’s such a great way of stating it because really then your job becomes helping the leadership team and being there kind of safety net and support.
[LISA]
Yep. Absolutely.
[ALISON]
That’s great. I wonder if you noticed along the way of growing to the point of having 60 employees, were there different kind of like thresholds of maybe amount of employees or number of clients where you realize like, oh wow, we’ve outgrown this or we need to now hire these people for leadership positions or does any like particular times stick out in your mind of like, oh, we have to make a shift here because it’s not working anymore?
[LISA]
Yes. And I remember the exact moment. It was right before we moved to this new office space. Actually it was right before, it was a couple of years before he moved into this new office space where we were growing at such a rate, that one, I needed somebody to manage the HR part of things. I didn’t have an HR person again. I was doing that myself. My office manager was assisting with that, but I thought with an organization is big we need somebody’s to manage the entire HR. So one of my therapists, I sent her to do some training in HR. So she spends half of her time, which actually it’s more than half of her time doing HR work and she also does some clinical work as well.

Then the other thing that happened is we were hiring a lot of people who were pre-licensed. So I needed someone to be a clinical supervisor to make sure that our pre-licensed people were getting the correct supervision, had somebody to report back to. So I hired a clinical director. As a school-based mental health component grew and grew and grew I knew I needed somebody to have sort of their feet on the ground. So I hired a director of school-based mental health. And all the people that are my leadership team with the exception of one, started out with me as a therapist, as a clinician. They are brilliant people and that’s no hyperbole, they are absolutely brilliant people. So I feel very fortunate.

Last year, two years of go, I hired a director of operations. Again, I needed someone to help us to refine our policies and procedures to stay on top of the changing rules around everything that we do. So I hired, he is actually the only male on the leadership team. He’s got a doctorate in history, but it turns out he can do anything and he’s proven that. So he’s now our director of operations and he stays on top of things. My sister, my biological sister has been my office manager from day one when it was just me. So she continues to be with me and she oversees our administrative staff.

We knew at some point with the level of employees that we had, who were doing billing and getting referrals, we needed to increase our administrative staff. We now have two other admins in the office and then we have a virtual assistant who does some work behind the scenes. So there were points, and I can’t say that there were specific points, but there were points where I knew that I needed to put some additional structure in place, meeting a person to make sure that we were doing and being the best that we could be and that there were no places where we would fall short.

Have we fallen short at times? Absolutely we have, but those are opportunities for us to learn and grow and figure out, okay, what do we need to do to put things in place so that this doesn’t happen again? We recently added another level. We have what we call field supervisors. They’re actually at the schools. So they go to the schools, they check in to make sure that the therapist is doing what they need to do. They’re talking with the administrators. They’re handling any problems that surface on a day to day basis. So that’s been a really nice addition to our team, is to have those field supervisors out, literally in those schools, making sure that things are going well.
[ALISON]
Nice. So it sounds like, was that just sort of like over a period of a few years you added those leadership positions or?
[LISA]
Yep. It was over, I mean, I knew at certain point that I needed specific people and help. But financially it took me some time to get there because everybody in my practice is on salary, but I wanted to make sure my leadership team was being compensated well. So I had to put a lot of thought into how can I make this happen because they’re only be seeing clients half the time, which certainly wasn’t be enough revenue to pay them their salaries. But as we grew and for every three therapists that we hired, I knew that that was enable me to be able to pay my leadership team the salary that I wanted to pay them. So that was kind of the metric that I used for that. Every third person that we hired was creating enough revenue to be able to pay my leadership team. So that was that one metric that I needed, that I used, but I also knew that as we grew bigger that there had to be layers in between to be able to support the practice because you can’t have a business as big without having additional layers of people.
[ALISON]
Right. Do you remember when those points were where you had to add in those layers? I know for me in my practice, it seemed like once we got between 15 and 20 clinicians, that’s when I had to look at, okay, what are some leadership positions we need to put in place? Because I couldn’t do it all anymore.
[LISA]
Yes. So I’m remembering the time when I was sitting in my office and I was thinking I really need to do this. I think at that point we were probably at about 15 therapists when I decided that I needed the HR person, I decided I needed the clinical director. I didn’t think that we were grow that much more. I mean, honestly, I don’t think that you can even imagine how big your practice is grow. It just sort of happens organically. But I do remember us being at like 15 and me going, I need somebody to manage the HR part of this. I need somebody to make sure that our pre-licensed people have supervision and are performing well and are reading their charts. So that was kind of like where I was at that point. That was a few years ago that I decided to expand things.

The other thing that I did was as a team, we all started meeting, we had regular meetings twice a week where we talked about our successes. We talked about struggles, we set goals and we continue to do that virtually where we sit and we meet for an hour, twice a week and we strategize. I think that has helped the team to become more committed to the vision and certainly more cohesive amongst ourselves. So I really, I kind of like that time. I think they enjoy it as well. There certainly been a lot of challenges that we have faced along the way.

During the pandemic one thing that happened is the shortage of mental health providers became even more stark. So trying to fill in the gaps where we knew we had needs, it’s actually an ongoing struggle for us because there’s just not a lot of people out there who are looking for jobs. I mean, mental health people are in demand. So we have to figure out how can we continue to compete and pay people a decent wage and offer benefits because there’s all much demand out there? That’s been a big factor for us.
[ALISON]
That’s been a challenge for almost every group practice owner that I’ve talked to over the past year, just being more competitive with hiring and trying to attract people. So have you found anything that’s worked well for you and terms of hiring?
[LISA]
Yep. So I think when we transitioned our employees from hourly employees to salary, that was the deal breaker for us. It really opened up opportunities to hire people who really were looking for the stability of a regular paycheck and benefits. Most of the therapists that work for me are young. Either they’re fresh out of graduate school or they’ve only had one or two professional jobs. So I know what they’re looking for. I know what they need. So I had to figure out how can I give them that financial stability because the other agency down the street, which is a bigger agency can afford to pay salaries and benefits and that kind of thing.

So that’s what. We did took that risk. It was, it was very scary but we did some calculations and figured out how we could do it. So they’ve all been on salary for two years now. The other thing is we beefed up our benefit package. So we have health insurance, dental insurance, they have supplemental insurance, they have PTO, a generous PTO policy. We also are giving them mental health days now. So when people are feeling stressed, because a lot of the work that we do right now is very stressful, we are giving them mental health days where they don’t have to use their PTO.

They can take a day without any explanation and use it for themselves. We have employee recognition every single month; two employees get a gift basket and we highlight them in our newsletter. So those are the things that we do that are extra. And honestly I’m always looking for other things that we can do for our staff as well because I appreciate them one two as a business owner, I know that there’s tons and tons of competition for mental health providers. So I need to do things to retain my people. So we’re always trying to think creatively about what we can do to retain them, attract them and retain them.
[ALISON]
That’s great. I love that idea of taking a mental health day.
[LISA]
Yes, yes. I thought that was kind of important.
[ALISON]
Yes, absolutely. Very cool. So what’s been your greatest joy and also your greatest struggle of being the CEO of practice this big?
[LISA]
So the greatest joy is I have such passion for school-based mental health. I just think every school should have school-based mental health and I have a great deal of passion for it. So to be able to reach children who ordinarily would not be able, would not easily be able to get mental health services is a tremendous join for me. We’ve seen thousands of kids and I think back on the time when I was in the schools and I just really enjoyed the work that I did, but that’s the biggest joy. I think second to that is being able to employ people who are young, who are fresh out of graduate school and to train them and teach them and supervise them clinically, give them opportunities to grow. It’s also a great joy of mine as well. What was the second part of your question?
[ALISON]
What’s the greatest struggle?
[LISA]
The greatest struggle is managing people. Even as a seasoned person who’s been supervising and managing people for many, many years I still find myself stumped by things at times. I think there’s sometimes when people come to work, they bring other issues into the work setting, either unresolved issues in their families or unresolved issues that are going on in their lives now. It’s a struggle sometimes to help people manage that but also for me to know how to manage it from an employer perspective. So that’s the biggest struggle. Really it’s in managing other people. I would say, I tell people all the time, if you’re go into private practice, it is not passive income. Don’t think that hiring other people is a passive stream of income because you’re be working and you have to also be okay with managing and supervising other people because that’s a huge part of being in private practice.
[ALISON]
That’s actually the same answer I would give as well.
[LISA]
So you can understand, I’m sure.
[ALISON]
Yes. It’s always interesting how we, I guess I assume wrongly because I know the education that folks have gone through and the ethics class and all that stuff that we’d all have similar expectations when it comes to certain things or know that we’re supposed to do things a certain way, but you shouldn’t assume that.
[LISA]
Correct. Absolutely. We found on ourselves struggling with certain situations and having to figure out how to resolve them. It’s not always been easy. I’ve had to terminate a couple of people. That’s never, ever fun. But at the end of the day, I’m make sure that people who work for me are professional, ethical, legal and represent me and my brand in the way that I want it to be represented. There’s certain situations that I find you can absolutely work with a person and then there are times where you cannot work with a person. So yes, I think just that whole piece of managing other human beings can be very challenging.
[ALISON]
Yes. I know you have another business, correct, that you wanted to tell us about?
[LISA]
Yes. So I am one of the co-founders of Clinicians of Color. Clinicians of Color is an online platform that supports BIPOC professionals in starting or growing a private practice. We’ve also expanded from the whole private practice building to offering clinical training. We’ve partnered with an EMDR trainer who does three trainings for us a year. We’re partnering with someone to do EFT training and so we ourselves as being a conduit and a repository for BIPOC mental health professionals to get what they need to be able to serve their communities and serve their communities well. We’ve also created a directory for BIPOC communities. It’s called cliniciansofcolor.org. We’re expand to have an association. So anybody who wants to avail themselves of all the benefits, we’re be offering health insurance, dental insurance, supplemental insurance, they’ll have to become part of our association to be able to access those services. So I love Clinicians of Color. We have Facebook group of 18,000 and I think we’re doing pretty dope things over there.
[ALISON]
Oh, that’s amazing. Congratulations. So what has been the response from the community from what the work that you’re doing there?
[LISA]
People love it. Our clinicians love it. I think because they see me and Kim Knight, who’s my business partner, they see us as being very committed to them. They see us as working very hard. Then just the community itself is filled with people who one, have amazing expertise and we wouldn’t have ordinarily crossed paths with them had we not created this platform. So we crossed paths in Clinicians of Color with people who were just absolutely brilliant. Again, I don’t use that word lightly. They’re researchers, they’re writers, they’re excellent clinicians.

So we’re thankful that we have a gathering place for people to feel safe and to be able to learn from one another. We’re very, we prioritize learning from one another. So when we have someone who’s an expert in Clinicians of Color, we pay them to teach whatever their expertise is. So it’s been a passion of mine. It is a lot of work because it is a second business. But I absolutely love it. I love the way that it’s grown and I love the community that has come out of Clinicians of Color.
[ALISON]
That’s awesome.
[LISA]
Yes, that. Thank you.
[ALISON]
Yes, it was great hearing about all the things that you’re doing, Lisa. If folks want to check out your practice or if they want to learn more about Clinicians of Color, where should they go?
[LISA]
So they can email me and my email address is [email protected]. I mean, I think if they even want to learn about my practice, they can email me there too. My practice website is thecenterforchilddevelopment.com and it’s located in Newark Delaware. So they can go on the website and check us out and certainly make contact with me there as well. I respond to every single question, an email that comes in. So if somebody has any questions even about school-based mental health and how to get it started in the are again, it’s a passion of mine. I’m happy to talk to people. So [email protected].
[ALISON]
Excellent. Well, thank you so much for taking the time to speak with us today.
[LISA]
My pleasure.
[ALISON]
Just wanted to give a shout out to our sponsor, Brighter Vision one more time. If you are interested in getting a Brighter Vision website, we have one for my practice and have had great experiences with it for the past six years, you can get started for a hundred off. Just go to the website, brightervision.com/joe, and you can get hooked up with that discount.

One thing I wanted to mention that we didn’t talk about in the interview is Lisa is giving away two months free for her directory, Clinicians of Color. Any BIPOC provider that wants to take advantage of that can use the code [TWOFREE]. So T-W-OF-R-E-E. I thought that was really cool. So thank you Lisa, for offering that.

If you are wanting to start a group practice and you’re just starting from scratch, definitely check out a program that we have at Practice of the Practice called Group Practice Launch. If you already have a group practice and you’re wanting to scale it up or make it more efficient or just get some support around the challenges that we all have as group practice owners, definitely check out Group Practice Boss. You can join that at any time. It’s at practiceofthepractice.com/grouppracticeboss.

All right, well, I hope everybody’s having a great holiday season and I will talk to you next time.

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This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests are providing legal, mental health, or other professional information. If you need a professional, you should find one.