Do you have a procedure manual for your group private practice? Why is it worth writing up? Why should you treat systems in your practice as a continuous work-in-progress?
In this podcast episode, LaToya Smith speaks about streamlining your practice by creating a procedural manual with Nakita W. Scott.
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Meet Nakita W. Scott
Nakita W. Scott MA, MSW, is a Licensed Clinical Social Worker living and practicing in Central Florida. She has been a social worker for eleven years and her experience includes military social work, school social work, and mental health counseling. She started her private practice a few months before the pandemic and has been in private practice for almost three years.
Her focus areas include Christian counseling, trauma, perinatal mental health, veterans, law enforcement, first responders, and ministry staff.
There are many documents and admin tasks that fall under the responsibility of the group practice owner, but why should you consider writing up a procedure manual?
The short answer: it will streamline your practice and save you loads of time.
It really outline[s] everything we’re supposed to do because one thing … I think all group practice owners realize [is] that you’re the person that everybody is going to ask, “What are we supposed to do? How are we supposed to handle everything?” You [set] the stage for all that. (Nakita W. Scott)
You can write out how you want the procedures within your business to flow based on the value systems within your group practice.
What goes into a procedure manual
Things to include in your procedure manual range from:
How clinicians and counselors need to keep track and write up their progress notes
Procedural routines with client emergencies
How to handle billing
The different forms and assessments that counselors utilize
What happens if a clinician is subpoenaed
So it’s really like the playbook for your practice. (LaToya Smith)
Discuss it with your clinicians
When you hire new clinicians into your group practice, give them all two to three days to read the whole procedural manual and then meet with you if they have any queries.
Ask your clinicians:
Are there any practices you have questions about?
Is there anything that you are confused about?
Is there anything that you feel needs to be revised or added?
I like that because that’s another good way to get new people on board and let them know that they also have a voice [within the practice]. (LaToya Smith)
Nakita’s tips for writing your procedure manual
This is where your value system becomes important.
What is the value system that your practice is based on and what do you want it to look like? Not just to your clients, but [also] to other professionals. (Nakita W. Scott)
Think about your value systems.
How can you embody them by integrating them into the procedures that run your business?
Think about other practices that you have worked in, if any.
How did they handle client relationships, how did they make clinicians feel comfortable, and what was their approach to business? Can you incorporate and change their principles to suit and support the best version of your practice?
Constantly reevaluate and be willing to make changes to keep the practice running smoothly.
Bring flexibility into your business, and avoid being so rigid that you are not willing to change what might need some adaptation.
Nakita’s advice to new group practice owners
Give yourself grace that you will not have everything figured out right away. It will take time, so take it step by step.
Useful links mentioned in this episode:
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LaToya is a consultant with Practice of the Practice and the owner of LCS Counseling and Consulting Agency in Fortworth Texas. She firmly believes that people don’t have to remain stuck in their pain or the place they became wounded. In addition to this, LaToya encourages her clients to be active in their treatment and work towards their desired outcome.
She has also launched Strong Witness which is a platform designed to connect, transform, and heal communities through the power of storytelling.
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You are listening to the Grow A Group Practice podcast, a podcast focused on helping people start, grow, and scale a group practice. Each week you’ll hear topics that are relevant to group practice owners. I’m LaToya Smith, a practice owner, and I love hearing about people’s stories and real-life experiences. So let’s get started.
Welcome back to the Grow A Group Practice podcast. My guest today is Miss Nakita Scott. I had the opportunity to meet Nakita as well, back in, I want to say it was April at a conference, and it was a beautiful conference, Faith in Practice Conference. Really enjoyed myself and I really had a great time meeting and chatting with her, even though I didn’t have too much time at the conference. It was definitely memorable and fun and knowledgeable to connect with her. So I asked her to be a guest on this podcast, so I’m really excited with Nakita. Welcome.
[NAKITA W. SCOTT]
Thank you so much for having me.
No problem, no problem. I knew, I think I said at that time, I want to interview for a podcast. I’m glad we were able to set a time for today. So, Nakita, tell us a little bit about you and your practice, location, all that stuff.
My practice is located in Central Florida, in the middle between Orlando and Tampa. I’ve been in group practice for almost three years. Didn’t start out that way. I was a school social worker first for about nine years and then right before the pandemic started, I started my practice.
I remember that conversation we had, and I was like, I never, I always wonder who lives in Central Florida, like in between and not on the coast. I remember you telling me people live there. Well, obviously people live there, but it was, I remember that conversation we had and I was just like, wow. Every time you think Florida, you think the water of the coast. So you were a school counselor for a long time, what happened during the pandemic that made you want to take that shift to open up your own practice?
Well, I was a contract therapist for a school counselor’s practice, and I had been a contract therapist for three years, and then a local therapist in my community reached out to me through Facebook Messenger and was like, “Have you ever thought about having your own practice?” I said, “Yes, maybe like in a few years.” She was like, “No, what about now?” There’s a local community agency that wanted to have mental health counseling on site because they work with individuals experiencing homelessness or poverty and they wanted them to be able to have access to mental health, affordable mental health.
I met with the director of the agency, The Mission of Winter Haven, and it was a great conversation. He says, “Whenever you’re ready.” So I thought about it, backed in pray for a few days, and it was also during hurricane season, so we’re in the middle of a hurricane. He called me one day and he was like, “What do you think?” I said, “Well, let me talk to the person that I’m working with first.” I talked to her and she was like, “Absolutely, that’s a great idea.” She’s like, “It will in no way affect our personal or professional relationship. Go for it.” So I did. I started laying the groundwork to start my practice and went from there.
That’s awesome. That’s one of those like perfect opportunities to walk right into, like ready made for you. I love this person that came to said, so what do you think, what that person was really starting to say and was like, hey, do it.
We all need friends like that or colleagues that will push us into something new and something greater. So that friend is awesome. Tell us now, I know like we were chatting a little bit before we jumped on and you mentioned that you started out the gate as a group practice, so you never started solo, just you?
No, I did the foundational work solo. I started in September of 2019, and by December I saw my first client. Then by January I had one of my provisionally licensed interns had joined me, and then by March or May, another intern joined me. So it just jumped right into group practice unexpectedly.
Yes, you definitely hit the ground running even that time, like solo for a couple months, and then group within what, three, four months, I think that’s great. I know today what we’re really going to be focusing on the, you’re going to help the listeners out with the policies and systems that you have in place for new hires. So tell us what that looks like, I guess, from the time you placed the ad or or orientation. What are, tell us about these policies that you have in place.
Most of the therapists that I have hired are actually people that I know or that have come recommended by colleagues. So I haven’t actually placed an ad for any clinicians so I feel like I’ve been fortunate in that instance where I’ve gotten people that have come highly recommended or people that I already had a professional relationship with. My process is, first and foremost, I had to develop an agency procedural manual. This really stems from my job as a school social worker. My boss had one, we were expected to read it, it really outlined everything that we were supposed to do. Because one of the things I realized, and I think all group practice owners realize is that you’re the person that everybody’s going to ask what are we supposed to do and how are we supposed to handle everything?
So you’re really setting the stage for all that stuff. It just started out with my other clinicians saying, well, what do we do if this happened? Situations would come up and they’d say, well, what should we do next? So I started writing those procedures out as we were handling them, and then one day I was like, “I probably should develop some processes for how I want things to go based on the value system of my practice.”
All right., i that, and you think, tell me what goes on or tell us what goes into the procedural matter? What are some things that you’re certain like, hey, this needs to go in there for me or for anybody with a group practice?
It talks about how they have to do their progress notes, how the progress notes. We use an EHR system, but we also have paper files as a backup, so how those files are supposed to be set up. We have telehealth procedures. We have procedures about if you have clients that have to be baker active, so what do we do in those emergencies? How do we handle billing? What do we do with our billing process, which really works more so for my assistant now. Then it also has in there just different forms that we utilize, different assessments that we utilize and it also talks about what will happen in the event that a clinician is subpoenaed or a client asks a clinician to get involved in their legal issue?
So it’s really like the playbook for your practice?
It is a playbook.
Yes, okay. All right, so it’s like, listen, sit down, look through this. If you have questions, for the most part, as it as it pertains to policies, you can find it right here in this playbook and it’s manual.
Okay, okay. So how does it go with new hires? You’re bringing people on, just tell us that, like, is that it? Do they read it and it’s it? Like what’s the best way to get a new hire acclimated, a new therapist to your practice using this manual?
I do have them read it. I give them about two or three days to read it so they’re able to come into the office and read through it. We haven’t made it electronic yet, which is our next goal. Then I also have a conversation with them. What are some practices that you still have questions about? Is there anything that you’re confused about? Is there anything that you feel needs to be revised or situations that they’ve incurred in other agencies that they feel like we should add to our policies as well?
I like that because that’s a good way to get new people on board and let them know that they also have a voice too. What else do you see that could be added to the manual? Is that what I hear you saying?
We talk about it during our staff meetings every time the practice is going through transition. So like with our upcoming relocation, everybody will revise, look at it again, and we’ll talk about anything that isn’t working that we need to revise or update or anything that somebody has a question about or is there a policy that we don’t even use or that’s not being used correctly that we may need to revise or address.
What’s a good way, even for practice owners to begin to put together their own procedural manual or like a playbook? Because I imagine for some, like I say it all the time, like, listen, admin is not my gifts. I know my gifts, admin is not it. What would you, you know words of encouragement or advice would you give it to a group therapist that admin isn’t their strength, like how do, it can look so overwhelming. And by the way you talk, I’m going to tell you admin is your strength. You’re okay with it and you enjoy it.
I’m okay with it, but I’m also type A so I’m very much like, this is how I want it to go and I think that’s the first step is thinking about what’s the value system that your practice is based on and what do you want it to look like not just to your clients, but to other professionals? Thinking about those relationships and also thinking about the things that you saw in the agencies that you worked for. So what are some practices that they had that worked out really well and what are some practices that you didn’t agree with that now that you’re an office owner, you want to change the new things that you want to implement?
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I got it now, so even in my non-admin-based strength mind, what I hear you saying too is like, listen, think of the values that you want in the practice then basically the manuals just laying that out. So even I could dream it, I can thank it and I can see it what’s important to me. Now put it on paper, like a step by step.
Put it on paper.
Okay, all right. The therapists are able, I love the fact again, the therapists are able to pour into it, look at it, add and take away from it. What are the type of systems do you have in place for your clinicians to make sure that they stay or admin staff too, everybody who’s with your practice, even yourself, to make sure your systems run smoothly?
Just constant reevaluation really. Even when we have our staff meetings, that’s something that we constantly talk about in our staff meetings; what’s going well, what’s not working, what needs to be updated? Clinicians and my assistant know they can always, I have an open-door policy so they can talk to me about anything and not being so type A that everything is set in stone, being flexible with what you’re willing, having policies that you’re like, no, this is a set policy and making that transparent to your staff; but also making transparent, okay, these are the policies that have wiggle rooms that we can change and revise if necessary.
So nothing solid or set in stone? I love the reevaluating too, and looking at what works. I heard this woman, I actually interviewed her for another podcast, Practice of the Practice podcast and we talked about systems and she wasn’t a therapist, but that’s her area, systems. She mentioned, listen, when I realized my systems were out of sorts, she said she shut seeing clients down for months just to make sure that every system was tight and in place. It was a learning lesson for me too, realizing how important systems are and how smoothly things can run when the right systems are in place for you.
Yes. Including your EHR system, just really knowing how to use that, making sure that your staff knows how to use it if you use one. Making sure they know what their role is as far as the EHR system. So like none of my clinicians do their own billing. That’s my admin’s job. She does the billing for everyone. Their job is to do their notes to make sure the diagnosis code is in there and all of that stuff and up to date billing. They don’t have to worry about scheduling. She does all the scheduling. Their job is to make sure that their availability is in that calendar and they update it at all times. So making sure they know what their role is as far as helping administrative staff.
So it truly is a playbook and everybody’s like a teammate and everybody knows their position to play. It is another question I thought about too, because sometimes we hear, and hopefully we’ll get to this in another podcast, like I’m sure this will be a totally different topic in another podcast too, but the idea of delegating, or not delegating, but having more than one person know what needs to be done, I mean, just in case that person isn’t available or isn’t there. Do you feel like this type of procedural manual is beneficial for times like that?
Yes, I do, because I’m not always there. We take vacations. We have family emergencies that come up. So even if my staff can get to me by phone the procedural manual should be there go to, okay, what do we do if this happens? If it’s a mental health crisis, that’s a totally different deal, but as far as like any administrative saying, this is what we do. If the client calls and wants to know if a clinician can see them at a different time, then letting them know, ‘Okay, well this is the clinician schedule. No, we’re not going to team call between the client and the clinician, seeing if the clinician will change their schedule.” If this clinician is an intern and I can’t be in the office, then they know automatically then their sessions have to be telehealth that day because I’m not in office. It takes them a little bit to get it when they’re new in the beginning and that’s fine. They know they can ask me any questions at all.
How do you think your manual is beneficial, be changed, be reevaluated, even in this season of leveling up or growing that you’re having? I know that you’re, like you mentioned a second ago, you’re about to be moving. Like you’re transitioning into a new season. How’s that manual beneficial now in these spaces?
It’s been beneficial as far as like even updating employee contracts. So I even have a copy of employee contracts between whether or not they’re full-time employee or if they’re provisioning license, interns or contract therapist and having discussions with them about things are changing. This is what I noticed. We’re moving to, we’re going to have more space. We’re going to have this and this going on, so this is what’s going to change. So like one of the things that we changed is we’re going to have a smaller waiting room in our new space. Now it’s going to be only the client that’s being seen and their support person if that person’s going in the therapy with them. Otherwise, everybody else has to wait in the lobby to contain space. Having conversations with parents that my assistant is not their kids’ babysitter, so don’t bring your kid. No, she cannot babysit your kids. So if you bring somebody in that’s a minor while you’re in session, you need to bring another adult to monitor them as well, things of that nature.
This is, like I said, it’s good because it’s one of those things, too, where it’s not set in stone, but you implement as you go. If there’s a problem, you fix it, you reevaluate, so it’s important. Okay. This is awesome. Again, congratulations on leveling up and growing into your new space and new therapist and all that. You know what too, we didn’t even talk about this, but if you could add it, don’t you have a nonprofit as well connected to your business?
I do. I started a nonprofit this year. It’s called the Graceful Holt Foundation. What it’s for is that the county that I live in is one of the poorest counties in the state of Florida, but it’s like the fourth largest. So not everybody has health insurance. At the time the Medicaid panels in our area closed, so we weren’t even able to accept Medicaid, clients that had Medicaid, so the foundation is for us to provide pro bono or reduce fee services for clients.
I think that’s awesome. I think it’s a beautiful thing that you’re doing it. I imagine with that too, you have a lot of contracts and a whole nother manual that goes with it.
Not yet. Working on it.
If it wasn’t made, you was on it. Well, Nakita, thank you so much. Before we go, I just want to ask what tips advice would you give to a therapist that’s just starting out, just starting a group practice at that? What would you say to them about the importance or how to start that procedural manual, amongst everything else they’re doing with starting that group practice? What would you say to them about that procedural manual?
Give yourself grace and have patience that you don’t have it all figured out right away. The manual did take me some time to put together. Again, revisions are ongoing. We evaluate those practices all the time. So be okay if something comes up and one of your clinicians or your admin person suggests to change. Doesn’t mean you have to change it but be open to that feedback, reach out to other therapists to see what they’re doing in their practices and if that’s something that will work for you. Again, there’s always so much advice out there. I think sometimes that’s the hard part, is trickling it down to what’s going to be the best thing for the vision that you have for your own practice.
But it’s if you don’t have it figured out today.
That’s the part. I was just about to say that because listen, that’s some of, listen, you don’t have to figure it all out like once, what I hear you saying, but again, go off your vision and just start and piece by piece you add, you reevaluate, you take away from. So it’s a working manual.
Right, it’s not really, all your systems are a work in progress all the time.
Okay, awesome. Nakita, tell the listeners where they can find you. Maybe they have questions about their procedures and how can they stay in touch with you if they want to get connected?
They can email me at [email protected] They can also message me through our Facebook and Instagram sites, which is Grace Counseling WH, is our handle. But it’s Grace Counseling Services of Winter Haven.
Awesome, awesome. Nakita, thank you so much for being my guest today and I’m just excited to have you on and thank you for all the tips with the procedural manual.
Thank you so much, LaToya.
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