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Interview with Group Practice Owner

That's me and my dog Sid!

Our Student Therapist, Melanie Treuhaft, had an assignment from her graduate university to interview someone who oversees a mental health organization. We collaboratively decided, it would probably make the most sense, especially in terms of efficiency, to interview me. As I was answering her questions related to program evaluation, I realized that this interview could be super helpful to add to our website in thinking about current clients, prospective clients, and anyone looking for more information about our practice. So here you go:

What is the organization or program target population?

Head & Heart Therapy works mostly with adults, although we have two clinicians who work with individuals ages 13 and up. Similarly, I work with couples and individuals of all ages, although I generally don't take new clients. Breanna Herock, LPC, ACS, our Clinical supervisor, also works with families and couples. We don't necessarily have a target population, per say. Part of the reason why is because, I believe everyone has the right to access mental health care, regardless of income, ethnicity, sexuality, gender expression, political beliefs, physical ability, etc. 

With that being said, we work primarily with mood disorders, trauma, grief and many of our clients are on the LGBTQIA+ spectrum. We also work with ethnic minorities and a significant amount of our client population is medicaid. Unfortunately our EHR (Simple Practice) is really difficult to pull data from, so I can't give you numbers just yet. But we are working on this and will hopefully, in the near future, facilitate our first Quality Assurance and Performance Improvement (QAPI) meeting. The QAPI committee is in the process of being created to measure our ability to align with our mission statement and goals as a company. It is also designed to be able to capture patterns in important client, staff, and financial data so that we can better serve our community. The data that will be presented at our QAPI meeting will inform policy and procedure changes, outreach efforts, event planning, and our onboarding and training process.

Because, in part, of our certificate with the state we are unable to work with clients who have a primary substance use diagnosis, despite the training of our staff. We also are mindful of who we work with because of the nature of our setting. Unfortunately, we can only work with a very limited number of clients who present with more acute symptoms. This limitation is intentional in order to best serve our clients and to prevent clinician burnout.

Similarly, due to ethical and legal reasons, we do not, at this time, diagnose neurodevelopmental disorders such as ADHD and/or autism. And we do not treat individuals who have a primary eating disorder. However, we do have practitioners who love working with neurodevelopmental disorders and our therapists are able to work with these diagnoses if they are not a primary presenting problem.

How does this organization or program meet the needs for this target population?

Oh gosh, good question. Did you come up with these questions? 

Many of our therapists have specialized training. For instance, Marissa Cano, LPC is currently completing the Training in Adoption Competency, conducted by the Oregon Post Adoption Resource Center. Marissa Cano, LPC was also awarded the NBCC Minority Fellowship which involved training specific to the BIPOC community and mentorship from an expert in that particular area. 

We currently have four therapists, including myself, who are fully trained in EMDR, a modality that is considered evidence based in treating trauma. Both myself and Breanna Herock, our Clinical Supervisor, have extensive training and credentials associated with addiction treatment (although again, just a reminder we are unable to work with any clients who have a primary substance use diagnosis) along with years of experience working with more "acute" populations. Breanna and I also have our Approved Clinical Supervisor (ACS) credential which speaks to our commitment to providing quality supervision. As the NBCC website states, "ACS credential holders have met national professional supervision standards and must meet continuing education requirements to maintain their credential." I have also completed Level 1 training in Internal Family Systems (IFS), another evidence based practice that research has shown that IFS can effectively reduce symptoms of depression, anxiety and trauma related disorders.

Head & Heart Therapy offers staff a hefty stipend for continuing education because we know how important training is in terms of providing specialized care to our clients. Ideally, we want all of our staff to have training in EMDR and/or IFS. 

We also have a pretty intense orientation process that involves required training on clinical documentation, care coordination, HIPAA, trauma-informed care, an hour long training on ageism, and a six and a half hour training entitled, Transgender & Gender Non-Binary (TGNB) Adult Clients, Culturally-Competent Strategies Every Clinician Should Know, among many other trainings. 

Part of the reason why we require such intensive training and why clients and prospective clients have to complete a ton of paperwork, is because we have what's called a Certificate of Approval (COA) from the Oregon Health Authority (OHA), which means we meet significant behavioral health standards.  

Even our Office Dog Sid has extensive training! For additional information, please check out our website. I try to keep it updated and reflective of our staff's specialized training and education. 

How has the program or organization grown since it began?
A therapist office with hanging lights, a couch, bookshelf, and big windows.
This was our office after our first move down the hall!

Well, I started Head & Heart Therapy in February of 2018 and it was just me! At the time I was working full time as the Clinical Director of the Integrative Trauma Treatment Center, a local pract

ice that specializes in treating trauma. Head & Heart Therapy began at a place called ActiveSpace in NW Portland, in this tiny office that I shared with another therapist. It was a neat building with all sorts of businesses. Eventually, I got a bigger office, then in April of 2021, right when I started hiring my first employees, we moved into our current location in downtown Portland. Currently, we now have seven employees (six staff are clinicians and we have an amazing Office Manager), one student (soon to be two), and three office dogs! And, we just recently hired Breanna, Herock, our Clinical Supervisor in November of 2023!

I am also proud to say that in the past we have worked with four students. 

How are stakeholder voices incorporated into the organization or program?

Another great question! Since the beginning, Head & Heart Therapy has adapted and grown through the voices of students, staff, and clients. We try to elicit as much feedback as possible, really taking that feedback to heart. Right now we conduct exit interviews, feedback forms, and have various meetings to evaluate quality assurance. And as much as I am able to, I try to personally connect with clients to see how things are going. 

We also had to go through a pretty rigorous process for our COA a year after we were awarded our COA in 2023 which involved an audit of our documentation, a site review, and staff interviews. If we decide to renew our COA, we will have another rigorous review of Head & Heart Therapy in 2026. With our certificate through the state, many of our processes provide our clients with additional opportunities to become more involved and to ensure their voices are heard. Similarly, our COA requires that we integrate QAPI within our organization to, "assess, monitor, and improve the quality and effectiveness of services provided to individuals and their families." Right now we are in the process of focusing on our Quality Assurance and Performance Improvement (QAPI) committee, determining how to best collect data, which will ensure that we are incorporating stakeholder voices in a more thorough and comprehensive way.

What are the current strengths of the organization or program?

At Head & Heart Therapy we have an amazing staff all with different areas of expertise and knowledge. Our therapists do a great job of individualizing our work to the needs of each client, infusing creativity and adaptability. And with an abundance of supervision for each team member, we carefully consider how we can be collaborative and effective with each client, using evidence based treatment. 

Additionally, we strive to create a trauma-informed workplace and have pretty good employee retention rates. I know many clinics and clinicians consider themselves "trauma informed," but we really put this in practice. For instance, two of our therapists, Marissa Cano, LPC and Sabrina Arnold, LPC, have both been at Head & Heart Therapy since we began taking on employees in 2021. To retain staff we offer competitive wages, extensive benefit packages, and attempt to keep clinical caseloads low. I have also been very mindful to create a soothing environment that takes into account sensory processing. For example, each office has a white board, fidgets, digital clocks, and tools for grounding. We are also mindful of lighting, sound, and visual stimuli. In order to promote cohesion, we have team building events at least once a year, emphasizing the importance of connection and the mental health of our staff. 

I am also very proud of our work with students. We do our best to ensure that student therapists, in addition to receiving comprehensive clinical training, get a significant amount of one-on one time with their direct supervisor, which is not always the case at many internship/practicum sites.

What are the current challenges of the organization or program?

Of course, all organizations have challenges. Working with health insurance and within the framework of our COA can be complicated, frustrating, and difficult. Unfortunately, many health insurances do not adequately compensate therapists, which is a big reason why so many therapists don't take insurance. However, because of our mission statement and philosophy we find it pretty imperative to work with the Oregon Health Plan and other insurances so that clients are able to access services. That requires some finesse in ensuring that we maintain competitive wages while also keeping caseloads low. Similarly, health insurance and the COA, often have high standards in terms of clinical documentation, clinical oversight, and general administrative work. To put it simply, working with the state and insurance can be very time consuming and can create barriers for clients. For example, once we were awarded our COA, we were unable to work with clients who have a primary substance use diagnosis. This has been confusing and frustrating to our staff and clients. 

We have also had some growing pains and had to downsize in December 2022. Right around that time we had some staff turnover, and unfortunately were unable to continue to offer Case Management to our clients, and we were unable to start working with the Hillsboro School District, offering in-school services, as we had planned.

How are these challenges being addressed?

Despite the inevitable challenges, I am so grateful to have an amazing team and access to resources. Our Office Manager in particular, and other team members, such as our Clinical supervisor, have been a huge help in terms of navigating health insurance and the COA. To me, this is why team cohesion is so imperative. Any system will have difficulties and ruptures, however collaboration, connection, patience, trust and adaptability are all so imperative. 

I am always consulting with colleagues, other group practice owners, other professionals, and try to stay up on education related to business ownership. I do my best to check in with staff, delegate what I can, and grow from any setbacks. 


Just a heads up, Melanie Treuhaft who conducted this interview has current openings for new clients! If you are interested in learning more about Melanie, check out her bio!

Below are some photos of our current office space (the bottom two photos) and photos of where it all began! (Top right image is a picture of the ActivSpace building in NW Portland, OR, where Head & Heart Therapy first started. The top left image is a picture of our first ever office. It was very tiny and shared with another therapist! The two images in the middle row are additional pictures of our first ever office.)



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