u/Putyourselffirst

RE: Linsay Clancy case

Im sorry (not really) but I think we can all agree the prosecution is doing a horrible job of this case, and not only because she's against an world class defense lawyer.. just objectively an unethical, irrelevant, bad job. Who chooses the prosecution? Does the state only habe one lawyer and they're just stuck with her, i cant imagine that being the case? Do they bid on who does the case or random assign? I just cant believe they chose someone who's again and again showed unethical harmful and incompetent practice... how does that work in the USA/MASS?

Battled my way through severe unmedicated ADHD chaos for this thing for 2 years and it's done!! ... somehow I thought I'd feel more genuine pride and emotion than I am though..

Apparently my overextended non-profit has a non-compete "unless otherwise approved by executive director" clause.. cant work providing same (therapy) services outside for pay while employed by agency.. my population has VERY limited service access in general and faces a lot of stigmatization and provider incompetence in general mental health. As a an anti-oppressive focused clinician I feel this is HIGHLY unethical for the larger community and employees.. its super rare for any therapy non-profits or our hospital system to have non-competes so wasnt expecting it when I wanted to start my PP on the side and told my supervisor (super excited for me generally and was also a bit shocked to read it)..

I understand a non-solicitation agreement which maybe is what the ED will request we make up when he gets back to me, and is already in my ethics codes requirement anyway... curious if any of your nonprofit have had non-competes or similar and how you've navigated those?

ETA: already consulted with regulatory body, HR full manual, colleagues, and public legal education (not going to sue or anything but apparently this circumstance is almost never enforcable and uphelpd for an agency)... just curious your experiences.

TLDR: CMH non-compete may make my dreams of getting dx supervision license impossible if they dont approve to change to a non-solicitation agreement and keep my current position when starting tiny PP on side.. submitted strong proposal but SO anxious waiting for approval or denial from ED.. entire next career phase depends on getting this approval.. love my current job and team.. Country isn't USA, so process to dx licensure is different.

Long:

My CMH fits my diagnosing specialty goals perfectly (ASD/ADHD), but with high agency no-show rates I cant meet the 3k time limitted hours bc i cant count advocacy cases or intakes (which is half of my job)... I'm planning to start a virtual PP to supplement a few more consistent hours a week to ensure i can get the hours despite no shows at agency..

Apparently we have a very loose non-compete regarding employed staff providing the same service outside the agency for pay unless approved by the ED.. I submitted a proposal outlining my goals, passion for my current job, and areas ND individuals fall through the gaps I want to help fill... so minimal competent PP providers, and agency location eligibility, diagnosis eligibility, 1 year long waitlist, session cap limitation and emphasizing how I would manage ethics (i.e. only accept clients not residing in our service region or connected to the agency, etc).. i was as positive but also realistic about the agency and limitations as possible to balance advocating for my community alongside appreciation of the agency - i genuinely do love the agency. I've never had to do anything like this.

I genuinely have faith my agency cares most about meeting needs of access for ND people, and my supervisor would support me. I'm stuck waiting for the ED and hopefully change the non-compete to a strict non-solicitation agreement but need to have a meeting together. In August everyone is on vacation 😭 I'm so anxious here..

The the concept of not being able to bc of a very general non-compete is absolutely terrifying.

I am so stressed guys. I never expected my agency would have this policy (nor did my manager) so got excited about PP and my dx journey before double checking the policy manual..

Curious how your insurance/medicaid companies and dx system works?! Canadian here! I've lurked on a lot of posts where insurance dx are discussed and I am still very confused.. skip to questions (bolded) if dont want context of our system for reference.

In Canada we have health insurance companies too, and memtal health (unless nonprofit or short-term hospital sessions) are often out of pocket as a simplistic explanation of where I'm viewing this from. Most insurance companies don't direct bill and reimburse, its private pay and clients submit receipts to insurance and then client gets reimbursed.. whether that be through workplace or private insurance..

I keep seeing our American counterparts talking about diagnosing for insurance purposes. We don't really need to do that here - literally nobody asks "what diagnosis are you treating?" to assess whether they pay you, you just get your sum of mental health benefits for the year/month and can use as you choose.. thats all I've ever been familiar with in my privinces and career thus far at least...

Are you all required to provide diagnosis to get care approved with all insurances?

Will insurance just deny mental health support if the client doesnt have a diagnosis?

What do you do if the client needs mental health care but doesn't "fit a diagnosis"?

If you habe to give one regardless is it always within the first session or 2?

Does any diagnosis you provide them go into their medical file and impact services they recieve in the future and how they're treated in the medical system?!

Obviously many will seek you out for a diagnosis specifically, or fit a diagnosis easily. It just seems odd to me, especially if the dx follows the client and its expected in the dirst few hours.. do you meet tjem and just go rifht into assessments so you have an accurate dx?! That seems difficult to build a relationship through if they're not actively coming to you with concerns of wanting a dx..

I've lurked for a long time on these discussions very confused about how this actually works for you? How does it align with your ethics?

Subsequent question - are all mental health professionals there able to diagnose? Here its relatively uncommon for social workers or certified counselors (our version of LPCs i believe) to diagnose unless you do additional training only available in some provinces for MSW grads.. but these professionals still provide mental health care without the dx part. We refer to clinical psychologists who've done specific training to diagnose typically. I am one of the few social workers who diagnose and thats only when someone seeks me out for that purpose, or I've worked with someone ongoing and we discuss the topic throughout our relationship growing therapeutically. Here dx are usually attached to someone's ongoing medical file and hard to "erase"..

I am a little anxious about starting but also excited I think. I've been working with my Dr over the last year to stop smoking which has just switched to binge eating, and reducing caffiene was a mess.. so while I've quit smoking ive gained SO much weight.. we decided its time to try ADHD meds despite reservations about it.. shes starfing me on a small dose for 2 weeks then depending upping it the next 2 and adjusting...

She told me to make sure to take it in the morning early bc it can mess with sleep, eat even if I dont feel hungry so my body maintains proper energy and bloodsugar throughout the day even if its just small snacks, and hydration! Told me there can be a crash mid afternoon especially when starting, so be aware of that and its expected for many people especially at first..

Any other tips or tricks?!

I first developed it during my intensive graduate practicum last April in a heatwave, sorted it out in a few months, but today (after 4 days of a heatwave and extreme emotional stress) its coming back on both hands and feet 😞

Anyone else seem to have these as main triggers? The timing of it's recurrence is stunningly similar..

On the up side, it doesnt itch (I've never had hugely itchy symptoms) and I passed my thesis today!

I quit smoking a few months ago with chantix and its going really well, but I also have ADHD and a tendency towards boredom binge eating and snacking.. its gotten so so so much worse and I feel disgusting... any tips?

I've tried using suckers, chewing on straws, biting my cheeks (theyre raw), gum, lozenges..

Any tips?!

I am interested in it as it seems like a good mix of cognitive, emotional, somatic/sensory elements and I'm not a huge fan of the hype of EMDR, IFS, and similar partly because they seem so consumerist and culty and less focused on complex developmental trauma which is my typical focus. However SP training looks OBSCENELY expensive. The evidence base also seems to be growing, and in a more objective and less bias form than other therapies - less total but seems higher quality and representative research.

Any readings, small trainings, or recommendations for exploring SP that i can use to explore and dip my toes before the intense investment of the full trainings? That looks like for the full 3 levels dozens of thousands of dollars.. while it looks like huge training, it would have to wait much into the future to afford.

I absolutely love my non-profit job, but the scope of services and population is niche and limitted compared to my interest and skills. I have a lot of flexibility eith work hours, caseload, health benefits and pension, and am passionate about that field. I just feel limitted in my scope and by the 10 session(ish) policy we have to manage demanding waitlists - lovely systemic issues.

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I am considering flexing my hours to have 2 or 3 Fridays off a month from my nonprofit to start a small virtual private practice for those days to scratch the ongoing-client and expanded scope itch. So my caseload would be tiny and may not start right away or have any benefits, but more for personal fulfillment and "side money" while still having my stable good nonprofit job that i love.

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I would be doing virtual at least for a while to reduce costs like office rental, parking, etc.. I know I'd still need to pay for programs like OWL or Jane, business license, marketing, etc.. it would be like a 3-5 client/Fri 2x a month caseload, literally nothing. I do partly-virtual clinical work at my current job already so am comfortable with that format for the time being. I have good work/life boundaries (already work from home so have a dedicated office/work only room).

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I considered joining a group practice where you rent out room per day for price, they help with systems and marketing, but all the places that do this near me are kinda scummy. Private seems to have the flexibility I'm looking for compared to what im seeing in group practice options and values.

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Have any of you guys done this? Was it meant to stay part time or sid you transition from nonprofit to full time private practice? Can you share any challenges or benefits you've had in this type of set up? Just looking for insight from people who have or have previously tried similar..