Dr. Lynn Friedman’s blog for her Johns Hopkins graduate students

Yesterday’s post brought a question about what to do when patients/clients call and they can not afford private fees.

This difficulty is extremely commonplace especially in this economy. And, it’s important for clinicians who receive these calls (whether or not they are actually in private practice yet) to do their best to help patients/clients to connect with low fee and sliding scale resources. Fortunately, here is the Greater Baltimore Washington area, there are a plethora of low fee and sliding scale resources. In other locales, this can be more challenging – that is, it is more easily said then done.

Yesterday’s post detailed a situation in which the counselor was doing outreach related to substance abuse prevention in teenagers. Prior to giving the workshop, it’s important that she familiarize herself with the resources in her locale. In that case, she could identify both organizations/individuals who treat substance abusing teenagers and their families. Also, she could identify counseling/therapy resources in general. Beyond this, prior to making referrals, I’d encourage her to call these organizations/individuals to make sure that they are accepting new clients/patients. In doing this, they will become familiar with who she is and what sorts of expertise she has to offer. In fact, she might even offer to give her talk to their counseling staffs.

How can she learn about places with sliding scale referrals? She might check out the local Departments of Psychology and Counseling to see if they have low fee clinics. Similarly, she might look into the local Departments of Psychiatry. Here in Washington, the GW PsyD program has a very low fee clinic and the GW Department of Psychiatry also offers a sliding scale for those in their catchment area. Beyond this, the Washington Center for Psychoanalysis offers sliding scale clinics for both psychotherapy and psychoanalysis. Also, the Baltimore Washington Institute has a similar clinic. Both are excellent resources. To find a list of these sorts of clinics, nationally, look here: www.washingtonpsychoanalyst.com/lowfeepsychotherapist.html

When she contacts these settings, it will be important for her to make a special point of learning how their referral process works. Then, she can talk with the client about what to anticipate. This is critical as many patients/clients become so frustrated with the maze of phone calls, holding patterns, etc., that they give up before treatment starts. As we’ve discussed, being referred to another clinician can be hurtful to the patient. Streamlining the process and functioning as their, “ombudsmen” can go a long way to ameliorating the hurt. Also, it is a way to ensure that patients receive good care. For those of us committed to the profession this is a very important part of our role. In fact, when we fall down on this part of the job we erode the public’s trust.

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