Tuesday, July 15, 2014

The Climb...

Feelings about the twerky Miley Cyrus aside, her song, "The Climb" (which she wrote back when she was sweet and innocent) has played through my head a lot lately. It even randomly popped up on my iPod while I was driving one day, ruminating about my stress level with this whole private practice business. This journey has definitely been a climb, one worth making, and I am hoping that I am heading back down the mountain, but I am sure there is another one somewhere in the distance.

The struggles I'm facing
The chances I'm taking
Sometimes might knock me down, but
No I'm not breaking
I may not know it, but
These are the moments that
I'm gonna remember most, yeah
Just gotta keep goin',
And I, I gotta be strong
Just keep pushing on, 'cause

There's always gonna be another mountain
I'm always gonna wanna make it move
Always gonna be an uphill battle
Sometimes I'm gonna have to lose
Ain't about how fast I get there
Ain't about what's waitin' on the other side
It's the climb

The biggest mountain I have faced so far is transferring all of my credentialing with insurance companies over to my new location. I am very lucky to be part of a large clinic that already had me credentialed with just about every possible carrier. What I wasn't sure of was how that would translate to my new solo practice at Stages. Two carriers denied me initially. I appealed and only one of them overturned. Which means that one (rather large) carrier continues to deny me coverage, and it means saying goodbye to those clients, unless they can afford to use their out-of-network benefits and pay for it... many people cannot do this.

The carrier that continues to deny me is Health Partners. They denied me originally saying they have enough providers in this demographic area (keep in mind, I was already in their network at my current practice). I appealed with a letter very specifically outlining the need for more providers in the south metro that specialize in perinatal mental health. They responded, "we have enough... " When pressed further (through many many back and forth emails with a rep there) I was also told that they rarely credential solo practices, and that there isn't anything I can do.
Pregnancy and Postpartum Support MN (PPSM), of which I am the proud Co-Director, has spent a lot of time (a LOT) interviewing and vetting providers in the Twin Cities metro area that declare a specialty in perinatal mental health, and who have paid an additional membership fee to be part of our resource list. This means something to us within PPSM. It means that they care so much about the area of perinatal mental health, and have had so much training, that they want to be known as having a competency in this very specialized area so that new and expectant parents can find them and be confident they are seeing someone that knows about this specialized area of mental health. We have ALL heard horror stories from clients who have seen providers who do not have a specialty in this area, and how many of them have left feeling ashamed, frightened and misunderstood not because the therapists hearts aren't in the right place, but because they are not adequately educated about working with Perinatal Mood and Anxiety Disorders (or PMADs).
Interestingly enough, my fellow co-director Lisa Cross and I did some research on the providers Health Partners has on their list with a declared specialty in PMADs. And guess what? Not one single one of them is on the PPSM Resource List. Lisa could also not find any that mention on their personal websites that they specifically work with PMADs. Why is that? Likely, it is because when Health Partners does credential someone, they are sent a generic checklist asking what things the provider will work with. A provider can check the box for postpartum depression or maternal mental health (depending on how it's worded on their form) but they do not need to prove their training in these areas. This explains why their list makes it appear that they have an adequate supply of providers who work with this specialty.

I'm still climbing this mountain, and while I have not crested the peak, I have had to stop and get some air. The truth is that we need some reform and education within insurance companies to let them know how specific PMADs are. Lisa and I attended a wonderful breakout at the PSI Conference in June about how Cigna is tackling this issue. We know it is happening (just not at Health Partners), it just needs to spread.

Tuesday, July 8, 2014

My New Adventure

Funny...I looked back right before I started writing this post and noticed that the last blog post was titled "Things will never be the same". I am on a new adventure to starting a private practice, and that is about how I am feeling right now. There is no turning back. It has been such a whirlwind of emotion (see Spongebob below) that I think I have probably gone through all five stages of grief at some point. But here I am. Breathing and everything. 

My friend and colleague, Veronica Jacobsen, owner of Baby Love in Eagan, MN, approached me several months ago about renting office space at her business and providing mental health services there. At first, I said no. I am very comfortable where I am now- Clinic Director of a large, thriving practice- and I just do not like change. I like comfortable. Very much, thank you. *cuddles in virtual blanket*

Veronica and I met again a couple of months later, and Veronica told me, "You know I'm holding that space for you, right?" I gave a very hesitant, "I will think about it" and said I had to get through the Daisy Dash 5K first. She was very patient with me, thankfully. But driving home, I started considering possibilities. There are SO many things in the field of perinatal mental health that I would like to do that because of my current position, I just realistically could not do them. Plus, I would definitely be more accessible to new and expectant parents if I were INSIDE of Baby Love (kind of like Starbucks in Target). I found myself getting more and more excited about the prospect of making the change. I talked it over with my husband, who has been wonderfully supportive in almost every idea that I come up with, and there it was... a decision was made to take this chance and join forces with Veronica to see what we can do together. 

I have now given my notice with my current employer, and I am in the process of transitioning my patients. I still go up and down on this wacky rollercoaster ride- excited, scared, sad, nervous... but mostly excited. I love a new challenge, and have been reminded what a great village I have. 

In the meantime, my new website is up, Stages Counseling and people can schedule appointments ONLINE! Which I am very, very excited about. I have a lot more to process and write about, but all in good time. 

More to come...

Friday, June 6, 2014

Things Will Never be the Same

Many of the new moms that I work with come in with the goal of "being like my old self". When I was newer to this field, I felt that was a realistic goal. We would discuss what that would look like, and how they would know when they are making progress, as any good therapist should in the process of treatment planning.

However, the longer that I work with this very special population of clients, and the further I get away from my own experience with postpartum depression (PPD), I realize that it is NOT a realistic goal. I also realize that often, people make their new experience to a new phase of their journey and realize that not only is that not a realistic goal, but that going through a perinatal mood/anxiety disorder (or PMAD for short) has strengthened them.

You don't believe me, do you?

You see, going through a PMAD is a life changing event. And in many cases, it is a traumatic one. Having a baby is supposed to be the happiest event in your life. You are supposed to be glowing, and thrilled, and becoming a mother or father should be "natural" and a state of bliss. Right? WRONG. Even for a parent who has not experienced a PMAD, becoming a parent is not always an easy transition. You are sleep deprived, generally feeling awful about your body, feeling incompetent at moments, and have a lack of time for your relationships. Now throw in some depression, anxiety, OCD, birth trauma, a preemie, multiples, etc. etc. etc, and one might be able to see how this could be a life-altering experience.

Living with a PMAD is like creating a line in the middle of your life- "before PMAD" and "after PMAD". Just like any other line with a before and after, there are changes that happen. A PMAD can change how you view the world, and everyone in it. You may become more cynical. You will likely learn who you can (and cannot) count on. You will be reminded that life is not fair. A PMAD can also change your body chemistry so that your brain may not be capable of going back to how it was "before". Generally, with a combination of therapy and self-care, and often, medication, you can return to a very good level of functioning. But you as a person are still different.

There are positives that come out of this experience as well. In hindsight, people are able to look back and see that they didn't realize how strong they were. How resilient they were. How wonderful their partner is, or how their relationship was strengthened as a result of weathering such a storm. But just like going through any major life altering event, like cancer, or a death, you are still not the same person that you were before.

Being the "same" does not mean that you failed. It means accepting that because of this event, you will not be the same. Ever. And that isn't a bad thing. You will be stronger, braver, and healthier. You may have scars, but you have a story of perseverance to go with the scars.