Although the majority of those who regularly read and participate in our online community here at Private Practice from the Inside Out are mental health professionals, we also have others in our midst including Certified Professional Accountants, attorneys, educators, and allied health professionals. One of those allied health professionals wrote in the following request for information and asked that I protect her identity. This is what “Amanda” wrote . . . .
Hi, Tamara. I am a speech-language pathologist. After resigning from a position in May (due to my concerns about unethical practices of the agency), I began to develop my own private practice. It’s actually growing faster than I thought it would, and now I have
enough clients that it would be difficult for me to continue to see all of these clients if I go back to school or get a new full time job. I am not sure if I will do either of those things yet, but I’m just wondering what appropriate etiquette would entail if I do have to discontinue service.
My regulatory college states that I would be required to refer the clients to another therapist (and there are some other rules), but I’m wondering if you have any recommendations regarding the amount of notice that I should provide (is 4 months enough?) and appropriate wording for the conversation that I would have with the clients. When my colleague moved from private practice into a full time position, it looked so easy, but now I’m wondering if there’s more that needs to be done.”
Hi, Amanda! I’m always happy to talk to health professionals about protocols in their practices and am particularly happy to have your profession represented here. Because I am not a speech-language pathologist, I would first encourage you to get familiar with your professional code(s) of ethics, your regional statutes, and your any licensing requirements that may address this issues. If you are here in the United states, you must also attend to the common standards of practice.
Your practice, like mental health, is relationship-based. For that reason, I would provide as much notice as is therapeutically possible. The four months that you have suggested seems adequate. Once you are clear about a final date of work, I would recommend that you send out written notice letting clients know that you will be helping clients transition to new health care providers over the next four months based on your decision to close your practice on a specific date.
After you send out this notice, I would follow up with face to face conversations with each client to reiterate the above information and allow an opportunity to answer any questions / concerns your client may have.
Then, approximately thirty days prior to the closing of your practice, I would follow up with a more detailed letter that references the previous letter and also
- summarizes your work with this client (including dates, presenting problems, course of treatment, and current status),
- explains your intent to (temporarily?) close your practice on a specific date so that you can pursue further education,
- expresses your gratitude for the opportunity you were given to work with this client,
- provides referrals to other speech-language pathologists whose work you respect, and
- offers any other types of support that you may deem appropriate including literature, websites, organizations, or support groups.
During that final month of work with your clients, I would again reiterate the above and begin the referral process. From a business standpoint, should you intend to resume your work in a private practice (in the same or a community nearby), it would behoove you to also send copies of this same correspondence to each of your referral sources for those clients.
And, don’t forget to put a plan in place for maintaining contact with those referral sources after the closure of your practice and while you are continuing your education. After all, if you don’t do this, I suspect with a two to five year lapse in contact, they will have found new favorite speech-language pathologists and you may have a difficult job getting your foot back in the door for new referrals.
Tamara – Great tips for those who want to take an extendd sabitical. Thank you, Brenda
PS: Also, I appreicate you featuring prior posts that are related in which I have participated. I enjoy the community you have helped to create! Nice to see my name in “print.”
🙂 You are so welcome!
Tamara,
Can you say more about the “common standards of practice”? I’m sure I know what you’re talking about, but perhaps I call it something else…
Also, that’s a great tip about staying in contact with referral sources for possible future collaboration. Great info, as always!
Lauren, “standards of practice” are the most nebulous of all the standards that we are expected to adhere to as mental health professionals. They are nebulous because they are determined by your local community. They aren’t likely to be found in a book or on a list but they are important to know. A local mental health attorney would be the best (but certainly not the only) one to advise you what those might be.
I can give you possible examples that may or may not apply to your locale. Think of the practices that are common in your area that relate to 24 hour coverage of your practice or how therapists communicate with other professionals about non-urgent client concerns. In some communities, voice mail might be sufficient; in other communities, the standard may be very different. This alone is a good reason to network with and consult with your local colleagues. There’s no other good way to learn the many nuances of mental health practices in your area.
And, the reason you need to be familiar with those standards of practice is because if / when you end up testifying in court, it is not uncommon at all for a mental health professional to be held to those locale standards of practice. This, by the way, is a great topic to bring up the next time you attend an ethics training.
Thanks! I’m already looking into it… This is one of these pieces of information that I would expect to be in some of the reading material about private practice.
Yes, Lauren, you will find professional standards of practice referenced in texts like Bernstein & Hartsell’s books The New Portable Lawyer for Mental Health Professionals and The Portable Ethicist for Mental Health Professionals.” These texts are invaluable resources for every mental health professional. I would be lost without them.
However, you’ll have to drill down into your own community to learn what those standards of practice are. Those are often unspoken but commonly accepted mores and practices among your colleagues. I know this is frustrating and unsettling, too, but it is important for every professional therapist to note them. Choosing to ignore or practice differently than those standards may increase your risk for malpractice. 🙂