Professional Identity and Branding: Key Elements for a Successful Entrepreneurial Equation

Engaging in marketing or self-promotion can be uncomfortable for the workforce, especially for my colleagues in the health and behavioral health realm. Content on leveraging professional identity has not traditionally been taught in academic programs; the priority is on learning competencies that ensure quality caring for others versus endorsing self-interests. Yet, the needle is shifting, and for many reasons.

“I want to be you”; I’ve been so fortunate to hear this language in recent years. Yet, the adage is accurate: with great power comes great responsibility. It is humbling to know my hard work is appreciated. However, it is overwhelming to know others view me as the standard by which to measure their own professional success. I’ve written a variety of content on this topic, from recent book chapters to blog posts. To achieve a successful entrepreneurial equation, you must be able to name your professional identity (PI) and leverage your professional brand (PB).

Professional Identity (PI)

Your PI is comprised of 3 areas. First is professional knowledge-core: your education and those coveted degrees. There is value is that didactic theory and learning from school. Though it is impossible to remember it all, so what matters most? I’ve had students approach me years after sitting in my classroom to share various “Ellen-isms” that popped in their heads when they least expected, such as, how “critical thinking enhances their objectivity” for clinical and operations decision-making. Some recall that “ethics are everywhere”, while others speak to the importance of discovering their “professional lane”, and venturing on a unique path. How does the knowledge gained from continuing education and trainings inform your evolving self? How do you consider the seminal documents of codes of ethics and standards of practice in your professional actions, work products, and professional interactions? Stop and consider, how does your brain trust influence your career trajectory?

Second are personal values and beliefs. How do these areas align with the mission and vision of your company, or its assorted functions? How might they affect what contracts you consider? Perhaps, they influence your pricing or billing practices, such as whether to accept insurance, or how to address co-payments, or late payments. For example, do you charge interest if any payment is late, whether the service rendered is for a patient visit or organizational consulting charge? If you do, at what point: 30, 45, or 60 days? Do you raise the interest if the timeframe goes beyond a particular point? At what point do you involve a collections agency? How much time do you devote to “free” consultations? How might your values influence what communities and populations you serve? Each of these questions are vital decision-points and beckon for your individual contemplation; I’ve made my decisions, what will yours be?

Finally comes that professional persona or, how do you present that professional identity to the world? It might be the style of your dress, presentation personality, or in your social media presence. How do you promote your efforts to the world, and what is your comfort in doing so? For example, I post a great deal on social media to market my work, whether articles, book chapters, my own books, as well as presentations and trainings; this blog gets a fair amount of attention. Engaging in marketing or self-promotion can be uncomfortable for the workforce, especially for my colleagues in the health and behavioral health realm. Content on leveraging professional identity is not traditionally taught in academic programs; the priority is on those competencies that ensure quality caring for others versus endorsing self-interests. Yet, the needle is shifting, and for many reasons. Increased numbers of professionals are going entrepreneurial and consulting routes. To be successful, you must be comfortable marketing your expertise; wear that professional persona with pride!

Professional Brand (PB)

Your PB is a brief statement that conveys your professional intent, focus, and value to stakeholders of your services. This includes patients, clients, members and consumers, to colleagues, referral sources, and the public. A solid PI drives a winning PB!

Your PB gets incorporated into every business product, from cover letters and work products, to online profiles. It should be printed on business cards and other marketing literature. The language is included in any quick pitch you do at events, or interviews where you share entrepreneurial expertise. The language is your clear and convincing response to those classic interview questions, such as, “Tell me about yourself”, or “Why should I hire you?”. 

Several elements encompass PB. Each serves a dual purpose: how do you want stakeholders and customers to experience you and, how do you want to present to them:

  • Tag line: a brief statement that cuts to the core of your efforts; it’s clear, memorable, and makes you shine above the rest! I, empower interprofessional knowledge; what about you?
  • Logo: a graphic image that represents your professional persona. If you have a creative core, play with this yourself. However, several companies rock this effort at reasonable rates, such as FIVERR to VistaLogo, and Design Hill. All provide bundled options for website development, logos for use across social media and other business platforms (e.g., digital devices, cards and stationary, presentation banners, and other products).
  • Theme: As an entrepreneur you bring a unique business lens geared to a target audience of stakeholders across certain sectors or practice settings. Consider this on the front end of your efforts, otherwise it becomes harder to market yourself and your company. It is common to use your company mission or vision statements for this effort.  
  • Elevator speech: You have 30-60 seconds to give a quick overview of your expertise, credentials, and goals. This brief article from Balance Careers provides sound guidance. 

PI and PB set the tone for your successful entrepreneurial equation. Are you up to the challenge?

I invite readers to share their recommendations on driving PI and PB.

Advocacy Amid Anguish for the Frontline Workforce

The Surgeon General’s advisory is landmark action whose priority is only emphasized by the latest horrific mass shootings, now at 213 and counting. We are way beyond burnout with advocacy amid the anguish mandated, and through an interprofessional effort.

My initial intent was to dedicate this week’s blog post to the Surgeon General’s Advisory. The document highlights the industry mandate for stakeholders to be accountable for action that mitigates workforce burnout: 

  • healthcare organizations 
  • insurers 
  • health technology companies 
  • policymakers
  • academic institutions 
  • researchers
  • communities

However, we are way beyond burnout! The battle cry by industry advocates is fierce. Workforce retention, turnover, and patient quality are beyond their tipping points; “more must be done or there will be nobody left to render care”. The Surgeon General’s advisory is landmark action whose priority is only emphasized by the latest horrific mass shootings, now at 213 and counting for 2022 alone.

Intensifying Collective Occupational Trauma

Society witnessed the worst of humanity: the death of 19 innocent children and two teachers in Uvalde, TX, followed so closely to the intentional murder of 13 persons in Buffalo, NY. Both events serve as added evidence of the severe collective occupational trauma inflicted on every practitioner and provider of care. My colleagues and I face these issues as human beings, as well as professionals, which is a felt in the most intimate and unique ways. 

Front-line practitioners and first-responders face unparalleled pressures in caring for victims or being forced to announce their deaths. Conveying that intimate information to loved ones carries an overbearing responsibility. Underneath a provider’s, often stoic, presentation lives interminable grief, pain, and loss, as they struggle to accept their inability to save the victim. The honor of caring for these fatalities bring an intense level of responsibility. Behavioral health professionals face a similar burden in rendering emergency and continuing mental health intervention to providers, witnesses, family, and community members. Recurrent workforce retruamatization has an especially fierce impact. The anguish contributes to rapidly escalating incidence of PTSD, suicidal ideation, and action across the workforce. Rates were high enough pre-pandemic, and continue to rise. The fusion of mental and physical health engulfs the body yielding escalation and exacerbation of chronic illness, auto-immune disorders, and other ailments; the workforce is being decimated.

Debriefing and Activating Advocacy

I’ve spent the better part of these past few weeks debriefing with past and present students, clinical social workers whom I supervise and mentor, experienced colleagues. Everyone is hurting in a unique way. Some need solace, while others require cues to stop doomscrolling. All demand action; workforce resource support and gun safety reform legislation are at the top of the list. 

Our emotions empower advocacy to heed the ethical tenets of autonomy, beneficence, fidelity, justice, and nonmalfeasance. Prioritizing these tenets ensures quality intervention for every patient and population, but also all health and behavioral health professions. Activating these principles looks different for each discipline. Yet, while each one shares distinct priorities, there is shared recognition of how interprofessional collaboration and advocacy will yield change including:

The industry must do better; our entire interprofessional workforce deserves far more. We must advocate amid the anguish, yet be ensured appropriate mental health support. How will you advocate for change? Feel free to add your comments about this blog post below, as well as other valuable resources. 

The Madness Behind My Market Validation and Professional Brand

Employers value investing in staff development, but that coveted benefit often falls to the bottom of the priority list from competing fiscal foci or insufficient funds. This is paradoxical amid the value-based healthcare climate where quality drives patient-satisfaction and ultimately, volume. That’s where my marketing validation madness enters the scene.

I frequently get queries about my entrepreneurial scope, especially after being a successful business owner for 18 years. I’ll fess up: this is not my traditional blog article, but serves dual duty as a Doctoral class assignment and my usual bi-weekly post. For those growing their professional identity and brand, it responds to queries I’ve received regarding my company’s fiscal focus, market validation, and ongoing trajectory.

Quality Professionals Render Quality Care, But

Healthcare organizations juggle costly operational priorities from delivery and quality of care, to population target scope, complexity, and case mix, as well as reimbursement and revenue capture. That Quadruple, if not Quintile Aim reigns supreme to render the right patient-centric care, at the right time, cost, by professionals who embrace the work, and informed by wholistic health equity. Yet, any healthcare organization’s quality of care also relies on hiring and retaining knowledge-rich, appropriately credentialed employees. Employers value investing in staff development, but that coveted benefit often falls to the bottom of the priority list from competing fiscal foci or insufficient funds. This is paradoxical amid the value-based healthcare climate where quality drives patient-satisfaction and ultimately, volume. That’s where my marketing validation madness enters the scene. 

Value via Alleviating Operational Burden

My blog followers may already know my mission; every contract I accept empowers the interprofessional workforce through knowledge acquisition. My services span CEU-products (webinars, presentations, trainings), professional speaking, authoring books and other publications, licensure supervision (Virginia only) and professional mentoring among other areas. My subject matter expertise is shared with associations, organizations and higher education; I teach at the baccalaureate and masters’ levels of academia. 

Organizations contract with me to ease their professional development burdens. I do the heavy lifting via per diem and bundled contracts encompassing their individualized needs. Some request CEU pre-approved content required for licensure or certification renewal of social workers, nurses, physical therapists, occupational therapists, and credentialed case managers (ACMs, CCMs). The high demand for mental health intervention mandates workforce expansion, and quickly; everyone wants to expand their behavioral health workforce but this takes a concerted effort. Social workers in Virginia seeking clinical licensure (LCSW) must receive Board-approved supervision process with an approved supervisor for 100 hours, a minimum of 1 hour of individual (or maximum of 50 hours of group) supervision weekly per 35-40-hr work week; this occurs in no less than 24 months and no more than 4 years from approval. Most healthcare organizations are unable to provide this labor-intensive process due to other staff priorities. It is worth an organization’s effort and time for a contracted provider as myself, to manage the regulatory rigor of application filing, regulatory monitoring of documentation, and service provision. Employers pay me a defined hourly rate for individual and group supervision. When an organization will not cover the (full) rate, individuals pay the same hourly rate. This actions yields a considerable return on investment for organizations: the more benefits provided for employees the better workforce retention, and patient satisfaction.

An Intentional Fiscal Focus 

Many presume my company provides therapy; this is unsurprising as a Virginia-licensed clinical social worker, certified clinical trauma professional with EMDR-basic certification, and holding credentialing as a board-certified case manager. Besides, there are a plethora of behavioral health billing codes I could leverage, especially with my integrated care scope. The current Magellan fee scale for Virginia Department of Medicaid Services is a fascinating read, though highlights an important disparity in payment; LCSWs earn 20-35% less than their fellow behavioral health colleagues (e.g., psychologists), per psychotherapy visit ($92 vs. $69 per 45 min, $120 vs. $90 per 60 min). That difference, plus time for billing and revenue capture, makes psychotherapy a tough road for sole proprietary, small business owners to travel, especially when it isn’t where the heart lies. It is also further incentive for me to continue empowering the workforce through my innovative business perspective, which is far more fiscally and professionally rewarding. 

Where Will My DBH-Road Lead?

I’ve carved out a unique, yet expansive space, locally, nationally, and globally; my assorted books and articles have a large global following. My gaze is always on market analysis to leverage expansion opportunities. Non-profit agencies or others who worry about affording my rates are never told no. Instead they are asked, “what can you afford?”. If an entity is interested in my unique presentation content, then we partner on pricing to make it accessible to them, as possible.

Expanding my brand happens organically at this point, as my energy drives ongoing inspiration and new dimensions for pursuit. As a Doctor in Behavioral Health Candidate (DBH-C), my lens spans the integrated care, population health, and health equity realms. I am an interprofessional subject matter expert working to mitigate physical, mental, and psychosocial health disparities. I also believe in the power of Trauma-informed care and leadership as vehicles to address workforce retention and manage turnover. These paths will provide further ways to spread those Doctoral wings. The author in me is excited to contribute my brain trust to industry white papers. I plan to advance my EMDR-training path and potentially offer intervention to our worn, interprofessional workforce. The incidence of collective occupational trauma from recent years is massive with EMDR a successful intervention to foster recovery from this unique trauma. Perhaps one day this blog will be monetized. Each of these services stays true to my current billing structure and company mission and vision. Where will my DBH-road go? The short answer is, wherever I want it to! Let this unique entrepreneurial journey continue!

15 Job Search Lessons for Social Work Grads

It’s that time of year! My Masters’ in Social Work students are ready to graduate and enter the workforce. Their efforts to secure employment pose new considerations courtesy of the pandemic. Here are 15 lessons to activate the job search for my students past and present.

Lesson 1: Organize 

Set up an electronic folder on your computer, with subfolders:

·       References

·       Cover letters

·       Interview questions

·       Submitted applications

·       Recruiter contacts

·       Key info about jobs applied for  

Develop an excel spreadsheet to track positions with information including application dates, if you heard back and when, job details (e.g., salary, key benefits, virtual or in-person, multiple sites), contact information. How to organize is up to you, but do something!

Lesson 2: Keep your resume focused, comprehensive, and competency-based.

A resume is your professional face. In your zest to post and send it to potential employers, you can easily include too much info, be too wordy, or use unprofessional language. Think:

·       Formatting: Use a resume template, plus career planning offices at your college or university, and: 

o  Indeed.com

o  The New Social Worker 

o  ResumeGenius  

·       Use competency-based language: Professions have competencies that viewed as pillars of practice. Use that language to describe roles for practicums, internships, or professional jobs; for example, ‘intervened with adolescent population’ instead of ‘worked with adolescents’. Another example is, ‘engaged in counseling’ instead of ‘provided, or did counseling’. Competency-based language also lives in course syllabi and licensure regulations for your state.

·       Attention to detail matters: A resume is your first impression to perspective employers. If there are errors, they will wonder, ‘if you can’t take the time to proof your own resume, why should they believe you’ll do better on the job?’. Do spelling AND grammar checks!

Lesson 3: Have references ready!

Reach out early to references and keep their names accessible! Maintain professional letters of recommendation in your online files. Keep references in the loop so they know to expect any calls or emails for information about you. With so many phishing emails, everyone is cautious about providing information. Your reference can easily miss a vital request to provide the recommendation that leads to a job offer!

Lesson 4: Stay in the know of current COVID 19 realities

Keep up on COVID19 facts and their impact for any populations you might work with. Brush up on Crisis theory, Trauma-informed care, and short-term counseling techniques. Also, review websites of potential employers for pandemic initiatives. This info will help you develop ideas on how to best serve the organization. Knowledge is power; this is a great way to tout your expertise in the interview!

Lesson 5: Know brief assessment tools and resources

With the uptick in mental health across populations and the workforce, have working knowledge of assessment tools to manage anxiety, stress, and depression. Quality resources live at Therapist Aid .

Lesson 6: Interviews are reciprocal opportunities

Interviews are not a guarantee of employment. Candidates can spend so much time during an interview discussing their expertise, they forget to ask key questions about the workplace. 

Research employers before the interview. View the employer’s website to learn their mission, vision, and goals. Learn how the organization conducts business. Ask questions about short and long term goals, and how they see you fitting into these plans. This tactic conveys your interest in the position. Interviews are for potential employers to interview you, but also you to interview them. This mindset puts you in control of the process, and decreases anxiety. Ask questions to learn if this job and setting are for you, such as those at Big Interview. 

Remember, decision-making timeframes vary, so ask about next steps. Organizations can take 2 days to make final decisions or months! Know what you are facing to help prioritize other offers!

Lesson 7: Ask about job stability

Amid such unpredictable times, it’s appropriate to ask about potential layoffs and furloughs. Some positions are funded by grants, so ask how long the position is funded and what happens next. Hiring freezes can be common and won’t necessarily be information shared. If you don’t ask, you won’t know.

Lesson 8: Be ready to name your unique strengths, and demonstrate them 

Job candidates will be asked how they will handle specific situations. Identify your strengths and how they would make a difference. Consider:

·       How do your strengths set you apart from other candidates?

·       Why should the organization hire you?

·       What examples can you provide so the employer understands your worth?

·       How can you demonstrate your ability to work with a team?

·       You will be asked about your weaknesses. Be prepared to respond in a professional manner, and have your answer ready. 

Lesson 9: The only constant in our industry is change 

Know this: the industry will change as will you; be open to what it means for you to change with it. 

Lesson 10: Be open to short-term or part-time roles

An exciting short-term or part-time role may turn into the best career option never anticipated. Don’t dismiss positions that are different from your expectations!

Lesson 11: Set up your professional social media profile. 

Set up a professional profile using established websites and job bank platforms. Facebook (or Meta) can help with networking, but use other websites that highlight recruitment:

Keep a profile professional! Use a polished photo versus a selfie with your BFF, pet, or family! Solid guidance is at What Recruiters Want to See on Your LinkedIn Profile

Lesson 12: Negotiation is expected

Negotiation is expected for any job. Negotiate for everything:

  • A higher hourly rate or salary
  • Remote options or flexible work hours
  • Coverage/reimbursement for professional fees (e.g. licensure exam application, exam prep courses, professional association dues)
  • Coverage/reimbursement for clinical supervision and if it is offered onsite. Organizations may pay a portion of the rate to the whole amount. They may only provide supervision internally or have waiting lists. If supervision is provided, you may need to promise to stay at the organization for set number of years post-completion, or pay pack a set amount.

You don’t know what you don’t know, so ask questions! The answers may surprise you! 

Lesson 13: Don’t be thrown by a title or position qualifications 

People apply for jobs based on titles; titles are deceptive! Learn about the scope of each role before dismissing a solid opportunity. 

Don’t dismiss a role based on qualifications alone. Application processes may ‘kick you out’ for not having hard competency qualifications (e.g., degree, licensure). Other knowledge or experiences can sway the decision; volunteer roles and practicums with a population speak volumes. Don’t assume you’re not qualified!

Lesson 14: Take the right job, not just any job

You want an income when you graduate, but strive for the right job. Listen to your clinical gut during the job search. Don’t jump on the first offer or settle if something feels off. Process the opportunity with peers, former professors, and mentors. We may be amid the Great Resignation, but, the grass isn’t always greener; there are brown spots everywhere. 

Lesson 15: Enjoy the job search

There is pressure to be employed, but explore opportunities. Get out there and enjoy the search!

I invite colleagues and followers to post other practical lessons below to empower our next generation of professionals!

New Annual Report Highlights Economic, Educational, and Racial Disparities

The economic, employment, and racial disparities detailed in County Health Rankings and Roadmaps’ 2022 Annual Report have a ripple effect across all social determinants of health. Access to all basic human needs is at issue and must be addressed.

County Health Rankings and Roadmaps (CHR&R) released their 2022 annual report this week, and what a read it is! Those in the health equity space unfamiliar with this resource need to get familiar quickly! The site provides current data and outcomes on societal disparities for every county in the United States. CHR & R was created by the University of Wisconsin Population Health Institute with funding from the Robert Wood Johnson Foundation. The site is among my favorite “go to” sites for health disparities data, along with CMS’s Mapping US Medicare Disparities and the Health Equity Tracker courtesy of the Satcher Health Leadership Institute and Morehouse School of Medicine). But, back to those CHR & R the interesting results!

What the Data Reveals

Much has been written during the pandemic about economic shifts and their impact on the population. The results of the CHR & R report are glaring, and have strong potential to impact wholistic health equity across physical, behavioral, and psychosocial health:

  • Many US residents do not earn a living wage: $35.80 an hour for households with one adult and two children:
    • In nearly all US counties, the typical wage is less than the living wage for the area. Among these counties, a more than 73% increase in wages is necessary to meet the living wage; some counties require a 229% increase.
  • The gender disparity gap is only eclipsed by that for racial disparities:
    • Women earn 81 cents on the dollar relative to White Men
    • Women of all races and ethnicities must work more time to earn the $61,807 average annual salary of a White man.
      • Asian Women: 34 days more (approximately 1 month)
      • White Women: 103 days more (> 3.5 months)
      • Black Women: 223 days more (> 7 months)
      • American Indian/Alaskan Native: 266 days (>8.5 months)
      • Hispanic Women: 299 days more (approximately 10 months)
    • The largest pay gaps exist in the South and Western Plains States, often related to prevailing systemic racism
  • Childcare costs negate the ability of many parents to work, and is considered unaffordable when it exceeds 7% of the household’s income:
    • No counties have the childcare cost for two children at or below the 7% benchmark
    • On average, a family with two children spends 25% of its household income on childcare 
    • Childcare cost burden is highest in urban metro regions and rural counties: 27% and 25% respectively
    • For a person earning the federal minimum wage of $7.25-an-hour, the average childcare costs for two children is >90% of their annual income.
  • Vast educational disparities appear across rural, suburban and urban schools:
    • 50% of all counties in the US have a public school funding deficit, needing to spend >$3,000 more per student, annually 
    • 70% of counties with deficits of > -$4,500 per student, annually, are rural
    • Counties with higher proportions of Black, Hispanic, and American Indian & Alaska Native populations have funding deficits higher than most US counties; deficits are especially high in certain areas, such as the Southern Black Belt region (systemic racism hits again).
    • Large school funding deficits (-$4,500 per student, annually) correlate with students performing below their grade level for reading and math.

Ripples Effects and Recommendations

The economic, employment, and racial disparities detailed in the report have a ripple effect across all social determinants of health. Access to all basic human needs is at issue, and must be addressed. The report includes a series of data maps, resources, and successful programming to mitigate the issues. Recommendations encompass, but are not limited to:

A table with additional measures and data sources are appears at end of the report, which reaffirms the product’s value to the industry. The report is accessible from the embedded URL above, or through the County Ranking and Roadmaps site, www.countyhealthrankings.org

Feel free to add your comments about this blog post below, or other valuable resources. 

Leading the Race for Health Equity: Are IPPS 2023 and CMS’s 2022 Strategic Plan Enough?

“Communities take care of their own”; that is especially true in attaining health equity. Was this grand effort by CMS too little, too late? Industry stakeholders have stepped up to lead the efforts for the population, and are now running far ahead of CMS.

News outlets were flush with reports last weeks of the latest happenings in the Social Determinants of Health (SDoH) space. The top stories were all aligned with press releases from the Centers for Medicare and Medicaid Services (CMS) touting efforts to address “Systemic Inequities” as part of their, 2022 Strategic Plan.

The bold effort encompassed: 

  1. Release of the Inpatient Prospective Payment System 2023 Rule, including the health equity trifecta of:
    • Request for public comment over the next 60 days on means to enhance and/or standardize SDoH documentation through data collection of inpatient claims and metrics that analyze disparities across programs and policies, including a request for information related to homelessness reported by hospitals on Medicare claims
    • Update of the Hospital Readmissions Reduction Program (HRRP) to improve performance for socially at-risk populations, and
    • Implementation of “birthing friendly” hospital designations to improve maternal health outcomes and reduce associated morbidity and mortality. 
  2. Commitment by (CMS) to mitigate health disparities through efforts aligned with Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities through the Federal Government.; all CMS offices  are to embed health equity into the core of their work:
    • Aimed to better identify and respond to inequities in health outcomes,
    • Barriers to coverage, and 
    • Access to care.

The means to achieve these efforts included a robust plan that looks great on paper:

  • Close gaps in health care access, quality, and outcomes for underserved populations.
  • Promote culturally and linguistically appropriate services Build on outreach efforts to enroll eligible people across Medicare, Medicaid/CHIP and the Marketplace. 
  • Expand and standardize the collection and use of data, including race, ethnicity, preferred language, sexual orientation, gender identity, disability, income, geography, et al. across CMS programs.
  • Evaluate policies to determine how CMS can support safety net providers 
  • Ensure engagement with and accountability to the communities served by CMS in policy development and program implementation 
  • Incorporate screening for and promote broader access to health-related social needs, including wider adoption of related quality measures, coordination with community-based organizations, and collection of social needs data in standardized formats 
  • Ensure CMS programs serve as a model and catalyst to advance health equity through our nation’s health care system, including with states, providers, plans, and other stakeholders.
  • Promote the highest quality outcomes and safest care for all people using the framework under the CMS National Quality Strategy.

Yet, my antennae shot up while reading one CMS quote:

“ The agency will bring together healthcare stakeholders—including payers—to promote implementing a health equity strategy. The first meeting will address achieving health equity in maternal healthcare, specifically. It will occur during the summer of 2022.”

Time to hurry up and wait. It seems the health equity strategy is not totally defined: shocking, I know! My elation at seeing formal acknowledgement and attention to, systemic inequities, was quickly dashed. Advancing legislation and funding for the SDoH alone will not fully mitigate the gaps in care. Most experts agree these well-intended efforts will fail, unless the systemic biases that have created and perpetuated the SDoH are also addressed. 

CMS will have to do better than introducing a health equity pillar with strategic language. On the other hand:

  • YES, for the $226.5 M announced this week via HHS and HRSA for Community Health Worker training; build that segment of the workforce. The fiscal and clinical impact of CHWs is massive, enhancing discharge planning outcomes, enhancing treatment and resource access to the most at-risk patients and populations, which bridges serious gaps in care.
  • Develop, fund, and maintain the data exchange infrastructure: 
    • Expand and implement more end to end, social risk analytics and assessment programs like those in play by UniteUs, Socially Determined., and 3M.
    • Expand ICD-10 CM Z codes and approve their reimbursement. I cloud the issue with logic, though reimbursing organizations for the blatant impact of the SDoH and MH on healthcare utilization (e.g., length of stay, ED admissions, readmissions, costs) would greatly enhance revenue coding and capture by healthcare organizations. Organizations will use the codes if there is direct fiscal incentive to do so. GO GRAVITY PROJECT !
    • Grow technology programs that directly support my hospital case management colleagues in assessing, referring, and directly connective patients to needed resources, such as FindHelp.
  • Expand, Food is Medicine programs nationwide, along with the means to assess and directly link patients to necessary nutritional resources GO FarmBoxRx, FoodSmart!
  • Grow funding to Community-based organizations, and safety-net programs, as in community action agencies, neighborhood health clinics, and federally qualified health centers: these are the folks in the trenches!

There was a time when, where CMS went (in terms of reimbursement, programming, and funding) the rest of the industry followed. Yet has this trend shifted? Many have heard me say, “Communities take care of their own”; that is especially true in attaining health equity. Was this latest effort by CMS enough? In time, outcomes will tell the story, but for now, industry stakeholders have stepped up to lead the efforts for their communities, and running ahead of pack.

Your comments are valued so feel free to add them below. 

The Dismal State of Maternal Wholistic Health for Women of Color

Change is long overdue for this massive maternal health chasm of wholistic health disparities, transcending physical, behavioral, and psychosocial health, and particularly for women of color (WOC)

April 11-17th marks annual Black Maternal Health Week. There will most likely be a flurry of well-intended articles, blog posts and announcements focused on legislation, funding of initiatives and programs, and advocacy. But here’s the lowdown: Black mothers have had higher mortality than White mothers for well over 100 years. They are > 3X more likely to die from pregnancy-related complications and 2X as likely to suffer from mental health issues than their White counterparts. The impact of historical, intergenerational, medical, racial trauma is invasive and enduring. Change is long overdue for this massive maternal health chasm of wholistic health disparities, transcending physical, behavioral, and psychosocial health, and particularly for women of color (WOC)

The recent Commonwealth Fund report on women’s reproductive health reveals how severe the issue remains:

  • U.S. women have the highest rate of maternal deaths among high-income countries. The current maternal mortality ratio of 17.4 per 100,000 pregnancies, equals roughly 660 maternal deaths. This earns the U.S. last place standing overall among all industrialized countries.
  • A woman’s chance of dying in southern states is 2X greater than those in the north:
    • Alabama, Arkansas, Kentucky, and Oklahoma report death ratios of greater than 30:100,000 live births 
    • California, Illinois, Ohio, and Pennsylvania reported death ratios less than half the figures in those states, <15 deaths: 100,000 live births

Data for WOC is beyond alarming: 

  • The maternal death ratio for Black women is 37.1:100,000 pregnancies. The number is 2.5X the ratio for white women (14.7) and three times the ratio for Hispanic women (11.8).
  • Hispanic mothers were 80% as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
  • A Black mother with a college education is at 60% greater risk for a maternal death than a White or Hispanic woman with less than a high school education.
  • Even when WOC verbalize health and mental health concerns to providers, their voice is disregarded:
    • WOC are more likely than White women to express their concerns and preferences regarding births though more frequently ignored
    • Women with Medicaid report inadequate postpartum care and support, where they are:
      • Pressured to have C-sections
      • Not scheduled for postpartum visits
      • Disrespected by providers due to insurance
  • Pregnancy-related mortality rates vary across ethnic groups, yet show a constant disturbing trend:
    • Black (40.8%), American Indian/Alaska Native (29.7%), Asian Pacific Islander (13.5%), and Hispanic (11.5%) compared to Whites (12.7%).
    • Upwards of 60% of these deaths are preventable. A CDC report, reveals the often avoidable causes:
      • Infection (13%)
      • Postpartum bleeding (11%)
      • Cardiovascular conditions such as Cardiomyopathy (11%), 
      • Blood clots (9%), 
      • High blood pressure (8%), 
      • Stroke (7%), and a category combining other cardiac conditions (15%). 

Maternal Mental Health Awareness Week is scheduled annually for the first week in May, though bears mention. Not treating maternal mental health conditions costs $32,000 per mother-infant pair, totaling $14.2 billion nationally

  • Black women are twice as likely as Whites to suffer from perinatal mood and anxiety disorders, and less likely to receive treatment: 40% compared to 20-25%  
  • Indigenous women have a higher incidence of depression, anxiety, and substance misuse during the perinatal period from 17-47%; Indigenous identity increased the likelihood by 62%
  • Migrant WOC are at greater risk for behavioral health issues during pregnancies (e.g., depression, schizophrenia, post-traumatic stress) from the interaction of psychosocial determinants as forced migration plus generalized insecurity associated with experiences as refugees, asylum seekers, and human trafficking victims

Endless data validates WOC’s maternal health mandates. Recent years have witnessed robust action courtesy of fierce voices and tireless work of many entities in the US and around the globe. Their agendas serve as a clearinghouse of efforts. The list below is a starting point of resources:

The “honorary” annual week is valued, but a wholistic health crisis of this magnitude mandates far more than 7 days of attention. Distinct legislation, dedicated and substantial funding at federal, state and local levels is vital. Yet, these efforts are for naught unless the systemic racism and implicit bias that perpetuate this reality are equally addressed. We must:

  • Identify, call out, and dismantle systemic racism across macro, meso, and micro spaces
  • Develop and implement population-inclusive clinical predictive analytics and algorithms
  • Ensure dedicated quality metrics that report the necessary outcomes to drive clinical programming, treatment, and concordant practices
  • Shift the academic curriculum to better prepare the interprofessional workforce to provide population-specific care without bias
  • Continue to advance the concordant provider-base
  • Expand ethnic, racial, and cultural programming, such as reimbursement of community-based Doulas, especially in medically underserved areas.
  • Expand access to fertility treatments and address racial disparities in outcomes for IVF. Black women are more likely to have infertility compared to other races, yet the access to treatment is minimal

Data has long validated this epidemic’s emergent state, which has continued to escalate. Maternal wholistic health is a public health emergency of the highest priority. This article is just the tip of the iceberg. I invite those in this care space to post additional resources and information.

What Good Is Health Plan Cost-Sharing When Persons Can’t Afford to Access Care?

Increasing numbers of persons challenged by cost-sharing options only adds to the growing tally of persons struggling with social determinants of health and mental health; this counters efforts to attain wholistic health equity.

Outcomes
Researchers analyzed data from the 2019 Survey of Consumer Finances with telling results:
• High percentages of non-elderly households lack sufficient assets to meet typical plan cost-sharing amounts.
-45% of single-person non-elderly households unable to pay average cost-sharing amounts of $2,000 annually; low income households were in the same boat
-63% could not pay over the higher plan amounts of $6,000.
• Available liquid assets for single-person non-elderly households with incomes <150% of the federal poverty level (FPL) were limited; available assets averaged $577 vs $1,753 for those between 150% and 400% of FPL, and $13,243 for those above 400% of FPL.
• Median available liquid assets among multi-person households were $698 for those below 150% of poverty compared to $2,996 for households between 150% and 400% of poverty, and $23,439 for households with incomes of 400% of poverty or more.
• 84% of multi-person households with incomes <150% of the FPL lack $4,000 in liquid assets
• 50% of households could not afford a basic employer insurance plan deductible ($2000)
• 2:3 households lacked funds to covered a high-end deductible ( $6000)

Deductibles, co-pays, co-insurance are common means of health plan cost-sharing. However, what happens when healthcare consumers are unable to pay them? A recent study by the Kaiser Family Foundation revealed the sorry truth: health plan enrollees are too often unable to access the care they need, or forced into medical debt and bankruptcy to do so. In a time when strong efforts are in play to bridge healthcare disparities and ease access to care, that reality remains an elusive butterfly for too many individuals.

Most households lack sufficient liquid assets to meet an out-of-pocket maximum. Some might recall that the Affordable Care Act limited out-of-pocket maximums for most private health insurance plans: $8700 for single coverage, $17,400 for family coverage. This is appalling considering the Affordable Care Act set out-of-pocket minimums, yet the average out-of-pocket maximum for single coverage in 2021 was $4272.

Rising Medical Debt
Amid the pandemic, high numbers of persons faced emergency medical bills from care, whether related to COVID-related costs, or deferred health and behavioral issues. Roughly 62% of households with incomes between 150% and 400% of the poverty level were unable to afford care or access the approximately $3000 needed to cover urgent care costs.

Recent reports show dismal results for persons dealing with psychosocial challenges, as well as rising medical debt:
• >50% of Americans experience medical debt
• >57% owed over $1000
• 40% had problems paying medical bills or affording premiums
• 65% who earned <$40,000 and 51% earning $40,000 to $75,000 could not afford premiums despite having employer-sponsored coverage.

• >51% of persons with employer-sponsored plans reported someone in their household delayed or skipped care, or filling a prescription due to the associated expense
• 26% of adults with an employer-sponsored plan had to cut spending on food, clothes, or other household items to pay their health-related expenses.
• 20% took on an additional credit card debt to pay their expenses

The rising numbers of persons challenged by cost-sharing options must be resolved. This reality only adds to the growing tally of persons struggling with social determinants of health and mental health, countering efforts to attain health equity. More must be done to enhance access to care for every person across the wholistic health landscape of physical, behavioral, and psychosocial health.

Managing the Doomscrolling Dichotomy

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope. The dynamic is impacting rising numbers of persons across the globe, along with their physical and behavioral health; this includes the professional workforce. Here are 5 ways to manage the doom scrolling dilemma.

A versions of this article was initially published by the CGI Newsletter, and appears with permission.

You have a break in the day and decide to catch up on your favorite social media feeds;  suddenly it’s 30 minutes later. What began as a look at your BFFs Facebook feed spiraled to viewing headlines, graphics, and disturbing images of recent events. You are sucked into a vortex of posts across platforms and apps, distracted from everything on your calendar: social, occupational, or education activities. Emotions bubble up: anger, bewilderment, frustration, rage, sadness. You become unable to focus, sleep, and feel crispy around the edges. Welcome to the world of doomscrolling: a dynamic impacting rising numbers of persons across the globe.

What it Means

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope.  Society has been exposed to a pervasive cycle of negative news these past two years including the pandemic, cultural, racial, and ethnic disparities, and the recent Ukraine crisis. It becomes easy to get caught up consuming mass quantities of online news in a single sitting.

The impact of these events on our wholistic health is telling. Growing studies speak to rising incidence of severe anxiety, depression, and psychological distress from over-consumption of pandemic-related media (Bendau et al., 2021). Daily social and traditional (e.g., new portals, magazines) media use exacerbates onset and exacerbation of depression and post-traumatic stress disorder (Price et al., 2022). Poor mental health negatively impacts sleep, putting further stress on the immune system; the interconnection between psychopathology and chronic illness is well-documented in the literature (Isvoranu et al., 2021).

The professional workforce walks a slippery slope with the doomscrolling dilemma, particularly those in behavioral health, integrated care, and related roles. Practitioners are faced with increasing numbers of patients seeking treatment for anxiety, depression, insomnia, and other symptoms related to the negative news cycle. Yet, each practitioner, is also a human being, striving to set limits on their own over-exposure to the media. Balancing professional self-care with respect for patient autonomy and rendering of effective treatment becomes the sharpest of double-edged swords. Professionals must limit their (over) exposure and potential collective occupational trauma, while intervening effectively with patients: an ethical dilemma of its own!

Why We Do It

            One quick answer is, misery loves company. Reading about negative events validates negative feelings felt by individuals. The more one seeks to satisfy this need, the more doomscrolling advances to addictive habit. Striving to stay informed about current events devolves into a vicious cycle where stress increases and cortisol levels rise. A myriad of health issues can result: increased blood pressure and glucose levels, migraine headaches, insomnia, or autoimmune disorders (e.g., lupus, multiple sclerosis, rheumatoid arthritis, Sjögren’s syndrome).  


What to Do About It

Here are 5 strategies to inform your efforts:

  1. Limit Social Media Bandwidth: Read one article in the morning, listen to a podcast from that favorite platform (or news outlet) you trust. 
  2. Take Social Media Breaks: Don’t get sucked in or your energy will be sucked out. You may stay off social media certain times of the day, or for longer periods of time (e.g., during the workday, weekends, or for several months).
  3. Use Body Scanning, Breathing, and Other Trauma-informed Tactics: Doomscrolling can trigger prior traumas. A colleague recently shared how use of trauma-informed interventions made the difference, for both clinician and patient. Regular body scans are an asset: take that nice deep breath, then start at the top of your head and move down your body. Note any sensations that appear: ringing in your ears, pressure around or behind your eyes, a tight neck or back, tingling in your chest or gut. 4-7-8 breathing is an asset as well. 
  4. Sleep Hygiene Strategies: Doomscrolling and insomnia are a dyad. Sound strategies that address both disruptors include:
    • Declare a screen-free sleep space.
    • Keep traditional items nearby, such as a notepad or book. Jot down thoughts that wake you up or read to tire your eyes without using a digital screen.
    • Detox devices by turning off notifications and removing apps; block apps and distracting websites using Freedom or other like-platforms. 
    • Avoid heated or emotional posts within an hour of bedtime
    • Keep screen-free hours one hour prior to bedtime and over the sleep cycle.
  5. Stay Proactive and Consistent: It is easy to fall off the Doomscrolling wagon. Stay vigilant; like any addiction, it won’t take much to fall down the rabbit hole and re-engage. Take control of doomscrolling before it takes control of you!

Have other thoughts? Feel free to add them below!

Empowering Your Healthcare Entrepreneur Within

Being an entrepreneur takes passion, professional vision, and energy What else must you consider? Here are 11 entrepreneurial lessons to follow.

What does it mean to be an entrepreneur as a health care professional? What does it mean to put yourself out there with a business, where you brand your unique presence, products, and/or services? I’ve pondered this through my own journey these past 18 years, and know I’m not alone. I have at least one conversation weekly with other professionals and students about my entrepreneurial path , with curiosity about:

·       The role 

·       What it involves 

·       How to get started 

·       How to keep it going, and especially

·       How not to fail.

Amid the “Great Resignation”, or as fellow entrepreneur (and my esteemed professor) Dr. Fanike-Kiara Olugbala Young calls it, the “Great Awakening, the workforce is pondering new career paths and options. To this end, I want to share information and lessons to guide your entrepreneurial journey.

What’s an Entrepreneur?

The definition says it all: “a person who organizes and manages any enterprise, especially a business, usually with considerable initiative and risk.”

My fellow entrepreneur’s say, ‘I wanted to make a greater impact, or difference for the workforce”. For me, the journey began with a desire to provide colleagues necessary knowledge to be successful in the ever-changing industry. Being an entrepreneur involves energy, initiative, expertise, and creative vision. It also involves a comfort with taking risks; financial risk, and risk to professional reputation. Each type of risk influences the other; if you are unable to operationalize your vision successfully, you won’t earn money. Inversely, if you aren’t prepared to invest a little money, you won’t be able to clearly implement your vision. 

Traditional academic health and human service degrees don’t feed the entrepreneurial spirit. There are few, to any formal courses on ‘forging your passion’. In fact, the entrepreneurial spirit can be unintentionally discouraged in formal degree programs, at least until the budding professional gains experience. Many innovative minds enter colleges daily, yet required content defined by academic accreditation takes priority. As an educator, I value the importance of theory and application. Yet, the growth of non-traditional professional paths mandate a way to empower distinct talents of budding entrepreneurs, sooner than later. 

Starting the Entrepreneurial Journey

One of my favorite quotes is, “The light at the end of the tunnel isn’t an illusion, the tunnel is” (Author unknown). This sentiment perfectly addresses the transition from full-time employee to full-fledged entrepreneur. The journey starts with a traditional job; you graduate with your degree and start a career. Yet, the rigor and routine begin to weigh heavily, and take their toll. The once, enthusiastic health care professional gets the itch to shift gears.

Underneath your frustration, passion takes root, and you long to do more than your current position will allow. Passion flourishes as you write a blog, article, give a presentation or webinar on a unique project. Word spreads about your unique perspective! Engaging in a different focus ignites more passion than you ever thought possible, and attracts attention. Conversations with other entrepreneurs empower you to develop a business plan, market your vision and you’re off; Leaving your full-time gig goes from dream to reality! 

Ellen’s 11 Entrepreneurial Lessons

Here are 11 lessons to kick-start your efforts. I welcome all entrepreneurial colleagues to add to the list, and know they will! (hear that Michelle G. Rhodes, Deanna Cooper Gillingham, Thomas Dahlborg, Wilson Hurley!)

Lesson #1: Give yourself permission to be an entrepreneur-this is the toughest leap to make. Let’s face it, you need to earn a living. You may sit in your office and daydream for months, or years before taking the plunge. Don’t wait so long that someone else comes forth with your great idea. Give yourself permission to consider options beyond the safety net of your full-time job.

Lesson #2: Define and own your passion-You may have a clear sense of what you want to do. For others, the idea may come when least expected. For me, a switch went off one day in 2004. I saw my enthusiastic colleagues suddenly look fried to a crisp. Organizations were cutting professional education, taking away a vital benefit for the workforce. With many conversations about how to improve health care quality, I wondered; how could any quality care occur without a knowledgeable workforce. BOOM! As a result, every contract I take, every presentation or training I develop, every article or book I write, and class I teach is consistent with my vision. What fun to empower the knowledge-base of my colleagues each day, plus the students entering our ranks. Remember, if you have fun with what you do, you will never feel like you’re working! 

Lesson #3: You don’t have to go from 0-60! It is ok to start slowly. Perhaps you keep your full-time job and do consulting on the side. Get a sense of who you are, your unique talents, and how much time and energy you want to invest. You may not be ready to go, full-time entrepreneur. Write a blog on a topic of interest, or give a presentation. Who knows where it will lead!

Lesson #4: Organize and focus your efforts- Passion can easily run amuck and take us in many directions. I’ve seen colleagues embark on their entrepreneurial journey with all the passion and purpose in the world, though become overwhelmed as they try to tame their newly unleashed energy. Start small, define your professional identity and brand, then you go global. 

Lesson #5: Tout your clout!– Inform the industry who you are and what you do. Be organized and strategic. Create a website with clear messaging unique to you! Consider, how is what you do is different from others? Who is your target audience? What do you want them to know about you? Leverage social media, your messaging, and grow that presence!

In addition, since being an entrepreneur is not just any job, develop a 30 second elevator speech. When someone asks, ‘what you do you do?’, be prepared to respond. I often say, “I empower the health care workforce through professional training, mentoring, and consultation”; succinct and to the point. What would your elevator speech be?

Lesson #6: Being an entrepreneur takes a strong work ethic–Organization and consistency become your mantras; end of discussion.

Lesson #7: Never underestimate your value and worth-Consider what to charge for the services you offer. Ask around and investigate the competition. See what is realistic for your region, or specialty. You may decide to do a schedule of options, offer professional courtesy or pro bono opportunities; your business and vision are an extension of you!

Lesson #8: Develop, and maintain a network of mentors-Being an entrepreneur gets lonely. Surround yourself with colleagues you trust for their guidance, plus unconditional support. They have to be honest with you, even if you don’t like what they have to say. Also, join professional associations and networks that foster your connection with others with like minds!

Lesson #9: Set limits and a sound schedule-Once you find your passion and love what you do, it becomes tough to stop working. I remember hearing, I could work longer hours since I set my own hours; so very true. You can burn out as an entrepreneur, as readily as you can in a traditional role, so be mindful! Being an entrepreneur comes from the unique energy within you. Nurture that inner soul and energy so your passion, purpose, patience don’t fade. 

In addition, learn to say no, or negotiate the date of deliverables. Back to that financial risk topic; you get paid when you work, or engage in successful products that will reap royalties. Fiscal vulnerability can push you to take on too much work, or work that you wish you hadn’t. Practice saying, “NO”, or “I’d love to do that project for you, but can only do it in March vs. January.”, or, “I only want to give you a quality product, and will need an extra week to do that”. You are in charge of your reputation, and destiny!

Lesson #10: There will be peaks and valleys-Financial scheduling is important, so prepare for inconsistent income. Be proactive vs. reactive, so diversify your business to allow for different revenue streams. In my case, I have contracts of different types and payment schedules to provide a cushion when I need it. 

Lesson #11: Be open to all possibilities-Our passion is a blessing and curse; it can expand our opportunities, though also limit our scope. Opportunities that may at first, seem daunting, could turn into important projects.

I never thought of writing a book; articles, yes, but never a book. After co-authoring three articles on the same topic with a colleague, my mentor, Suzanne Powell said, “just write the book.” and we did!  COLLABORATE for Professional Case Management was born. My ethics and health equities core beckoned: I have now authored 3 books with next editions in the works: The Essential Guide to Interprofessional Ethics for Health Care Case Management (2019) the Social Determinants of Health: Case Management’s Next Frontier (2019) and End of Life Care for Case Management (2020). I’m writing my 5th book for publication in Winter, 2023: The Social Determinants of Mental Health: Advancing Wholistic Practice Excellence.

What else do I do? A Google search or glimpse at my LinkedIn Bio will fill you in; every day is different and uniquely inspiring. How high can you fly? That’s up to you. The world is your oyster: GO GRAB IT!

Have other entrepreneurial lessons to share? Add them below~