Episode 144 | Making Your Practice a Safe + Diverse Space Safe with Lujuana Milton

Maureen Werrbach

Hey everyone, welcome back. Today I’m going to be sharing a clip from an expert training. I do this every once in a while on the podcast. And this clip is in our membership, The Exchange, you can listen to the whole thing there if you’re a member. If not, you can join by going to the group practice exchange dot com and you’ll see a link to sign up there.

This particular training was called Making Your Practice a Diverse and Safe Space for Your Clients and Team. And the expert was Lujuana Milton, we’ve had her on several times.

And she also was a speaker at our group practice owners conference a couple of years ago. I always love what she has to say. And so I am excited to share one piece of this training for all of our listeners on making your practice a diverse space and a safe space for your clients and your teams.

In this particular clip, she’s going to talk about some of the barriers that exist for clients of color, as well as some of the things that business owners, group practice owners, as well as staff need to consider. And one of those things that really resonated with me was therapeutic approaches being really Eurocentric, and the need to adapt some of those therapeutic approaches that we learned in college and grad school to better work with BIPOC clients. So she talks about that. She talks about a handful of other things that create a lack of or create barriers to, for clients to receiving the type of care that they need, as well as things for clinicians of color or staff of color that are in group practice. So take a listen and we’ll circle back around.

Lujuana Milton 

Now, when we talk about cultural competence, there’s many barriers, right? There are reasons why clients don’t access certain mental health treatments, mental health treatment. And there’s also reasons behind why clinicians or staff don’t feel supported within practices.

And the first barrier is lack of access, right?

So the Affordable Care Act has improved mental health treatment. But research has found that a number of uninsured people, the number of uninsured people actually increased since the ACA’s implementation. And we all know the long standing issues as it relates to the pandemic, that many individuals and families have, or will be losing their insurance coverage or their jobs, leading to a lack of access to affordable and effective treatment.

Furthermore, access to diverse clinicians is few and far between despite increases in demand from clients who are requesting treatment services from diverse clinicians.

Alright, so I mean, I get we get at least four or five calls looking to speak with a clinician who matches someone’s cultural background, matches a language and language needs. And a lot of times you know, because of the nature of the work, we are full, and we can’t always see people and this is something that is really difficult in the work that we are doing. And oftentimes, we find that a lot of our staff will often end up working more hours because They want to meet the needs of the community. You know, I’ll often say like, that’s not fair to you, we have to be able to advocate and find access to quality staff to meet the needs of our clients. And also meet the needs of our particular clients as it relates to access and affordability.

Then second barrier is the financial issues, right?

So the socio-economics and financial stability of individuals create barriers, including affording co-pays deductibles and self pay fees. Again, the pandemic has significantly impacted many individuals and families finances. And as it relates to working with diverse and diverse clientele, we also have to understand how people view money. Whether it’s money struggles, or their relationship with money from a cultural context, and how can we address that in a way that is non-offensive, and that meets the needs of our clients. This is again, not only talking the talk, but walking the walk. Because when you walk the walk, your staff will then see that, and when your staff see that they may feel more safe in the practice in which they are dedicating their time and energy to, right?

You want to have a space where you know, like for our clients, we are about 95% insurance based. And you know, many people have difficulties meeting their co-pays or to their deductibles. There are times when we have conversations where we may need to, you know, talk about pro-bono work, providing pro-bono work, providing an opportunity where, you know–there have been times where I said, you know, we’ve made the decision, if they can make a payment of $1, then that’s what they will do. And we will, we will figure it out from there.

So really kind of taking into account financial issues being a barrier, especially in the current context and climate that we’re in. Third is bias.

And, you know, there have been therapist bias toward clients, and client bias toward the therapist or our staff. As we create a diverse staff, we’re recognizing that where we are geographically, there are lots of microaggressions, explicit discrimination, or racism towards our staff, our office staff, and our interns, and even our clinical staff. So recognizing that, providing support to our clients and to our staff, is extremely important to us. This is not just a conversation that goes unheeded. I want to make sure that my clinicians and my staff feel supported and that this isn’t something that I condone in our practice.

And then how do we address these barriers and biases and instances of racism in an ethical way, in our practice?

So these are conversations, we just had an incident where our Black identifying clinician actually experienced anti-Blackness, anti-Blackness attitudes, and just very aggressive reactions from a particular client. And this was from our office manager, who called the client and talked with them several times. You know, I talked with them several times, we wanted to make sure that the clinician felt supported, what do you want to do moving forward? How do you want what would be best to address this, and also talk being transparent about certain administrative issues within the group practice, that we kind of have to address ethically and liability wise, and and then how can we address this in a way that you feel supported? So this is a conversation that will continually happen and is embedded in our discussions and within our staff.

And then finally, the therapeutic approaches. Like I mentioned, most therapeutic approaches and perspectives are Eurocentric, and not researched with diverse individuals in mind, and we have to adapt, what are the current treatment approaches to make sense for certain populations.

I’ve been working, we actually are almost finished with a training. Another staff member and I are actually providing a CBT training and how we can actually adapt the techniques and CBT to meet the needs of Black identifying individuals and treatment. Because we recognize that some of those techniques don’t always fit in line. And in particular, with the Black identifying population.

So we actually created this training and we’re presenting it to a university for for individuals to have as part of their CPUs. It’s a one wonderful, wonderful opportunity that we can start out from our practice and some of the practice that we we are currently utilizing, and then educate our overall community.

Maureen Werrbach

All right, so what did you guys think? I’d love to have a dialogue going on on what you got from this clip from the training. Again, like I mentioned, if you want to listen to the whole training on how to create a safe space, that’s also diverse, that’s safe for clients as well as your staff, join the exchange and take a listen to that training. We have a ton of trainings in there. Hundreds of them actually all specific to group practice ownership. And so I’d love to see you in there.