The recent influx of Intensive In-Home Agencies and the issues associated with them.

Get new comments by email
You can cancel email alerts at anytime.
Comments (17)

Creole Soul in Richmond, Virginia

39 months ago

I would like to know if anyone has noticed a recent influx of Intensive In-Home agencies in your area? I am asking because there are literally like 1000 in just the Richmond, VA area alone! Now Richmond is not that big, but with all these agencies, they have to be servicing the same people.

Issue #1-They service and actively solicit services pretty much 100% low income people. Why? Because most of these people are recieving Medicaid and most of these agencies are Medicaid based paid which = guaranteed payment, unlike relying on private insurance.

Issue #2- This type of business has very low startup costs but the rate of return is GREAT, which means you could pull in almost $50K in less than 6 months. This is why there are so many agencies in the area.

Issue #3-Ethics. There is soooo much room for unethical behavior it's not even funny. The basic premise of these types of business are you see a person (aka a client) for 10 hours per week, submit paperwork to Medicaid for approval for payment. Voila! How easy is that? As it stands now in Virginia, Medicaid pays approx. $60 per hour per client. So if you have 3 clients, that's $1800 per week. This leaves a lot of room for unethical behavior, such as not really seeing clients for those 10 hours, overbilling, billing for services not rendered, client and agency being in cahoots, etc.

Issue #4-Many of the client population who are being serviced, who also happen to be low income, are being overly diagnosed with disorders such as Bipolar Disorder, ADHD, Oppositional Defiant Disorder, Conduct Disorder, etc. Is there a strong correlation between being low-income and having a mental health disorder? Maybe that should be studied instead of putting a band aid on the problem.

Issue #5- Because many of the kids being serviced by these agencies have been diagnosed with ADHD, many of the parents now see that as a way to bring in income via SSI. And what's worse is that many of these agencies are pushing for this.

- Was this comment helpful? Yes (12) / No Reply - Report abuse

Creole Soul in Richmond, Virginia

39 months ago

cont'd

cont'd Issue #5- Although the pay incentive is only a marginal amount, these agencies promote and support the reciept of SSI for kids with ADHD.

Issue #6- These agencies are a step down from Social Services and CPS and a step up from outpatient care. The major issues are not looked at, such as un/undereducated, un/underemployment, social/environmental factors (living in violent neighborrhoods), and other social issues that contribut to these people's issues. Instead these agencies offer a temporary solution to a permanent problem, which is a bigger problem in itself.

Issue #7-The pay sucks. Many of these agencies low ball their employees, who are referred to as QMHP or QMPP. They don't reimburse for mileage or gas, so you use much of your own personal money to put back into their business. You will also find yourself using your own personal resources (car, phone, email, jump drive, etc.) to conduct business for them with no compensation or reimbursement.

Issue #8-You are inundated with paperwork weekly. You could have had a "Harry Potter" type series of books written based on the amount of paperwork you will write over the course of your "career" as a QMHP. Be prepared to not have a social life.

Issue #9- You will get burned out quick and these agencies know it, but they don't care. As long as you turn in that weekly paperwork, they could care less about the lives of the people who keep the business going, the people in the field. And you will find these agencies often defer to Medicaid and licensing.

Issue #10- The people who start up these agencies don;t really care about the people they are supposed to be servicing. You will find that all they care about is the money. You have to have a passion for this field because you will find out very quickly that most of the issues of the client population you will service are self-inflicted; meaning they are victims of their own bad decision making and expect others (QMHP) to fix their problem

- Was this comment helpful? Yes (12) / No (1) Reply - Report abuse

Dparham in Petersburg, Virginia

35 months ago

I was an daytreatment and youth counselor for six years they changed the medicaid laws left me with no work and i am a very good counselor. Im sorry that companies messed things up if anyone can help me find new employment at one of the better companies i would appreciate it and also the paper work at these inhome companies is ridiculous i agree with that but what can you do.

- Was this comment helpful? Yes (4) / No Reply - Report abuse

Brian in Virginia Beach, Virginia

16 months ago

I agree with you that there are many unscrupulous Mental Health employees out there committing fraudulent acts, however I'm sure there are many passionate counselors that follow the code of ethics and do their best to uphold integrity as a professional. Not all agencies are bad. Of course these companies care about money why do you think they are in business to be broke, lol? At the same time I agree that the focus should not be on the money but the quality of services. PAPERWORK!!! Are you seriously complaining about this? The entire mental health field is drowning in paperwork, we all know this is for Medicaid purposes. The pay is relevant to the agency. Some agencies pay good some low ball, you have to know what your worth as a QMHP. And yes there is a "strong correlation" between low-income and mental health diagnosis. There is also a strong correlation between low-income populations and the development of HIV/STD's, so should we get rid of the community clinics because they are only putting a band aid on the more apparent issue rather than the main issue of not practicing abstinence? Also, you obviously have enough time for a social life if you post a message as long a you did, or did you write this one the job during a client session in which you would be wasting tax payer money as well and technically breaking the law yourself with your exhaustive post, lol...hope you find another field to work in!

- Was this comment helpful? Yes (4) / No (11) Reply - Report abuse

MrsDalloway in Denison, Texas

16 months ago

Brian in Virginia Beach, Virginia said: I agree with you that there are many unscrupulous Mental Health employees out there committing fraudulent acts, however I'm sure there are many passionate counselors that follow the code of ethics and do their best to uphold integrity as a professional. Not all agencies are bad. Of course these companies care about money why do you think they are in business to be broke, lol? At the same time I agree that the focus should not be on the money but the quality of services. PAPERWORK!!! Are you seriously complaining about this? The entire mental health field is drowning in paperwork, we all know this is for Medicaid purposes. The pay is relevant to the agency. Some agencies pay good some low ball, you have to know what your worth as a QMHP. And yes there is a "strong correlation" between low-income and mental health diagnosis. There is also a strong correlation between low-income populations and the development of HIV/STD's, so should we get rid of the community clinics because they are only putting a band aid on the more apparent issue rather than the main issue of not practicing abstinence? Also, you obviously have enough time for a social life if you post a message as long a you did, or did you write this one the job during a client session in which you would be wasting tax payer money as well and technically breaking the law yourself with your exhaustive post, lol...hope you find another field to work in!

From reading your own post, perhaps you should consider another field of work Brian!Your tone is snappy, rude, judgemental, and a bit defensive...leaves me wondering why...?

- Was this comment helpful? Yes (7) / No (1) Reply - Report abuse

Brian in Virginia Beach, Virginia

16 months ago

I am from NY so I don't sugarcoat anything, I tell it like it is. What do you have to provide to the conversation besides a review on me lol?

- Was this comment helpful? Yes (1) / No (10) Reply - Report abuse

DadMike in Maryland

16 months ago

What discourages a lot of people is that these agencies are a business- and like any business, they want to make a profit.
And the people they aim to help are often extremely difficult to service. There is no cure for mental illness, only alleviation of symptoms if treatment succeeds. Relapse is frequent as clients often hate their meds. In addition, childhood behavioral problems are still very poorly understood, and therefore frequently poorly treated. Insurance knows this, and pays accordingly.
Actual improvement for clients is so difficult, paperwork compliance becomes the focus. To focus on clinical improvement too often means focusing in incompetence and failure- paperwork is easier to supervise, and that's what makes the money, too.
There are good clinicians out there, and great workers, too- even great programs. But the system is set up in such way that bad agencies, workers, and supervisors can thrive, esp. if they are simply chasing profit.

- Was this comment helpful? Yes (3) / No Reply - Report abuse

Creole Soul in Richmond, Virginia

15 months ago

Brian in Virginia Beach, Virginia said: I am from NY so I don't sugarcoat anything, I tell it like it is. What do you have to provide to the conversation besides a review on me lol?

Who cares where you are from. Do you think being from New York somehow gives you a pass to be a jacka$$?

- Was this comment helpful? Yes (5) / No Reply - Report abuse

Creole Soul in Richmond, Virginia

15 months ago

I have completely ventured away from this field as it was too stressful. Low pay, very long hours. I'm not built for that kind of life. But thanks for your replies.

- Was this comment helpful? Yes (5) / No Reply - Report abuse

Anthony Hoskins in Portsmouth, Virginia

13 months ago

Honestly, I see both sides of this issue. I would have to begin with the common theme, that Everyone in the profession is not like this. Those issues that the writer presented are VERY VALID. Being that I have been in that portion of the field for nearly 20 years, I have seen each issue which the writer discussed come to fruition. However, I have also seen the opposite of each. Now,

Issue #1: Yes, most services target Low income people. With the contracts that are usually arranged either through medicaid or City Based Agency Funding (FAPT, Court, Etc.,), contain an influx of low income individuals. Honestly, that is the population most served by these agencies because initially most individuals are told that that is where the problem is. Those with private insurance are welcome to receive care, but those in that group usually choose a lesser method of care such as outpatient therapy. In the event that outpatient is unsuccessful, the outpatient therapist may refer to in-home to aid with the overall therapeutic process. Simply put, It's the main population served...Not always by choice, but volume with many unable to have private insurance.

Issue #2: You are EXACTLY RIGHT...To a point. Yes the start-up in terms of costs are relatively low; however, the process itself (human rights committee membership, NUMEROUS visits from licensure where you have to be in accordance with state regs in order to receive your state permission to even practice, multiple visits from licensure and medicaid) compensates fully for this. Those who are not ethical are always caught.

- Was this comment helpful? Yes (4) / No Reply - Report abuse

Anthony Hoskins in Portsmouth, Virginia

13 months ago

Issue #3: Every mental health field, hell medical, business, any field has room for unethical behavior. That being said, yes there are unethical practices in the in home business...Falsified hours, forgeries, saying one is doing counseling when they aren't, fraternization, the list goes on, I am sure you know this. Nonetheless, That is an issue that is agency/counselor specific. I have seen both sides of this issue. Again I have also seen that those individuals are usually caught.

Issue #4: You can't blame the in home agencies on this one. Current regulations leave full diagnosis to 1. The CSB then 2. The psychiatrist. The assessor who comes out for in home only gives an initial diagnosis based on the fact that they are licensed. However, at that point, the kid was already diagnosed and most agencies are just copying that. Now, I would say for the sake of integrity, there needs to be follow up on these diagnoses whenever the clinician believes that there is a problem with the diagnosis.

- Was this comment helpful? Yes (5) / No Reply - Report abuse

Anthony Hoskins in Portsmouth, Virginia

13 months ago

Issue #5: That is old school, but you are right. I have seen this when I started in 1998. Now, with the regulations in place for SSI and In Home becoming more stringent, you will see that this is somewhat decreased. I will tell you from experience though...Most parents already know to do this before any worker comes in the home.

Issue #6: While a good point, you are speaking to more of a political issue here. Intensive in home is a middle ground between outpatient and residential/jail/foster care. While many advocate and interact with DSS and other entities, actual counseling is only supposed to deal with the issues in the home. Many times, counselors have their roles skewed for the sake of attempting to cover all of the areas you mentioned as problem areas. Unfortunately, write that in a note and you are going to have it returned because it isn't clinically sound. Many want to address those areas but are left without the tools to do so.

- Was this comment helpful? Yes (3) / No Reply - Report abuse

Anthony Hoskins in Portsmouth, Virginia

13 months ago

Issue #6b: Plus few look to learn about affecting legislature which is where this issue's solution truly lies.

Issue #7: I am sorry but I haven't seen the pay for intensive in home suck for me. The flexibility and pay based on my experience has always been strongly in relation to my worth. But as another writer said, its about knowing your worth. Yes, some agencies do low ball, however, there needs to be self awareness on the part of that counselor to know not to fall into working with agencies of that nature.

- Was this comment helpful? Yes / No Reply - Report abuse

Anthony Hoskins in Portsmouth, Virginia

13 months ago

Issue #8: It's the mental health field...That is the nature of the beast. You remember that...If it isn't documented, then it didn't happen. It's about time management as far as social life is concerned.

Issue #9: You're Right. It's a business and many agencies don't care about nothing but the bottom line. The better ones however will always suggest that needing help is okay and that either use of EAP or finding therapy is the best resource when doing this kind of work due to the high burnout rate. Additionally, agencies have no choice but to defer to Medicaid and Licensing...If the paperwork is wrong, then people lose money and businesses are shut down. Again, one must practice self care in this high intensity profession.

- Was this comment helpful? Yes (2) / No Reply - Report abuse

Anthony Hoskins in Portsmouth, Virginia

13 months ago

#10: This is the adage of the frustrated counselor...I have been there MANY TIMES...Some agencies care about the people, some care about the allure of the dollar. That is true; however, The counselor who chooses to stay after learning this becomes what they hate. I could go on and on but I think you and I see the same points. I will say this...You sound like I have on many occasions, but Experience and passion for the people made me take steps to get my own agency and not reflect the unethical practices which tarnish an otherwise strong and helpful field. Hope to continue this discussion with you.

- Was this comment helpful? Yes (2) / No Reply - Report abuse

Anthony Hoskins in Portsmouth, Virginia

13 months ago

Creole Soul in Richmond, Virginia said: I have completely ventured away from this field as it was too stressful. Low pay, very long hours. I'm not built for that kind of life. But thanks for your replies.

Hope you get to see my response.

- Was this comment helpful? Yes (4) / No Reply - Report abuse

FROM TX2VA2NY in Houston, Texas

3 months ago

After completing my master's degree in clinical community psychology, I moved to VA to pursue PhD in clinical Psychology. During that time, I worked as an intensive in-home counselor which I hated.

#1 90% of my colleagues only had bachelor degrees (in none related fields). This is particularly a problem because....Well, they did not have any clinical experience. They were mentors at best and not really that effective at serving as that.

#2 Pressure to bill 32-40 per week. I am clinician and this was the quite disturbing that any clinical director (unqualified as well) could justify a family having 10-12 hours of counseling. Again, this requirement was directly related to INCREASE of FRAUD that I witnessed. With service hours being 7am-8am and 3pm-7pm (not accounting for travel between clients; it was impossible to bill for 40 hours. Again, if you did not bill 40 hours, directors would FIND a way to break up sessions...which was clearly a unethical...oh, yeah and illegal. Needless to say, I worked for 30-45 days at best but made sure I walked away quickly as I did not want to associated with pop-up agency that could have jeopardized getting my licensure.

- Was this comment helpful? Yes (4) / No Reply - Report abuse

» Sign in or create an account to comment on this topic.