Behind the Scenes: In-Depth Conversation with a Course Creator Ashlyn Douglass-Barnes on Bariatric Surgery Evaluations [Show Notes]

In this conversation, Alexandria Theodor addresses the surge of Facebook inquiries she’s received regarding bariatric surgery evaluations, particularly as a potential niche or side income for therapists. To provide clarity, she discusses key aspects of the specialty with Ashlyn Douglass-Barnes, LCSW, the creator of a comprehensive course on the subject. They cover the uniqueness of the bariatric evaluation niche, the qualifications required, and the considerations for billing, and marketing. Ashlyn shares her personal journey into the niche and highlights the importance of thorough training for effective evaluations. For those interested in changing their specialty or building a side hustle, bariatric evaluations are a wonderful opportunity to expand.

Ashlyn has generously offered a $25 discount to anyone who uses the coupon code StressLess at checkout (full transparency, this is an affiliate coupon).

Want to see a real example of a bariatric evaluation website in action?

Met Ashlyn Douglass-Barnes:

Ashlyn Douglass-Barnes, LCSW, is a licensed clinical social worker and qualified supervisor with degrees from Florida State University. As Clinical Director at a non-profit counseling center, she brings experience from various mental health settings. Ashlyn specializes in pre- and post-surgical mental health clearance and counseling for bariatric surgery, using a cognitive-behavioral, client-centered approach focused on empathy and empowerment.

Reach out to Ashlyn by visiting her website. She is available to talk all things bariatric coaching, evaluations, her course, newsletter, consultation and so much more.

Transcript

This editable transcript was computer generated and might contain errors. People can also change the text after it was created.

Alexandria Theordor: Hello everybody. If you don’t already know me, my name is Alex Theodore. And you might have seen me on Facebook for questions about the bariatric surgery evaluations because my inbox has been blowing up with this new possibility of either side income or maybe a completely new Niche. So as opposed to trying to answer everybody’s questions all at once. I’m hoping that this video is going to help shed some light on some things. And so Ashlyn the course creator was so graciously to kind of spare some time today to go through some of those frequently asked questions that I’ve been receiving so you get it straight from the horse’s mouth and I’m be happy to share some of my experience as well. Don’t worry. I’m not trying to keep anything, but I did want to give you guys the opportunity to kind of hear straight from her what’s working. What’s not and so you can make a better decision if this course is best for you Aslyn. Thank you so much for spending some time with me today.

Ashlyn Douglass-Barnes: Thank you so much for having me. I’m so excited to know that this is been bringing a lot of questions which it often brings a lot of questions for B2 because it’s not a niche that it has a lot of people in it. So makes sense that people have a lot of questions about it.

Alexandria Theordor: And I think it’s just because it. Is not an specialty but the same time once it’s a specialty.

Ashlyn Douglass-Barnes: Yeah.

Alexandria Theordor: It’s like why haven’t I thought of it before it’s not something that we hear about in school EMDR seem to kind of thing. this is its own different world, but still uses a lot of the same tactics. So would you mind talking a little bit about how you got into this Niche and maybe decide to create a course in general?

Ashlyn Douglass-Barnes: Yeah, so many things in therapy. This Niche is me. So I am a 12-year post bariatric patient who had a somewhat negative experience when I had my psychological evaluation for my getting ready to have bariatric surgery. And so I for a long time didn’t want to necessarily, it’s a little close to home so I didn’t get into it for quite a while but eventually as I saw that there weren’t a lot of providers in the area and…

Alexandria Theordor: And it really is a very comprehensive course,…

Ashlyn Douglass-Barnes: there wasn’t a lot of providers who had lived experience.

Alexandria Theordor: I mean so for reference,…

Ashlyn Douglass-Barnes: So not necessary though,…

Alexandria Theordor: I purchase your course into and…

Ashlyn Douglass-Barnes: most people in the mental health side of this aren’t necessarily lived experience and…

Alexandria Theordor: took it a couple months ago. So it’s still relatively new Niche for me. But what I loved about…

Ashlyn Douglass-Barnes: that’s okay. But for me,…

Alexandria Theordor: how it really goes into all aspects not just…

Ashlyn Douglass-Barnes: I wanted to kind of be able to help other clients have a better experience.

Alexandria Theordor: what evaluation is but like you said the marketing like the highs and…

Ashlyn Douglass-Barnes: And then what I figured out is there’s no real training on this especially nuts and…

Alexandria Theordor: low Seasons the billing aspects and so it truly is a comprehensive course…

Ashlyn Douglass-Barnes: bolts. what is the letter need to look like?

Alexandria Theordor: where I felt ready to get up and…

Ashlyn Douglass-Barnes: What is the template look like? How would you do marketing?

Alexandria Theordor: go once it was done.

Ashlyn Douglass-Barnes: So there’s a little bit of information. Beyond the education surrounding Bariatrics, but not necessarily on how to do the actual evaluation. And so I created that several years ago and Have been doing that ever since.

Alexandria Theordor: No, and I think you achieve that now. I mean everybody has different experiences. I came from a very heavy medical background. So a lot of the things sounded familiar to me, but just in a different person but that being said, I mean are there what licenses are able to do this? Because I get that pretty quickly You’re an LCSW great.

Ashlyn Douglass-Barnes: That was my hope.

Alexandria Theordor: Can I as an LPC or a marriage and family therapist do this, too?

Ashlyn Douglass-Barnes: Yes.

00:05:00

Ashlyn Douglass-Barnes: Yeah, so the American Society of metabolic of bariatric surgery. So the asmbs which is our governing body. They recommend that it is someone with a terminal license. So we are at the end of the possible license. So we don’t necessarily want to associate level or registered interns is what we call them in Florida or students. So they recommend that you are a fully terminal license mental health providers,…

Alexandria Theordor: Gotcha. So…

Ashlyn Douglass-Barnes: so you could be any of the Master Level licenses.

Alexandria Theordor: if you’re putting a mental health diagnosis,…

Ashlyn Douglass-Barnes: Lmhc’s lmfts lpcs lcsws.

Alexandria Theordor: usually with some type of CPT code if you’re used to Private Practice billing, you’re probably in the clear for the most part sounds good.

Ashlyn Douglass-Barnes: All of those are appropriate as long as we can diagnose and…

Alexandria Theordor: Speaking of billing right this is something that’s covered by insurance or…

Ashlyn Douglass-Barnes: evaluate and so in Most states, there is one state. I think it’s Alabama…

Alexandria Theordor: is this strictly a private pay niche?

Ashlyn Douglass-Barnes: where social workers technically aren’t allowed to give diagnosis, but they get around that they call it something so we did get clarification from ASF. Yes that they are allowed to do that. Their state just has some really interesting language around diagnosis. I think it’s called a tentative. Diagnosis very strange for Alabama, but I did get clarification because I kind of posed that to them as well. And then also psychiatrists MDS. They are allowed to do these evaluations as well. But in the mental health world as long as you are terminally licensed you are allowed to complete these evaluations.

Ashlyn Douglass-Barnes: Yes, yes.

Ashlyn Douglass-Barnes: So this is an interesting question. So the majority of people will do these self-pay. and I go over the scripting of this in the training exactly how we explain to clients why this would be self-pay even if you accept Insurance because these evaluations are likely going to find that there is no mental health concerns and therefore we don’t have a diagnosis which means we don’t have available diagnosis for the evaluation. So most the majority of people do these self-pay if you would like to use insurance. It’s just your comfort level or are you find accessibility or you want to work on a higher volume? You may choose to use Insurance. There is no specialty code for this. So it’s just going to be your traditional intake most the clients would qualify for an adjustment disorder because something has changed within the last six months where they are now needing to consider bariatric surgery. So there’s usually a change as

Ashlyn Douglass-Barnes: Significant change in function or medical or even social psychosocial so maybe they’re Mobility is changed their medical situation has changed they’ve moved over from diabetic to diabetic and now they’re trying to figure out the best treatment for them and we used to have fo631 which is food disorder due to known physiological condition. I still use that quite a bit. So obesity would be the known physiological condition. There are a few insurances that don’t specifically like that code for whatever reason but to me that is one that really fits everyone because nobody’s coming to be that isn’t having experiencing some kind of symptom of a mood disorder usually depression or anxiety surrounding their change in medical condition. Where now they’re considering this surgery. So that’s an accurate one the floor Florida Medicaid for whatever reason we do have a specialty code for these in debt. We call them an in-depth evaluation. So there is actually a separation for these

Ashlyn Douglass-Barnes: In the Florida Medicaid handbook, so there may be a specialized assessment code in your Medicaid handbook and…

Alexandria Theordor: Yeah, that’s where I get a lot of questions from people can this be a completely private pay thing…

Ashlyn Douglass-Barnes: different states.

Alexandria Theordor: because maybe they’re planning on kind of going out of network,…

Ashlyn Douglass-Barnes: It’s pretty rare for someone to take Medicaid loan to these assessments though.

Alexandria Theordor: or maybe they already have a full-time job,…

Ashlyn Douglass-Barnes: That’s me. So I think that again the majority of the people that I’m therapists that I’m working for are working with rather are our coaching.

Alexandria Theordor: but want to do something psychic and don’t want to deal with insurance. So the second most popular question I get then is it’s like, how much do you charge? Yeah.

00:10:00

Ashlyn Douglass-Barnes: They’re going into self-pay and the majority even in my area are gonna be self-pay. If you do use insurance, we are allowed to charge documentation fee. So just FMLA long term disability. You are allowed to charge it for you to complete paperwork. And so I do about a $50 letter fee, but I’ve coached clients that have it. They’re more up in the hundred or seventy five. There’s a little more and usually what we do for that is we say it takes about a half an hour worth of my time to fill out the paperwork. And so if my hour is a 200 dollar hour then that 30 minutes, so that’s how we kind of backtrack the justification and most of the time clients are

Ashlyn Douglass-Barnes: Understanding of that and special once you explain where that’s not a random number. I normally charge two hundred dollars an hour. It takes me about 30 minutes. So that’s about a hundred dollars worth of my time and they’re like, okay that certainly makes sense. So you can go either way, especially if you’re in a state with pretty high Insurance payouts, it makes sense if you want to continue insurance, but again, if you don’t or you’re trying to get out of that maybe you’re doing more intense it more things outside of insurance and you want to add that that’s certainly doable as well.

Ashlyn Douglass-Barnes: Yes, and this one is so hard to and it’s funny and I will say in the training I say one thing and some of my opinion on this has changed. So in the training I will say call around figure out what you’re on your area tolerance is for this but I’d have to be honest. I think a lot of us are our mind set around this is really shifted. You got to charge what is worth your time and it may be helpful. So you don’t under charge to see what other people are charging. So I’m working with a coaching client right now. She’s out and the Denver area her area tolerance is far higher than mine is here in Orlando.

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: So when she looked around really she needed to be in the 400s versus where I am, which is in the 200s because in her area which she figured out is if she doesn’t charge enough then people may feel that she is not qualified or there’s something different or in a negative way and in her area. It’s a little

Ashlyn Douglass-Barnes: Affluent, so the tolerance there is a bit higher so you probably need to do a little research and so what other people are charging not necessarily to base yours completely off. I have someone in my directory who charges a thousand dollars for their evaluations. They do a full site neurocyte so you don’t necessarily need to do that. But I would say I certainly wouldn’t want you to charge $150 if they’re going rate is 250 and people are used to paying that now it may be a marketing thing…

Alexandria Theordor: Yeah, no, absolutely. And that’s I mean for reference for people watching.

Ashlyn Douglass-Barnes: where you’re a little under the market and that’s fine. But I want you to make that as a conscious dishes decision with information that you have.

Alexandria Theordor: I’m here in New Jersey and at this point I have one Insurance pal that I’m sure with this way.

Ashlyn Douglass-Barnes: So again that Network or…

Alexandria Theordor: It gives me a little bit of a safety net. Most people are out of network and…

Ashlyn Douglass-Barnes: that area tolerance as well as …

Alexandria Theordor: the rate that I’m charging that I looked off of basically research that I found was 550 for the complete evaluation.

Ashlyn Douglass-Barnes: what you’re willing to charge. So some of my coaching clients come to me and they say hey, I want to work out of volume. I want to do this full-time and so they may make a different decision than the client that are the therapist that wants to maybe do three to five of these a week and…

Alexandria Theordor: So that is one possibly two meetings if need be as well as the report writing and any kind of consultation coordination to care with the doctors outside of it.

Ashlyn Douglass-Barnes: so we can charge a little more because they’re okay if 10 people come in…

Alexandria Theordor: If you’re doing Insurance,…

Ashlyn Douglass-Barnes: if only three to five say,…

Alexandria Theordor: you might be billing for each session individually the report writing and…

Ashlyn Douglass-Barnes: okay, I think that that’s something to think about as well.

Alexandria Theordor: then maybe consultations if they’re extended ones usually if it’s 15 minutes or less. We just kind of throw it as a freebie, but that might give you an idea to Ballpark at least where you can be looking at. How long does it take to do the eval? I mean you said the writing part is about a half hour of your time. But can you give us an idea from start to finish with the client

Alexandria Theordor: look at

Ashlyn Douglass-Barnes: right

Ashlyn Douglass-Barnes: Sure.

Alexandria Theordor: mmm

Alexandria Theordor: man

00:15:00

Alexandria Theordor: doesn’t say you’ve been doing this for a while this is not like your third assessment here.

Ashlyn Douglass-Barnes: So you can do this in one of two ways. So some people like to do one and done. So again, if you’re more on a volume basis, this is what you want to do full-time. You’re just kind of stacking them usually one and done but also sometimes especially when I have coaching clients who are trying to separate out a little bit there and…

Alexandria Theordor: you want

Ashlyn Douglass-Barnes: maybe they’re gonna go through the insurance they’ll do it as two appointments. So they’ll do the biopsychosocial in the first and…

Alexandria Theordor: yeah.

Ashlyn Douglass-Barnes: then they’ll do the education series and the bariatric specific questions in the second appointment. And so again that gives them especially the payout is a little higher that may be closer to their self-pay rate or the rate that they want to get for the entire assessment. So I’ve gotten it where I’ve templated the letter into my EMR and I’ve actually gotten it down to about an hour in session and about 15 minutes doing the paperwork back when I was using more of that full letter. Where is it a Word document as having to double check to make sure all the names are everything was great it.

Alexandria Theordor: we want there. We want it all usually. Yeah. Yeah.

Ashlyn Douglass-Barnes: About an hour and a half part of the reason that I’ve been able one. I’ve done probably 1,000 of the literally. I should probably preface this with I’ve been doing this for a really long time and I probably literally done over a thousand at this point and overseeing probably at least a thousand more so that is one thing but I think in the beginning I would always give myself about 90 minutes with the clients and then as I’ve changed out my paperwork and this is one of the things too in the training you get all the paperwork and I specifically make it so that you’re asking the client every question that you need the answer to before they even come and it’s really important that they complete that paperwork prior to making the appointment so that way they are taking the time to answer all those questions and there’s quite a bit of questions to be answered but that way my paperwork and their paperwork follow other. So every question that they ask the answer on my side follows it and…

Alexandria Theordor: Red flag fail it’s red flag. Okay, let’s talk about it.

Ashlyn Douglass-Barnes: was very

Alexandria Theordor: That’s okay. Yeah.

Alexandria Theordor: That’s a scary thing.

Ashlyn Douglass-Barnes: I did that on purpose so that I could and…

Alexandria Theordor: Yeah, yeah.

Ashlyn Douglass-Barnes: it makes it faster so I don’t want to have to move around and where’s this question? And where is that question it follows it. So a lot of what we’re doing and sometimes getting faster is also figuring out how much to ask and how much now to ask. So these assessments. We have to think of a little differently they are not therapy. So I don’t need the depth of answer that I do in a therapy session. I need the depth of the answer to answer the question on the assessment. And so sometimes for non psychologists. This is a little more challenging because we weren’t really taught the difference in.

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: Yeah. Yeah, we we want your child tell me all the details of your child. I’m just looking over arching. Did you have a safe childhood? Generally your needs were met versus the nitty-gritty so in the beginning I probably got way too much information as I was trying to kind of get into the group of these and also,

Ashlyn Douglass-Barnes: Some of these two are just getting used to helping the client also answer in the way that you need them to so, I don’t necessarily ask every question again. I definitely don’t ask every question again.

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: I’m mainly asking clarifying questions. So I’m going through and it’s interesting because I don’t do a ton of this in normal therapy, but for these evals I run concurrent with my documentation. So I have their answers up and my documentation up and I’m doing it at the same time that I’m talking to him. And I have a touch screen which makes things really easy because I’m literally and…

00:20:00

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: all of the forms that I’ve input it into my system that I give you in the training our checkboxes and there’s only a few that I actually need to type things in so that makes that a lot faster and more efficient but I still want to have very thorough and really good evaluations. I just want the documentation part on my end to be faster and more efficient because the majority of the time it will get into why this is probably and another question, but I want to spend the majority of my time on education versus getting all the details of their life…

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: because at the end of the day that doesn’t necessarily impact outcomes their knowledge about when to come back and what is expected them dictates outcomes and we found that kind of over and over again in research, so Yeah.

Ashlyn Douglass-Barnes: Yes.

Ashlyn Douglass-Barnes: Correct.

Ashlyn Douglass-Barnes: Yeah. This is probably the biggest misnomer about these evaluations and the liability of these evaluations. So we are not saying that anyone is appropriate or unappropriate for surgery itself. That is a medical question for medical providers to answer so we are not saying this client is a good candidate for surgery. So sometimes therapists will ask me. I have my clients in coaching our therapist. I keep saying client and they’ll say what if the client dies on the table? Are they going to come back and sue me?

Ashlyn Douglass-Barnes: It is especially if you watch 600 pound lot, you’re exposure to bariatric surgery is probably not a lot. So you probably are not aware that the majority of the patients that are having bariatric surgery are not who’s on 600 pound life. They’re usually around a hundred pounds overweight with some medical complications, but not to the impact of what that show would indicate. So the answer to that is that we never said that they were good for surgery. Anyways, we were just saying they have the ability to give informed consent. So our job is to ensure that they don’t have significant significance neurological conditions that impact their ability to make decisions for themselves and that if they have maybe something that does impact neurologically maybe autism or a neurodevelopment disorder that they have support and those people are going to be able to help them to make those decisions. and again I go into really my nudes details in the training.

Ashlyn Douglass-Barnes: if you see this, this is what you ask but it is.

Ashlyn Douglass-Barnes: We’re not suggesting that anyone is good or bad for surgery. We’re not saying you are the perfect candidate or…

Alexandria Theordor: Yeah, and I mean you’ve said a couple points that I really want to highlight is with the education piece.

Ashlyn Douglass-Barnes: you need to do all these things in general.

Alexandria Theordor: The smoking thing came up in your session…

Ashlyn Douglass-Barnes: We may give recommendations.

Alexandria Theordor: but not and…

Ashlyn Douglass-Barnes: We may say hey,…

Alexandria Theordor: in the surgeon session and your course is a really beautiful job of giving you the psycho educational material.

Ashlyn Douglass-Barnes: it sounds like you’ve got a little bit of something mental health Brewing. This is how you get into services or…

Alexandria Theordor: So first question that came up in my mind was like …

Ashlyn Douglass-Barnes: this is what you may see that you may want to seek out Services.

Alexandria Theordor: why does soak smoking manner in mental health yeah,…

Ashlyn Douglass-Barnes: It’s not very often that we’re requiring…

Alexandria Theordor: we know we shouldn’t smoke but there are some serious complications that could happen…

Ashlyn Douglass-Barnes: unless it’s life threatening substance abuse Eating Disorders severe mental health and…

Alexandria Theordor: if you smoke post surgery but you outline that beautifully so even if you know nothing about this population,…

Ashlyn Douglass-Barnes: even with severe mental…

Alexandria Theordor: I mean rather you sold to do your due diligence research.

Ashlyn Douglass-Barnes: which does come up when people are bed bound or…

Alexandria Theordor: I wouldn’t just take this course to be done with it,…

Ashlyn Douglass-Barnes: not able to make decisions for themselves.

Alexandria Theordor: but it gives you a strong foundation.

Ashlyn Douglass-Barnes: We still may have instances…

Alexandria Theordor: So you understand and…

Ashlyn Douglass-Barnes: where that may be true…

Alexandria Theordor: then can follow up and…

Ashlyn Douglass-Barnes: but delaying surgery may actually cause their own death and…

Alexandria Theordor: learn more about why and that’s really important.

Ashlyn Douglass-Barnes: so those are situations and…

Alexandria Theordor: And another thing that I want to kind of throw out for people…

Ashlyn Douglass-Barnes: again, I’ll get into the training that we would reach out like we would know…

Alexandria Theordor: who are thinking about the course and…

Ashlyn Douglass-Barnes: what we see but we reach out to the surgeon to…

Alexandria Theordor: this population is you’re working very closely with these surgeons now some people and…

Ashlyn Douglass-Barnes: Hey if I delay this client,…

Alexandria Theordor: correct me…

Ashlyn Douglass-Barnes: is there a potential they could die and…

00:25:00

Alexandria Theordor: if I’m wrong. It might just be a port out and…

Ashlyn Douglass-Barnes: if the answer is yes, and there’s no point in delaying them…

Alexandria Theordor: you never talk to them again about others you’re talking to this situation.

Ashlyn Douglass-Barnes: because they won’t be able the

Alexandria Theordor: So it’s a little different than our standard therapy.

Alexandria Theordor: Where everything is kind of behind the closed doors and you talk to people on occasion there’s much more open dialogue and making sure that informed consent is very clear up front.

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: We could so those cases we’re going to work a little they’re very rare and then my entire career I’ve had two where the client probably was suicidal and pretty significantly mental health was impaired but it was because their current situation because of their weight they’re at bed bound. And so what kind of life could they lead and their fear is if they didn’t get the surgery in both cases, their health was so declined that they could die and their surgeon had made them aware of that. That would probably make me pretty that my life got into a point of unmanageability on my own so

Ashlyn Douglass-Barnes: In those cases, but the liability on these are relatively low there is a whole team of people that have to also sign off there’s nutritionists. There’s the cardiologist there’s all sorts of people. So as this is America you could be sued at any time for any reason and could you potentially be sued if client ID. I’ve never been sued for any reason good better and different either delaying delaying or a client passing away which we have had because that is also the outcome of obesity. Sometimes that conditions do deteriorate to the point where it can cause someone in their life. So that is a part of this Niche but it is very rare. And like I said, I’ve never been sued even though I’ve been in some situations more likely than anything the main person in the suit is going to be the surgeon itself or the hospital system because that’s where the money is but I don’t really view these I understand why people do have

Ashlyn Douglass-Barnes: certain liability, but I don’t view these as a high liability because there’s a large team of people that have to make decisions after so I really think of this too is giving the surgeon heads up so that they can make good decisions. So we had a client recently that Told us that they were smoking but they had told the surgeon they weren’t smoking.

Ashlyn Douglass-Barnes: So we’re gonna disclose that so I can’t stop them from moving forward for smoking but I notated that they were smoking and I actually personally reached out to the surgeon.

Alexandria Theordor: So that’s a big piece of this is the marketing and…

Ashlyn Douglass-Barnes: It is one that I know and I think would have been very understanding of the situation and…

Alexandria Theordor: it’s a question. I get asked frequently. can I just write a college degree profile? Throw it up and…

Ashlyn Douglass-Barnes: might have changed…

Alexandria Theordor: be done with that. What are your thoughts?

Ashlyn Douglass-Barnes: how she was going through approach the situation knowing that the client was in fear that she would find out and be very upset with her. And so the surgeon said here’s what we’re gonna do. She’s like, I’ll run the nicotine test. So there’s a test that they normally do for nicotine. She’ I’ll go ahead and have them fail out and then the client and I will sit down and have a discussion about how we’re gonna move forward. I’m not gonna discharge them. I’m not gonna leave him hanging. I have a plan for what I do in these situations. I wish that she came forward to me and let me know so I could help her first going this route. But again the surgeon needs to make those decisions. It’s not for us but I will give that information to the surgeon. So the surgeon can have those conversations and hey this

Ashlyn Douglass-Barnes: And we’re gonna educate them of course of why we don’t recommend smoking as it can lead to ulcers and cause pretty serious medical complications and that’s why the surgeon is so concerned about you smoking. It’s not that they think you, are a bad person for smoking or anything like that. It’s a medical issue. So I think to part of our job in the liability Factor too that kind of liability shares is we’re sharing information with the surgeon for the surgeon to make the decision. I’m not necessarily for us to

00:30:00

Alexandria Theordor: It’s a nice breaker. It’s an icebreaker. I mean, I have an appointment tomorrow with somebody that I actually just got off the phone with before this call and we have a little breakfast date so to speak. we’re gonna kind of meet face to face formally for the first time. I’m gonna bring something to eat something for her to share with me and we’re just gonna chat again. It’s not meant to bribe her in any way so there’s something to do with her hands. So it’s not this awkwardness just kind of sitting next week so that’s…

Ashlyn Douglass-Barnes: yeah.

Alexandria Theordor: where I think of it.

Ashlyn Douglass-Barnes: Yeah.

Ashlyn Douglass-Barnes: Yeah.

Ashlyn Douglass-Barnes: Yeah, so you always want to have that signed before you ever talk to them…

Alexandria Theordor: Exactly the training and what’s the return on investment and…

Ashlyn Douglass-Barnes: because again like Yeah.

Alexandria Theordor: it might be really hard to answer specifically.

Ashlyn Douglass-Barnes: other forms of immigration assessments DCF of So for your price point it would take one eval…

Alexandria Theordor: Everyone said

Ashlyn Douglass-Barnes: that they may but that’s good.

Ashlyn Douglass-Barnes: 

Alexandria Theordor: Mm- Yeah. Yeah.

Ashlyn Douglass-Barnes: may disclose something to you that you need to disclose It kind of depends on…

Ashlyn Douglass-Barnes: disclose to the surgeon and what you’re charging. But I always tell people to you just need one surgeon if you just have one so I have 12 but I also have a group practice where this is almost all what we do we have availability for 40 spots a week, it’s a full time. then they may be upset with you because you disclosed it but it’s like that is my job the entire point of this is that everything gets disclosed. Usually what I do too. if the client says that I lied about something this is come up twice so…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: You can do this full-time.

Ashlyn Douglass-Barnes: so our Yes,…

Ashlyn Douglass-Barnes: our client that smoked I had yeah.

Alexandria Theordor: If someone wanted to it doesn’t have to be a side gig like you can make your home.

Ashlyn Douglass-Barnes: had a provider who is really strict. You can’t smoke for a year. You said you smoked and she said no. No, it’s a misunderstanding. So the client filled out that form and said I have smoked so they gave me all the information so I don’t normally disclose the client facing paperwork what they fill out but on the bottom of that form it says that if the information is Correct.

Ashlyn Douglass-Barnes: 

Ashlyn Douglass-Barnes: Not detested if it is contested. I will disclose this information if need be and so that client had said I’d lied the provider reached out to me and said hi. The client said that she didn’t tell you that and I said, that’s interesting. Let me look the paperwork. I said, okay, I’m gonna send you the paperwork that she signed and filled out and you can do with that as you please but sometimes that does come up and a little bit of backtracking. I probably shouldn’t have told you that and it’s we need to disclose it. But again in the training I go over to how do we word this so that they best understand this is in their best interest. There’s a reason that we do like the smoking in particular that one can get kind of contested.

Ashlyn Douglass-Barnes: Yes, you could especially if you have some busy surgeons.

Alexandria Theordor: Mm-hmm

Ashlyn Douglass-Barnes: But especially…

Ashlyn Douglass-Barnes: If you smoke post surgery you can have ulcers…

Ashlyn Douglass-Barnes: if you’re in an office that maybe has multiple people that they refer to…

Ashlyn Douglass-Barnes: if you have ulcers they can bleed Bariatrics lend themselves to anemia already.

Ashlyn Douglass-Barnes: but if you have one good surgeon, you can get this up and running literally overnight…

Ashlyn Douglass-Barnes: If you have a bleeding also that can irritate anemia or…

Ashlyn Douglass-Barnes: because your surgeon will be the one…

Ashlyn Douglass-Barnes: make anemia worse…

Ashlyn Douglass-Barnes: who literally the next day will have people new clients coming in and…

Alexandria Theordor: that’s nice. Yeah.

Ashlyn Douglass-Barnes: if you have untreated anemia and you need a blood transfusion, you don’t get one you could die.

Ashlyn Douglass-Barnes: you may want to ask them to when you’re going in …

Ashlyn Douglass-Barnes: So that is really…

Ashlyn Douglass-Barnes: if they have an intake day so I know I had the first surgery I ever worked with his intake days are Mondays and…

Ashlyn Douglass-Barnes: why in particular.

Alexandria Theordor: mmm

Ashlyn Douglass-Barnes: Thursdays and so I knew on Mondays and Thursdays that’s where my emails would come in. So I always had space to make my phone calls and get everybody situated on that same while anticipation was high. They met with the surgeon.

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: They’re really excited. I’m one of their next steps. So I knew when those referrals came out a lot of Surgeons don’t necessarily have it intake day or they don’t set themselves up that way that’s just the way he did it, but then I could kind of but again knowing that information being able to kind of meet clients that way occasionally sometimes a surgeon Yes smoking that’s such an important one to educate around because though there are types of surgery that the search so the one surgeon that had talked to me. She said what we’re probably gonna do is I’m going to offer her as sleeve instead of bypass because sleeve has less likelihood for ulcers and if she’s going to smoke again in the future, I can at least help her protect herself a little bit And way back in the day. I used to be in the office on intake day. So they would just meet me and he had intakes I think it’s like Thursday afternoons or something and I’ll just hang out they would meet me make their next appointment. That was just something you like to do.

Ashlyn Douglass-Barnes: 

Ashlyn Douglass-Barnes: 

Ashlyn Douglass-Barnes: Yeah, and I was really close by so I was literally around the corner.

Ashlyn Douglass-Barnes: if she goes back so her rule is one year.

Ashlyn Douglass-Barnes: So I would do admin work in a back office and…

Ashlyn Douglass-Barnes: And again, this is surgeon to surgeon.

Ashlyn Douglass-Barnes: then pop in and…

Ashlyn Douglass-Barnes: This is not of a statement her role is one year.

Ashlyn Douglass-Barnes: and get everyone scheduled as a part of there.

Ashlyn Douglass-Barnes: No smoking and

Ashlyn Douglass-Barnes: This is a while ago before I was as busy as I am now,…

Ashlyn Douglass-Barnes: then you have your choice of all types of bariatric surgery,

Ashlyn Douglass-Barnes: but that worked really well for me…

Ashlyn Douglass-Barnes: but in her world that if you have smoked within last year she wants you only do gastric sleep so different and

Ashlyn Douglass-Barnes: because that way one I had dedicated time gets mad men work done and we just made those appointments all at the same time.

Alexandria Theordor: I know you’re talking a lot about the practice being busy,…

Ashlyn Douglass-Barnes: again, we aren’t making those decisions. We’re letting the surgeon…

Alexandria Theordor: which is fantastic.

Ashlyn Douglass-Barnes: So that way it was easy for them to follow through…

Ashlyn Douglass-Barnes: but that information allows them.

Alexandria Theordor: Do you have any thoughts on…

Ashlyn Douglass-Barnes: I will say to

Alexandria Theordor: if someone just want to do this as a side gig listen,…

Ashlyn Douglass-Barnes: but you can get creative again a lot of the surgeons.

Alexandria Theordor: if I can get four or five extra sessions a month to kind of pay off a car payment,…

Ashlyn Douglass-Barnes: They’re trying to save money. They used to have an internal evaluator.

Alexandria Theordor: that would be great in my book. is that even possible or…

Ashlyn Douglass-Barnes: They no longer do so.

Alexandria Theordor: they send themselves up for failure to just too much?

Ashlyn Douglass-Barnes: They’re looking for those resources. They mean we talk a lot about guessing their nose. Can you turn them around faster? And is your price different? So whatever the issue is that they maybe having with their current evaluator, how can you work around that so especially during the busy season? Sometimes people will get six weeks backed up on appointments. Around and if you can get them in within a week and turn around their paperwork within 48 hours or by the following Monday, whatever you set up for yourself that may be a marketing piece too and how you kind of guess their nose. And those are some of those things you can think about before you go into meet them. So that way you can kind of answer some of those questions more confidently. You may also in this Niche not be talking directly to the surgeon. You may be talking to their Patient Advocate their nurse their front desk. I’ve one office. It’s his wife. She kind of runs everything that’s not surgery. So like her and…

00:35:00

Ashlyn Douglass-Barnes: 

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: I are the ones talking. It’s a very small office or I have other ones. They have Hospital systems that have So my communication is through the patient advocate if I need to flag something for the surgeon.

Alexandria Theordor: Which is funny…

Ashlyn Douglass-Barnes: I have to flag it with the patient advocate first and…

Alexandria Theordor: because I prefer the one and done like I came…

Ashlyn Douglass-Barnes: then I can you Yeah, no.

Alexandria Theordor: where I was feeling burned out from therapy.

Ashlyn Douglass-Barnes: do our next step and No, you definitely definitely…

Alexandria Theordor: I almost thought about leaving completely and…

Ashlyn Douglass-Barnes: and if you’re wanting less again, then the advocate…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: then I found your Niche and…

Ashlyn Douglass-Barnes: I would price yourself that way advocate will report to the surgeon…

Alexandria Theordor: I was like, this is an opportunity to still keep my clinical skills sharp,…

Ashlyn Douglass-Barnes: but yeah, I might just find one office the surgeon will either report back to them or report directly to me…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: but not have to be in therapy for three years with the same person.

Ashlyn Douglass-Barnes: gonna provide you referrals and if you feel like you’re getting overwhelmed you may want to find someone else that you can also refer or to talk to the surgeon about specifically what type of ones you want. So I have one coaching client if they want. So each office may have it set up a little differently, but this is definitely something where we have a bit more communication with the referral source, and I know you’re gonna ask me the surgeon…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: Okay.

Ashlyn Douglass-Barnes: who really only likes doing evals on people who want ongoing therapy and so her and the surgeon kind of have an understanding that someone who’s interested who’s really looking for that long-term care support. Those are the referrals for her and not the one and surgeon is the referral source. So we want to make sure that we are Community openly with them.

Ashlyn Douglass-Barnes: 

Alexandria Theordor: right Yeah.

Ashlyn Douglass-Barnes: does kind of the opposite of some people but she has that kind of communication with the patient advocate and surgeon and so those are the ones she really likes to take on because she likes having long lasting relationships with clients versus the one and done model which is totally fine. So,

Ashlyn Douglass-Barnes: right most people

Ashlyn Douglass-Barnes: Okay.

Ashlyn Douglass-Barnes: 

Alexandria Theordor: Yeah. …

Ashlyn Douglass-Barnes: So the biggest thing with this which I love is that your referral source And actually that’s part of…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: if for my peeps who are maybe going on maternity leave and…

Ashlyn Douglass-Barnes: source is not the general public how the training came to be as well during the pandemic. because that is like…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: want to spend time at home with baby and…

Ashlyn Douglass-Barnes: I had a needle and…

Ashlyn Douglass-Barnes: a friend of mine who had reached out. a haystack. Your referral…

Alexandria Theordor: but want to do something clinical…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: but not full practice.

Ashlyn Douglass-Barnes: I’m out I can’t do this anymore. referral source is the surgeons they are the holder…

Alexandria Theordor: That’s as an option for somebody…

Ashlyn Douglass-Barnes: I don’t know holder of all…

Ashlyn Douglass-Barnes: all make some money.

Ashlyn Douglass-Barnes: all the field. You just need a break and this is a way you can still make money while on that break. And again, maybe you never do it again, or maybe you find It’s interesting for her. She found this relation. She really loved Ed. So she’s like no I’m gonna keep doing it, but it was a way for her to step out almost have a sabbatical but still have a step in and I like to show up with some food tends to feel a little better. We even had us talking to a coaching client. Why don’t we throw a $5 gift card for Starbucks in there? And then we can have virtual coffee you bought them coffee. They may be a little more likely to call.

Alexandria Theordor: who maybe has a Yeah.

Ashlyn Douglass-Barnes: what she’s like. I’m just gonna go travel the world and I said, what if you just did a couple evals one day a week because she was gonna be in South America. I said you 250 four week doing one day where you have stable Internet. It’s a thousand dollars a week for you to travel around and then when you come back never do one again, all the appropriate clients. So yes for some legitimacy having website having a psychology today making sure you talk about Bariatrics because there are people gonna do due diligence and Google you and see if they can see if you know anything about Bariatrics but in general because so few people do these evaluations the surgeon will send them directly to you. And so your marketing and again we talk about this in this training is you probably want to go out to the surgeons introduce yourself send the letter. But get unburnt out and please come back to the field because she actually had a different Niche that was really needed and I’m like no. No we still need you in the…

Ashlyn Douglass-Barnes: 

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: 

Alexandria Theordor: So you could really make this your own depending on…

Alexandria Theordor: what your lifestyle is, which is what I’m all about. It is a life first and then a business that works around it versus the other way around. I want to be respectful because we’re getting close to I believe you have a session after this so I don’t want to hold you much longer.

Ashlyn Douglass-Barnes: Yes, especially because our clients are really expecting daytime hours on this most clients are not expecting you to do nights and…

Alexandria Theordor: Do you have any other final thoughts before we wrap up and…

Ashlyn Douglass-Barnes: weekends. They are expecting you’re gonna be like every other medical provider.

Alexandria Theordor: then I’m also going to talk about before we close a little gift that you brought for everybody today.

Ashlyn Douglass-Barnes: They’re calling. So if only during the day when the kids are at school or you have your partner or someone who’s helping you comes at a certain time. You can really make these times work but also on the flip side, it’s a marketing if you are nice weekend. So your stay at home. Mom partner comes home and you could offer these nights the weekends and we have some weekend hours and nights and people are always like, I can come in on a Saturday. I have so many appointments already. That would be great. So it’s interesting because the expectation is not nice and weekends, but they’re very appreciative and can be a marketing aspect for nights and weekends. Because you added a $5 gift card, there may be a little more pull to say I’d like to talk to you now. We aren’t buying referrals. We never ever give money for referrals. We never give gifts based off referrals, but sometimes that may start the conversation or when I bring food. I put a little card on the food so that way every time someone open. They’re like who brought us food bariatric surgeons. Don’t get a lot of visitors. So every time they open it. They’ll see my card. Ashlyn came by dropped off some information. what does she do? She does our evals? okay. that’s good. so I don’t feel there’s any Yeah. Yeah. Yeah.

Ashlyn Douglass-Barnes: 

Ashlyn Douglass-Barnes: Okay.

Ashlyn Douglass-Barnes: Yes. Yes, so I would say. right

Ashlyn Douglass-Barnes: 

Ashlyn Douglass-Barnes: The only therapists that are maybe not a good fit for this Edge is…

Ashlyn Douglass-Barnes: right

Ashlyn Douglass-Barnes: if you have a true bias towards those that are in larger bodies and so you probably do need to have a conversation with yourself. If you truly believe that the only reason that people are in larger bodies is because they lack willpower or they just need to eat less and exercise more. This may not be the group for you and the underlying cause of obesity is not lack of willpower. There’s a metabolic condition I go over this in the training as well to a better help people. Maybe you’ve never been in large bodies understand.

Ashlyn Douglass-Barnes: And sometimes to I’ll do a lunch and…

Ashlyn Douglass-Barnes: There’s a metabolic condition that causes most obesity and…

00:40:00

Ashlyn Douglass-Barnes: learn so I’ll ask them if there’s a topic so suicide assessment…

Ashlyn Douglass-Barnes: actually us do with your pancreas and…

Ashlyn Douglass-Barnes: how to know when to refer for post-op…

Ashlyn Douglass-Barnes: your insulin and it’s not talked about a lot. It’s why all the fancy glp1 medications seem like a miracle drug…

Ashlyn Douglass-Barnes: how to go about finding therapists and know anything about marriage. So I’ll do a little lunch and…

Ashlyn Douglass-Barnes: because they’re actually treating the underlying cause of obesity.

Ashlyn Douglass-Barnes: learn and I will bring in lunch. I’ll ask them sometimes I’ll just say,…

Ashlyn Douglass-Barnes: So I would say other than that,…

Ashlyn Douglass-Barnes: where does everyone wants to be like PF Chang’s I’m like,…

Ashlyn Douglass-Barnes: this is really a good Niche. It doesn’t matter…

Ashlyn Douglass-Barnes: all right. Tell me…

Ashlyn Douglass-Barnes: what you yourself look like the clients themselves tend to be very understanding. what you want just ordered off the lunch menu I go pick it up and then I do my education series. And again, that’s not a return for referrals or any is just education and we do that in quite a few They’re not looking to you to be the perfect example of Bariatrics. They don’t expect you to have lived experience. If you do it’s great. If you don’t they’re bariatric surgeon likely is not a bariatric surgery. They know a lot about it. So those that isn’t it but I really recommend that.

Ashlyn Douglass-Barnes: 

Ashlyn Douglass-Barnes: Giving this a shot the clients as a whole are highly motivated. They need you to move forward. So they’re highly motivated to see you to accommodate to do what they need to do to get this completed. They are a group that probably has a little more people pleasing and perfectionistic behavior, which it’s kind of helpful for us. Sometimes we have to kind of cut through some of that but I do think that this is a really wonderful Niche it literally is my Niche and I’m also working on a training for intensives that are not as intense. So if you’re someone who is maybe thinking about I could do pre-opt intensives. I’m working on a training for that. Especially it’s more of a psycho educational intensive versus like a trauma or a very intense intensive.

Alexandria Theordor: To reach out to me.

Ashlyn Douglass-Barnes: And so that maybe also something especially you’re trying to kind of get out of that hour to our Therapy model that’s something else…

Alexandria Theordor: I’ll link mine as well about my experience with this and Ashlyn was very generous enough to give us a gift. So there is a $25 discount for anyone who uses the coupon code stress less. I will write it down below that that is again a gift from her to us to give this course a shot and…

Ashlyn Douglass-Barnes: but same population again, you already have your referral so you’re doing all the stuff you already have to do and that can just be something else that you add but it is a wonderful Niche to work with and…

Alexandria Theordor: to test it and I can say personal experience.

Ashlyn Douglass-Barnes: a very much needed.

Alexandria Theordor: I was blown away with the amount of information in there.

Ashlyn Douglass-Barnes: There aren’t a ton of us. It’s pretty evident when people call me and…

Alexandria Theordor: And this is my new Niche.

Ashlyn Douglass-Barnes: they’re like, you’re the 30th therapist.

Alexandria Theordor: Thank you Ashlyn so much for coming and…

Ashlyn Douglass-Barnes: I’ve called and no one knows how to do these emails or…

Alexandria Theordor: I can’t wait to hear…

Ashlyn Douglass-Barnes: I’ve had three done and…

Alexandria Theordor: what people say when they watch this video a lot.

Ashlyn Douglass-Barnes: they’re all incorrect. that definitely definitely is there.

Alexandria Theordor: Yeah.

Ashlyn Douglass-Barnes: Yes, and also if they want to sign up for the newsletter, I do send out a Weekly Newsletter and that also includes the I do free case consultation once a month we do case consultation though lately. It’s been mostly business consultation, which is totally fine. That’s free. It’s the second Friday of every month at noon Eastern so that will literally be tomorrow when we recorded this.

Alexandria Theordor: I mean the fact that you get a course and…

Ashlyn Douglass-Barnes: So that is something come catch me next month,…

Alexandria Theordor: a consultation Community all in one purchase is fantastic because when I bought it,…

Ashlyn Douglass-Barnes: but in that newsletter,…

Alexandria Theordor: I knew I was getting a course.

Ashlyn Douglass-Barnes: I always let you know it’s valuable information.

Alexandria Theordor: I was not expecting the consultation which was a huge bonus surprise.

Ashlyn Douglass-Barnes: So right now we have a little bit of a slow season so last month and…

Alexandria Theordor: And I’m glad you brought up. I didn’t want to call it out in case I was supposed to be the surprise at the end of…

Ashlyn Douglass-Barnes: this month we’ve been like what do you do during the slow season to get ready for the busy season…

Alexandria Theordor: But yeah now it’s worth it just for the consultation…

Ashlyn Douglass-Barnes: which will start here shortly.

Alexandria Theordor: because supervision.

Ashlyn Douglass-Barnes: And so I also give you valuable information and…

Alexandria Theordor: I mean that’s easily a hundred bucks a week right there. so I’m gonna let you run cuz I know you have an eval.

Ashlyn Douglass-Barnes: newsletter but as well as any kind of trainings that I have coming up or…

Alexandria Theordor: Thank you so much for spending time with me today and…

Ashlyn Douglass-Barnes: events anything else that I may be working on…

Alexandria Theordor: getting these questions answered. I know people are going to be thrilled to get kind of formal answers to these questions that have been buzzing up my inbox for the past two weeks.

Ashlyn Douglass-Barnes: how to get into coaching or one-time case consultation. I do that too. Sometimes people just want to do A one hour about their business or one hour about cases or marketing. I’m more than happy to do that as well.

Alexandria Theordor: Here, bye-bye. ya.

Ashlyn Douglass-Barnes: And that’s all on my website. You can literally do it all from my website.

Alexandria Theordor: There we go. It’s all done.

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