New free Zoom group for LGBTQ young adults 18-24

I am posting to promote this specific group as it currently has no waitlist.

I also still have several low-cost/sliding scale groups for LGBTQ youth 6-18, though these tend to have waitlists, but please do e-mail me if interested. 

weekly Zoom group for LGBTQ young adults 

ages 18-24

open to folks located anywhere

completely free of charge always

Thursdays 5pm Eastern U.S. time

erika @ erikashira . com if interested

This is not a therapy group, so it is open to folks located anywhere. Group members tend to be neurodivergent, a lot of former homeschoolers or people who otherwise didn't really click with school. We mostly free chat about whatever the group wants, whether that's queer topics, personal updates, hobbies, current events, questions about adulting, or really anything else. Members can bring photos/videos/etc. to share as well, whether their own creations or just things they enjoyed and thought others might like. When people are interested, we sometimes play games (always free-to-play online games that don't require any particular hardware or software, like Garticphone or Jackbox). 

We are completely flexible as to participation with camera/mic on or off, chat box only, or switching it up depending on comfort level.

Now taking private insurance for short-term evaluation and consultation for children, adults, and families

I am now taking most Massachusetts private insurance in order to provide more people with affordable access to care. I am unfortunately having a difficult time taking MassHealth as a solo clinician, but I will keep trying. 

More about types of services I provide and my general philosophies can be found here.

I am particularly prioritizing brief short-term work with individuals and families who are finding themselves on someone's radar and needing to connect with services quickly in order to receive an initial evaluation and recommendations for pursuing further services (or assurance that nothing formal is needed at this time). I can provide brief developmental and psychological assessment of infants and children of all ages with and without disabilities, brief diagnostic and clinical assessment for adults with and without disabilities, and other related types of brief assessment and recommendations. I also specialize in working with adults, particularly parents, who may have undiagnosed neurodivergence and may be facing misdiagnosis or misconceptions as to the reasons they present as "a bit different" and are in need of an affirming evaluation. My evaluations are disability-positive, neurodiversity-affirming, and respectful of family culture including subcultural affinities. 

I also offer flexible consultation models for children and adults with disabilities who have no pressing clinical concerns, but find themselves needing an established connection with a clinician for verification of disability status or other systems-related reasons. I believe that most people who have had psychiatric or neurodevelopmental disabilities all of their lives do not need treatment, but I also understand that the medical model believes that disabled folks "are followed by someone for that" and I am happy to be that someone. 

Similarly, I offer flexible consultation/training models for children for whom frequent talk therapy is not the best model due to trauma, neurodivergence, culture, or some combination, and who may do better with a model in which the clinician teaches the family and familiar providers to support the youth more indirectly. 

I understand that when working with systems, time is often of the essence in terms of establishing an initial connection with a provider and having someone on record. I make it a point to see folks for an initial appointment usually within the week, though subsequent meetings, collateral contacts if appropriate, and written evaluations unfortunately always take some time. My main goal is to prevent families from being referred to crisis services in the absence of an actual emergency and/or reported to DCF "to make sure services are in place" absent concerns of actual abuse or neglect, as these types of contacts are traumatic and an unnecessary use of services that should be reserved for emergencies. 

photo I took of a red maple leaf on rocky pavement

Accepting most Massachusetts private insurance for gender-affirming care letters

More info here.

I am currently accepting Aetna, Cigna, Carelon, and soon will be accepting most of the other private insurance plans, except for BCBS unfortunately.

I will typically write a gender-affirming care letter in 1-2 sessions. I believe in personal autonomy and client-directed care. I may require documentation or collateral consults in a few instances, but there is very little about someone's presentation or history that I would consider a barrier to a grown adult pursuing care that has been shown to improve quality of life and stability in almost all instances. I am very familiar with the diverse presentation of autistic and other neurodivergent adults and make it a point to be sensitive and educate myself about clients' ethnicities, religions, and other cultural aspects when performing assessments. 

Naming and shaming: Mental health companies using obnoxious spammy recruiters

Like an increasing number of us, I have added to my LinkedIn profile that I do not wish to hear from recruiters. For years, I have had in my "about" section that I do not provide ongoing therapy and do not wish to hear from recruiters regarding therapy jobs. I do also of course explain what types of services I do provide, and that I am happy to discuss sliding scales and creative solutions for those who, you know, actually have some idea what I do and are looking for something in that ballpark.

The recruiters don't actually read the profiles though, despite sending messages stating they are extremely impressed with my profile and thought I would be a good fit. 

Since the "about" section text wasn't working to get them to stop, I moved my message to recruiters to the headline: 

Image: My LinkedIn profile, showing a white middle-aged person with pink hair. Text reads Erika Shira (Ask me my pronouns) LMHC, MT-BC. Not interested in hearing from recruiters about services I do not provide. Messages from individuals or businesses who ignore boundaries will be reposted publicly.

They kept messaging, so I added "messages from individuals or businesses who ignore boundaries will be reposted publicly" and now will be doing so. I certainly would not want to seek mental health care nor employment with a company that doesn't know how to treat humans like humans, so I will be calling them out when I see them. Honestly, doesn't it seem like basic human decency to browse someone's social media or public online presence a little bit before contacting them? I make it a habit to always do this when messaging people with whom I do not have regular contact; more than once, I have seen that someone I was considering messaging has posted about a loss in the family or something similar that is occupying their mind. I've been grateful to see this so I knew not to message them some annoying question, but rather to send them a message of support if we have that sort of relationship and to leave them in peace if we do not. Some of these recruiters apparently don't even read people's headlines before spamming them, and may be using bots.

Here's one I got recently:

LinkedIn message from Ali Turin, asking me to apply for a job at Charlie Health

Ali Turin, a Senior Clinical Talent Acquisition Specialist at Charlie Health, messaged me with a job listing. The message reads, in part, "Our Creative Arts Programming Leadership flagged your profile as a great fit for Charlie Health..." 

How? They saw the headline that says I don't provide therapy and don't wish to hear from recruiters, yet thought they'd try anyway? Interesting. 

LinkedIn message with my response, which is in the text below

I replied, stating "Is there a reason you are ignoring where my profile clearly states I do not provide therapy and not to contact me with such offers?" I did not receive any reply.

I did, however, receive not one but two e-mails from Ali Turin of Charlie Health, apparently just wanting to make sure I was not interested in working for such a ridiculous organization:

E-mail from Ali Turin, which I detail below

The e-mail reads, "Hey Erika, I hope you're well! I just shot you a note on LinkedIn but also wanted to follow up via email in case you don't check your LinkedIn often," then proceeds to discuss the job listing and has a Calendly link to schedule a 30-minute chat in case I just hadn't gotten enough of Ali Turin.

Another e-mail from Ali Turin and my response, which I detail below

This e-mail reads "Hey Erika, Wanted to quickly double down on my last note, in case it slipped through the cracks. I'm excited to share more about how we have built a world-class clinical team and model. It would also be great to learn more about you (your online profile can only tell me so much!). Are you up for a call?"

My response reads, "Hi, I responded to you on LinkedIn. I don't appreciate the spamming and ignoring of boundaries, though it does let me know something about your company's values in case anyone asks."

So yeah, if anyone is interested in knowing more about Charlie Health, there you go. 

If you are administering screening tools to everyone, this is poor clinical practice

When using screening tools, make sure you are actually at the point where this is necessary/appropriate.

What is a screening tool? It's exactly that. It's something that's meant to be administered to broad populations in order to flag undetected conditions that might otherwise go unnoticed, so these can be addressed. The tool is administered, and if it is positive for certain things, it then creates a record that the person has a previously undetected/currently unmet need.

If you are in a setting that uses these, make sure you understand this, and only administer screening tools to people who need to be screened, i.e., people who don't know if they have any conditions for which the tool screens. 

If you are doing hearing screenings, don't administer these to people with known hearing loss. Ask everyone if they've been previously identified, because medical/school records are often inaccurate (no need to ask someone who you do know is Deaf/hard of hearing). Just document that it was deferred due to already being identified. If you administer a screener, this create a records at the individual and population level showing they have a previously undetected/currently unmet need, which they don't. It skews data on how many people are going around with undetected conditions, and it enters into the person's individual medical or school record that they are experiencing medical neglect that they are actually not.

If you are doing screenings to detect emotional/behavioral concerns in children, don't administer these to youth/families who report their child has a diagnosed psychiatric disability for which they are receiving treatment. It still may be appropriate to administer other brief tools that look at social functioning, mood, etc. over time, but not the tools that are intended to flag undetected concerns.

Also, with the tools that are based on self-report, most are unclear whether the person is to answer them based on how they function with their accommodations (medication, learned strategies, loved ones who are aware and support appropriately, accommodations in place at work or school) or how they would function without these. If we fill them out based on current functioning, we create a medical record showing that a person with an ongoing disability has no functional impairment. This creates problems. If we fill them out based on how the person would function with no intervention, we create a medical record that someone is functioning poorly and has unmet needs. This also creates problems.

If you work somewhere that has no way to indicate that you deferred a screening for a valid clinical reason, or which returns metrics that the provider or facility are out of compliance for not administering a tool, this is not patient-centered and is poor practice. Aside from the clinical reasons I discussed, any person should be able to decline any procedure without any context of pressure or resentment around this. Aside from rare true imminent risk situations, health care and social services participation should be no different from going to the hairdresser or auto mechanic in terms of how the professional explains the pros and cons of something, the customer decides what they would like, and that's the end of it. Insurance sometimes complicates this, but dealing with the insurance companies is something we as providers have chosen to take on, and should not be passing on to the patient.