Why Good Behaviour Support Cannot Be Rushed, with Laura Barnes (Ep 62)

Behaviour support is sometimes talked about as though practitioners spend their days writing reports and collecting a high hourly rate. Laura Barnes gives a much more honest account of what the work actually involves, especially when supporting people with complex mental health needs, dual diagnoses, substance use, violence and significant risks to themselves or others.

In this episode of the NDIS Provider Growth Journey, Michael speaks with Laura, a behaviour support practitioner and clinical manager at Conscious Care Therapeutic Support. They talk about the difference between building a service around billable targets and doing the level of clinical work that participants genuinely need. Laura explains why strong behaviour support requires proper assessments, thoughtful risk management, useful training and a willingness to understand the details that cannot be captured in a generic strategy.

Laura also shares the business realities behind the hourly rate. A complex report may take 60 hours when only 30 hours have been funded. Practitioners may travel for hours to reach someone who cannot consistently use telehealth, while being able to charge for only a small part of that journey. There are also appointments to organise, research to complete and difficult clinical decisions that cannot always be billed.

The conversation also looks at AI and why Laura believes it cannot replace clinical judgement. AI may help with research or simple tasks, but it does not attend the sessions, hear the phone calls or understand the small moments that can completely change how a person’s behaviour is understood. For Laura, the challenge is finding a way to run a sustainable business without turning behaviour support into a report-writing sweatshop.

Learn more about Laura and Conscious Care Therapeutic Support:

https://therapeuticsupport.com.au/

That was a great podcast.

If you want some one-on-one support, get in touch with me, michael@athletickoala.com.au

Transcript

SPEAKER_00 0:06

Welcome to the podcast. Today we have Laura Barnes, and she is a magician of helping people who are not actually easy to help. Laura, why would I say that? What's your job?

SPEAKER_01 0:16

I'm a mere behavior support practitioner, but I'm also a clinical manager of conscious care therapeutic support. And our main jam is the spicy end of mental health, dual diagnoses, personality disorders, substance use disorders, violence beyond what might be deemed normal.

SPEAKER_00 0:39

Okay, that's a very nice way of putting it. The reality is you work with people who others are not built to work with, and you support people who, if you're not doing your job well, their life's going to be way harder, and so is everyone else's life around them. And people have this idea that behaviour support just earn heaps of money and sit around writing reports, which may or may not be true. We'll know by the end of this podcast. But also, Laura, you're the founder, one of the founders of this, and you know what it's like to build from the ground up.

SPEAKER_01 1:07

Yes, if you want to stick to what Google could put out for strategies. No, if you actually want to do your job. So if you want a cruisy walk in the park, you are going to you can have it, but you're not going to have many clients or participants. You're not going to be thinking outside the box. You're actually not doing the proper assessments or the risk assessments or the proper training or the proper work. If you actually want to meet people where they're at, which is the reason why people end up with behavior support funding, they've got to prove that they've got behaviors of harm to self, others, and in different environments. So we instantly have chaos for our caseload. That's not easy. No matter who it is, whether it's a child or whether it's an adult with a lifelong incarceration rap shake. More often than not, people want to do the right thing. They want to you can't step into NDIS or into a caring role or community services without actually caring. Those that don't care end up being focused on the money, and their quality output is no good.

SPEAKER_00 2:37

Okay, that makes sense. So, and then that would raise the next question. How does someone be a behavior support practitioner or run a behaviour support business and look after people well and charge what they're worth? Because, like, let's be real, uh, you deserve every cent you get for the work you do, and I actually business coach a couple of behavior supports practitioners, and I can't believe how much more money they could make if they just did a few little things differently. So, yes, so how does someone ethically make a business work well on their behavior support?

SPEAKER_01 3:14

For me, what works well, and look, we can advertise to cows come home and put it out there that you do all this amazing work, but that's just words, right? At the end of the day, they are just words and it's not actions. You've actually got to be able to not just talk the talk, but you've got to be able to walk it. So if you are saying all of this stuff, prove it. Referrals can come naturally, and yes, you can do lots of things to get more referrals and do all of that. But do you want to build to be a sweatshop or build to be quality? And I think that's for me, having worked in sweatshop environments, that's the you know, it how much do you want to grow, really? And what do you want that output to look like? And no matter what, and this is you know, even as a manager, I hold a full caseload. And it's not because we're a special, it's because I d we don't want to just palm people off and spot caseloads around because someone else is doing something else. What when you when you step into doing whatever role it is, whether it's behavior support, allied health, whatever it is, step in and do it well and prove it. Because word of mouth gets around, and that can become your leverage. When you say sweatshop, what you're meaning is you're all about get the reports done, get the the revenue and KPIs in, get your the KPIs are almost unachievable from a clinical perspective, because there's so many things are unbillable, but there is so much that we do that we can't bill. What? Yeah. It has to be clinical, it has to be based on that particular participant. If we're coming across situations or environments or diagnoses or anything, and we just go, I want to explore that. I don't think it's quite related to this participant, but it might be, but I'm not quite sure. That's questionable whether that can actually be filled or not. If we ring to make an appointment and that conversation can go on 15 minutes or so, we can't bill that. Anything to do with booking appointments, we can't bill. If we are funded 30 hours, which seems like a lot, to do a behavior support plan, that's without the intervention stuff, two-line items. That's 30 hours. Now, for me to write, spend 30 hours on a report. No, I average half an hour per page. 60-page report. For my guys, I'm not even touching the sides. Particularly when we look at the interaction between justice and mental health, community mental health, particularly when personality disorders are involved. Of course, it depends on how long we've been working with that person. It might start off with a 120, 150-page report, which say it's 120. That's for me 60 hours. So that's 30 hours I can't build. So I traveled two hours to see some of my participants, which I do because they've not found another practitioner in that area who has the skills to take on that level of complexity. So I'm driving two hours to them and I can charge 15 minutes. There needs to be a level of face-to-face, and I can't bill it. And that's my choice. That's okay. I take that into consideration, but that is a major one.

SPEAKER_00 7:08

Got it. Okay. So the people who don't live in behavior support world are going to be listening to this going, it takes you 60 hours to write a really long report. Which you can charge 30 hours. And then the people are going to be saying, why isn't Laura just using AI? Talk us through why you don't use AI to get a drafted and stuff like that, or talk us through why where this time is is taken up because a lot of people can't grasp that. And then they are hypercritical of Allied Health in general.

SPEAKER_01 7:41

Yeah. AI has we all use chat GPT and the likes for really random things, right? We do it. GPT to do research or give me a list of current research. But to actually why would we be breaching privacy and confidentiality by uploading reports into there, going analyze this, tell me what you want, tell this is what I want. You can do the whole act as a behavior specialist, analyze these reports for support workers and family to implement, and you have to meet the NDIS criteria. We can give it all the prompts and it can spit stuff out. Like I've I've played, I've looked, and I've gone, okay, let's really look at this critical thinking component. We can't expect an algorithm to think and know about the nuances that we have. We can put those prompts in place, but it's not going to know about those small little moments in time that we've observed that we haven't put into the prompt. AI isn't there in our sessions and in our phone calls and isn't there in the emotions, in the depths of Philly with our participants. If you don't know, you don't know. I had a wise participant tell me that one day. ChatGPT and AI, if it doesn't know, it doesn't know. Interestingly, you can read reports where you go, oh my lord, how much of that is AI? That is crazy. And sure. Again, it comes back to do you want to be a sweatshop, pump it out, meet your KPIs and get your billables in, or do you want to do quality? And I would rather do quality over quantity. Because people that we support deserve the best of us.

SPEAKER_00 9:35

That's why they employ us. So then that raises another question, which is is the level of impact on someone's life worth the additional unpaid time to produce a 60-hour report instead of a 30-hour report? Like, is it worth doing that? Is it not? Like, because it's a big call to do 30 hours unpaid work.

SPEAKER_01 9:57

It's huge. You've got to weigh it up. If that's what they need, they deserve it. There's also the flip side to is it just waft that you're doing? Is that 60 hours? Could you actually do that in 45? Or could you do it in 30? Are there things that you can actually do to improve how much time you're spending on that? If it's clinically justified, it's absolutely worth it. I would rather know that death is not on my conscience. I would rather know that I have put everything I can possibly and realistically do for a report and for a person than leave stuff out and things go haywire down six months down the track or a month down the track, and I go, Oh, yeah, I should have put in that report. So they deserve it. But then on the flip side, as a manager, we've also got to take in the new psychosocial laws of protecting our staff. And then I look at it and I go, okay, so why are my clinicians spending 60 hours on a report and can only bill 30? What can we do in there? If someone is spending 18 hours on a Saturday to put together some transition plan that they can't bill, can they actually effectively manage their caseload? More often than not, yeah. But so long as you're managing your caseload and your time and your actions effectively, and the funding as well. Because what happens if you get I've had NDIS turn but turn around and say, no, we're not funding you level three behavior support funding, even though they've got six RPs in place. And so here I am on 60 hours for 12 months to do two BSPs. The participant absolutely deserves 100% of me. And they've still got 100% of me, but I've also got to take into account the funding.

SPEAKER_00 11:58

Laura, do you know what? This has been one of the best podcasts because what you're doing is you're showing people what goes through the mind of a owner of an allied health business. And it's not just, oh, you just earn heaps of money per hour. It's like, no, there's these other factors. If someone wants to find you, they'd look up conscious care therapeutic support or they get in touch with me and I'll put in them in touch with you. Laura, just thank you. Thank you for being real and thank you for the great work you're doing to help people. I really appreciate it.

SPEAKER_01 12:25

Oh, you've got to be real.

SPEAKER_00 12:27

Laura, I love your work. We'll catch you for another podcast another time.

SPEAKER_01 12:30

No worries. Thank you.