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2020 – 03 – What Clients Need

So, you might be thinking to yourself, “Hmmmm, I can see why trauma informed care is important. But what does client experience really have to do with it?” This is a great question and one that can only be answered through understanding the link between the care that we offer and the experience that the client receives. As we shift our focus to ensuring that our care is thoughtful, nonjudgemental, and focused on client needs, our clients will begin to experience a shift in their experience of treatment.

Trauma Informed Care is about self-awareness.

I previously worked for a behavioral healthcare management company that hospitals would hire to upstart behavioral health clinics. In my role, I was hired to create a behavioral health clinic for senior patients at a small, rural hospital in a very small town in Texas. It was an odd setup as I did not work for the hospital yet, I worked at the hospital. The hospital essentially was not my boss. They were my client. So, it was very important that I ran a highly successful and profitable clinic for the hospital so that they would continue to renew our contract to manage the behavioral health clinic for them.

During the first year of operating that clinic, my main focus was on successfully marketing it and making it sustainable. As with any startup, the first major barrier is getting people to know that you exist. During one of my very first meetings with the hospital CEO, I asked him about how the hospital advertises their programs to the community. He told me that they advertise in many different ways, including everything from radio commercials to even billboards on the highway. He listed off many different ways that they advertised but he did not list one very important way: online marketing. I asked if the hospital had a website and he said yes. I asked if the hospital had a Facebook page and he told me no. He said to me, “Dr. Coy, I don’t believe in that online stuff. People are mean and nasty on Facebook and I don’t want our great hospital to have anything to do with social media. So, no. We do not use Facebook or any other online platform other than our website. That’s good enough.” I was shocked. Even in that small Texas town, I couldn’t help but notice that nearly EVERYONE had a smartphone and it seemed that nearly everyone was very active on social media. It seemed like an odd stance but I figured that perhaps he knew more about the community than I did and maybe people in that area responded better to radio and newspaper ads.

Later that night, I was curious about my conversation with the hospital CEO. So I decided to do a little searching by doing a quick and simple Google search of the hospital. I found out that the hospital did, in fact, have an online presence beyond their website…and it wasn’t good. Google Maps reviews were there and they were terrible. Yelp reviews? Yup, and awful. And yes, there was even a Facebook page that someone in the community had established (with incorrect contact information). This was probably the most disturbing as the hospital page had an extremely low rating on the Facebook page and even included comments from people in the community who shared their horror stories about their poor experiences!

I went back to the CEO the next day and told him that the hospital was in fact on Facebook and I showed him the page with the incorrect information and the horrific comments. He was shocked…and angry. Within a few hours, his team was able to gain control of the page, update the page with accurate information, and invite patients who had a positive experience with the hospital to add their comments and ratings to improve their score and overall brand. Once the hospital started to acknowledge, own, and manage their online presence, they were able to take control of it. Still, the negative experiences that clients were sharing online were hurting the hospital’s reputation. But it was eye-opening for the CEO. And for the first time, as he read through the experiences that people shared with their online community, he committed to completely changing their practices. But it was not until they were made aware of the kind of negative experiences that their patients were having, that they could implement changes to fix it. And in order to really make the kind of trauma informed care changes that needed to be made, the hospital needed to start listening to patients and making decisions based on their feedback.

Client Needs – 5 Trends

Having a trauma-informed care perspective ensures that we are not pushing our agenda onto our clients but instead, we are listening to their needs and adapting our services accordingly to meet those needs. Even when we have great intentions about what we want for our clients, it may not be what they want and therefore, ineffective. Instead, we need to be actively taking on an approach that elicits feedback and responds appropriately. But how do we know what clients want/need? In order to answer that question, we must gather client feedback.

With the integration of health care and behavioral health care, we are seeing many of the same trends within both aspects of the continuum of care. The more integrated clients’ overall health becomes, the more that clients are holding the same expectations across the board for what they believe make good overall care. These expectations influence what causes a client to stay in treatment until completion versus what causes them to stop prematurely. Here are 5 top trends:

  1. Clients are expecting to be given an intake appointment within a reasonable amount of time for scheduling. Many clients seek out behavioral health service when they are in a crisis or just following a crisis situation. They often perceive their need for help to be immediate and they expect to get into treatment as soon as possible.
  2. Clients are not willing to wait for their therapists or doctors to be late. Not only do they have busy schedules but they see this as a lack of respect for them and their time.
  3. Clients want to know upfront what their services will look like. This includes costs, what their insurance will cover, how long treatment should last, and what they will get through their service experience. Understanding behavioral health and health insurance is more confusing than ever and clients want to be able to make an informed decision about what they will be receiving.
  4. Clients expect a personal experience. Each time they come to you or your clinic, they do not want to repeat their background or story. They want you to remember them. They want you to say things like “Last time you told me your family was going on a trip – how was the trip and what did you see and do?”
  5. Clients want to be able to use technology that is helpful. This includes an easy way to schedule appointments and reminders for these appointments. Preferably, clients want texting reminders over phone calls. They also want to be able to have control over the viewing of their records (like through a portal) and be able to share them with other providers when needed.

But of all the things that are seen as new trends in client expectations, one thing remains the same and is not expected to change – clients want to build a lasting relationship with a therapist who knows them and who they trust. If they don’t like or feel connected to their mental health professional, they are unlikely to stay or to comply with treatment plans.


Every service line or type of healthcare has some unique challenges. In behavioral health, we know that there is a high need for services, yet increasing shortages in care capacity and resources. In my local community, for example, the need for services continues to increase, but budget cuts and changes in reimbursement and requiring many behavioral health organizations to stop hiring new positions or even have layoffs. Sound familiar? Most likely your community is experiencing a similar situation.

High caseloads and high staff turnover is a universal challenge in behavioral health community organizations that makes it difficult to provide an ideal experience. We have to recognize that in many situations, not delivering an ideal experience is not the result of a therapist who does not care – but rather that workloads, systems, and processes don’t support this and need to be changed.

Other unique things – in behavioral health, decisions are often times made during a crisis. There is not a lot of time to prepare, to research, or to think through a decision. Treatment plans are long and don’t always have a clear ending. And depending on the specific population, clients or their families are not always able to advocate for themselves or tell us when things are not working.

So there’s no perfect answer to these challenges, but there are some things that can help. And keeping that in mind, we will move to our next section which is talking about specific tools that you can use to understand what your clients want and need.