A discussion with a therapist friend prompted me to think about how we measure the success of our independent therapy practices. There seems to be a tacit assumption, here in the UK, that as independent therapists we’re aiming to grow our practices, hire a team of therapists, and that more (employees and clients) is best.

My five year (and ten year!) plan doesn’t involve employing other therapists, working lots more hours or making lots more money. So what other metrics do we have for measuring progress with our businesses?

When I try and visualise a successful outcome for my business, I’m interested to notice that my mind is drawn first to how I will be feeling, when I’ve reached my business goals. I will be calm, not frazzled, I will enjoy my client work which will be challenging and rewarding, not frustrating and overwelming. I will be supported by, and support, a group of like minded colleagues.

So if someone were to record a documentary film, a day in the life of my therapy business when I’d reached my goals, what would the camera show? Me smiling and relaxed – my shoulders would be low. I’d have breakfast, and coffee, with my family, before I left for work. High energy sessions with happy children, and me feeding back to parents the progress their child was making. On my computer screen my caseload would show throughput, there would be no waiting list, as soon as I finished up with one child, a new family (who I was excited to work with) would enquire. I’d eat a healthy lunch, while reading a relevant research paper, and get home with energy to spare to play with my son before bed time.

Not quite what you tend to see written in a business plan! (Although I also have financial targets that I need to meet.) I’m interested in other ways (besides money) that we measure success, and other goals that we strive for.

Let me know how you measure your own success, what does it look like for you?

To finish this series on Becoming Independent I’m going to write about two challenges I have: resisting doing things the way I always did them in the NHS and scheduling clients.

When I started working independently I kept asking myself: am I doing this because it meets my client’s needs or because this is the way I’ve always done it? One of the things I appreciate most about working independently is the freedom and flexibility I have to offer clients what they need.

Length of therapy blocks

Here’s an example. I started out booking clients in for 6 weeks blocks of therapy, like we used to in the NHS. Then I realised I didn’t need to be constrained by this timeframe if it wasn’t working for me. Although when I reflected on it, I realised it was working. 6 weeks is long enough to make measurable progress towards goals and allows me and the family to continuously review how we’re getting on. Parents can commit to blocks of 6 weeks; it doesn’t seem like speech therapy is something they’ll be doing forever.

In most cases, I have dropped the “consolidation period” between blocks of therapy, which we used in the NHS. Although I still use it for Parent Child Interaction Therapy because I see families benefitting from it. With direct therapy I see clients on a weekly basis for as long as they’re making progress towards their goals.

I’ve cut down on paperwork. I see parents each week and we discuss targets and progress, I don’t tend to write review reports or formal programmes, they’re not normally necessary.

Scheduling

I don’t have much advice to offer about how to arrange your therapy schedule, I wanted to flag this as one of my challenges. Parents enquiring about private therapy assume they can request an appointment time that works for them, which of course they can! However, as I only work two days a week it feels like more often than not our diaries don’t match up. Some parents are able to juggle things around; move the swimming lessons or switch the day of the week they work from home. Others aren’t, and ask me to recommend a different therapist.

I’ve learnt a few things that might be useful:

• The 8.30am slot is popular, but doesn’t suit families who have other school aged children to drop off.
• The 3.30pm and 4.30pm slots are also popular but don’t tend to be productive with nursery or reception aged children who’ve spent the day at school.
• Many parents are surprised when I suggest they could drop their child to nursery/school later or pick them up earlier to accommodate therapy sessions. Nurseries/schools respond to this in different ways, some are happy to release the child for therapy and others are not. It seems to be worth a try.
• When I had more free appointments, I tried to be strategic, e.g. offering mid morning (and sometimes hard to fill) appointments to children who did the afternoon session at nursery.

In some ways things are more straightforward now I’m close to capacity: either parents can make it work, or they can’t, and that’s okay with me. I bring up my availability early in the conversation, because if Tuesday at 2.30pm is impossible for a family, I don’t want them to feel they’ve wasted their time giving me a lot of background information.

That’s it for the Becoming Independent series! Did I miss something you’ve been wondering about? Let me know.

Photo by Cygnoir.

I book my appointments in Cliniko, and it synchronises with my personal and family calendars on iCal. For privacy you can adjust the level of information displayed in iCal, choosing first name, full name or initials. It’s straightforward to book clients in for blocks of sessions and Cliniko emails the parent a reminder before each session. I’ve set it to go out 2 days before the appointment, at 10am. The email simply reminds families of the date and time of the upcoming therapy session, which parents tell me they find useful.

I write my clinical case notes using a form that I’ve customised. It’s a mix of check boxes (e.g. where the appointment was and who the child attended with) and free form text boxes for things like the session’s aims and information about how the child responded. It’s easy to look back over past sessions and see how the child is progressing.

The other features I use are invoicing and file attachments. You can upload your company logo to Cliniko and make a professional looking template for invoices. It’s quick to produce them and the system can either email the invoice to the client directly or you can save it and email it yourself. It also lets you track who has and hasn’t paid. I use the file attachment feature to upload documents to each patient’s record. I scan in the case history form and any assessment record sheets – once you’ve made a pdf, it’s a drag and drop interface to add them to a patient’s record. I also upload all the reports and letters I write so they’re in one place, secure and available whenever I need them.

There are some fun touches, like it reminds you when it’s a client’s birthday, as well as lots of features that I don’t yet use. For example it supports clients booking their own appointments directly online, via your website. You can also use it to track your business expenses.

Cliniko has allowed me to run an (almost!) paperless business. I can write and review case notes wherever I am. And the automated appointment reminders increase attendance rates. I recommend it. (I pay for my Cliniko subscription, and they don’t know I’ve written this review!)

I kept two principles in mind when deciding what I needed to buy or borrow to start my therapy business:

• Wait and see what I need and then buy it – with internet shopping lots of things are available on next day delivery.
• Buy things that can be stored easily and used for multiple purposes – as I’d need to store everything at home and then carry it to therapy sessions.

Assessment materials

I bought two standardised assessments, my most expensive purchase. I’m happy with the two I chose and how many times I’ve used them. The publishers have displays at industry conferences or events and offer discounts, so if you’re planning on going to an event and need to buy assessments check and see if the timing works out.

I also use informal measures like Language For Thinking and sequencing pictures from Black Sheep Press. Some observation schedules are available for free online, like the Modified Checklist for Autism in Toddlers – so I use these.

Toys and books

My colleagues in the NHS asked what I’d like as a leaving gift, so my toy collection started with a tea set, a train set and Mr Potato Head! I bought toy animals, food and a fishing game. My parents still have toys from when my sisters and I were little so I “borrowed” soft toys and books from them. (Check the content of books, I love There’s a Hippopotamus on Our Roof Eating Cake but in my original copy, the character gets a smack: I skip this page.)

I’ve found some great bargains at charity shops and bought things to motivate particular clients. Homemade toys often go down well too, I still have the sparkly tube I made back in 2008 and still get strange looks carrying it to work on the bus!

Technology

I use my iPad in therapy. I record and watch back videos in Parent Child Interaction therapy, with a small set of speakers to boost the audio. I also use it to play games such as my favourites from Toca Boca. When I made a snakes and ladders style game to work on speech sounds, I realised I didn’t have dice, so I downloaded a free app (I think it’s for poker!)

We already had a colour printer and scanner at home, and I use both regularly. I bought a laminator and I use it for making visual timetables and other resources. I’ve written before about Lessonpix – the online product I use to make my visuals (and bingo games!) Finally, I use Cliniko to manage my appointments, write my case notes and send invoices. I’ll write more about how I use it in the next post.

Other bits and pieces

I bought two folding child sized tables and four chairs which I used for every session in my original therapy rooms and currently don’t use at all.

And my secret weapon? A box of tissues. I’ve finally realised that if I bring the tissues, I’m much less likely to get sneezed on!

This blog post is part of a series, read the previous posts here.

I feel uneasy talking about money here on the blog and in real life with clients. Kathleen Shannon has some useful advice in her Money Mojo post. Kathleen works with creative entrepreneurs and while that’s not how I’d describe myself, the Braid Creative blog is a wonderful resource. Kathleen encourages readers to “sell your goods with confidence” and talk about money, so here goes.

Prices

People starting their own therapy business ask me how I decided what to charge. I searched online for therapists in London, to see how much other people were charging. Then I calculated each therapist’s hourly rate. There was quite a range! I looked at how experienced each therapist was, and what they specialised in. I estimated my monthly costs, considered how many days I wanted to work and how much money I needed to make.

I want to be transparent about money; I decided on an hourly rate, and I charge the same for everything that I offer: assessments, therapy sessions, report writing, school visits and travel time. I publish this information on my website. I think parents want to know what therapy costs when considering therapy for their child. And it saves me time; if my prices are more than a parent wants to pay, they can see this on my website before they call me – much easier.

Payments

I started out accepting cash, cheques and bank transfers, on a session by session basis or for a half term’s worth of sessions. I’ve gradually changed this, now:

• I require a deposit to confirm the initial booking.
• Parents pay in advance for a block (a half term) of sessions.
• I accept payments by bank transfer, online via Paypal, or in person by credit or debit card.
• I don’t accept cash or cheques.

This is working well for me. It means I deal with “billing” just once every half term, and I’m not going to the bank every week, or chasing late payments. As parents are paying in advance they think about whether they can make all the sessions; the number of cancellations due to clashes with other appointments has decreased. I was apprehensive explaining this new policy to parents who were used to paying in cash after each session. No new clients have questioned it.

PayPal Here Chip and PIN card reader

I bought this card reader (on a special offer of £49.95). PayPal charge a 2.75% fee, I’m happy to pay for the convenience. It’s a great little gizmo, that works via a bluetooth connection to my phone. As long as I remember to charge the device, it’s quick and easy to take payments. It can send a receipt by email or text message.

Accounts

I’m self employed, I got advice from an accountant before I started seeing clients and I pay for support with my taxes each year. I keep a simple spreadsheet to record the money coming in, and going out and have a separate bank account, although it’s not required.

Is there something else you want to know about the money side of setting up my therapy business? Get in touch. Next up: resources, what do you need and what can you manage without?

This blog is part of a series about Becoming Independent.

I don’t have space to see clients at my flat. I needed to decide if I’d go and visit people, or rent a therapy room and have clients come to me. When I calculated how much time I’d spend travelling from family to family, I realised I’d only be able to see 4 or 5 clients in a day. It made more sense for me to rent a room, I’m able to book in between 6 and 8 clients a day.

There are of course advantages to seeing clients in their own home or educational setting. There are also advantages to seeing people in a distraction free, neutral space where both children and their parents can focus on the therapy session.

I work part time, so I looked for rooms I could rent by the hour or day. I’ve used 5 different therapy rooms and learnt what’s important to me, here are some things to consider.

Where is the room?

I look for somewhere close to public transport. One of my current rooms has a car park which is a bonus. Families have also commented that they enjoying coming somewhere close to cafes and shops. I decided not to work from one practice that looked gorgeous during the day, but felt isolated at night, I didn’t think I’d feel safe.

Is it accessible?

Think about the access. If you work with pre-schoolers like I do, they may arrive in pushchairs. My first therapy room was up 3 flights of stairs. They may also be in the process of toilet training, how far away is the toilet?!

Is there space for your clients to wait if they arrive early? Are there any resources you can borrow, such as child sized furniture or musical instruments? Is the room suitably furnished, or will you need to remove fragile things before getting started each day? How often is it cleaned? Is there any storage you can use?

What are the rental terms?

The places I’ve worked from have varied hugely in terms of the admin, and payment terms. Two places required me to sign a contract, provide my insurance information, and give notice if I wanted to stop using the room. Others have been more flexible. When I was gradually returning to work after maternity leave, I chose a room I could book on an ad hoc basis to minimise the risk of paying for a room I wasn’t using. Then when it wasn’t available on the days I needed, I found a room where I book 6 sessions at a time, but don’t need to sign a contract. I was surprised that when I asked for a discount, one place was happy to give me one.

What’s not essential but nice to have?

I like the idea of having access to a kitchen, but in 18 months I’ve only made myself 1 cup of tea! I do use the sink to fill and empty buckets for water play though. I thought wireless internet access would be useful, but on the rare occasions I’ve needed my iPad online, I’ve tethered it to my phone.

Referrals and other benefits

It might be worth thinking about what other businesses or services work at any location you’re considering, as they may be able to refer people to you. Some venues offer other incentives: when I rented a room in a wellness centre, I was considered a “teacher” and could go to yoga classes for £1!

Each time I need to look for a new therapy room I feel overwhelmed, something always comes up though! If you have questions about finding a therapy room leave a comment or email me.

This post is part of a series, I wrote about how I advertise my service and how clients contact me in previous posts. Coming next pricing, billing and all things money.

People have asked me how I advertise my practice. When I ask clients how they found me about half say someone they know recommended me. Some tell me they found me via the ASLTIP directory, and the rest searched google and found my website.

Encourage Personal Recommendations

Happy clients tell their friends! I’ve worked with a former client’s next door neighbour, been contacted by a woman who said her sister’s friend suggested me, and had parents recommended me to their child’s classmates.

I told people in the NHS and education department where I used to work, that I was leaving to work independently, and I’ve had enquiries and recommendations from them. I also tell people I meet that I’m a paediatric SLT – I once worked with my yoga teacher’s son! So carrying business cards is useful, I have these mini ones from moo.

I receive personal recommendations from other independent SLTs in the local area. Several friends work on a part-time basis, or specialise in particular areas of therapy. When these therapists receive an enquiry from a family they don’t want to take on (for various reasons) they recommend the family contact me. And I signpost families to particular colleagues if I think they’ll be a better fit for the child.

Use the Directory of Independent Speech and Language Therapists

I am a member of the Association of Speech and Language Therapists in Independent Practice so have an entry in their directory. Parents who find me here often haven’t seen my website, so they aren’t always aware of how I work and my prices.

Finding My Site by Searching on Google

I haven’t tried paying for google ads. I attempted to make my site findable by thinking about what parents might search for and including relevant content. I write blog posts about things I hope parents will be interested in, and I added myself to google maps. You can use a free or low cost service, like Squarespace, to make a website without having to hire a designer.

What didn’t work?

I haven’t had much success with adverts. In 18 months I’ve had two enquires from a (free) advert on netmums. I spent £20 on an advert on a local parenting website (I think they also included me in their newsletter) which didn’t generate any interest. I’ve written articles about communication development that were included in local parenting magazines, but again these didn’t lead to any enquiries.

I emailed around 25 local nurseries to introduce myself and explain what I could offer, attaching a pdf of a flyer I’d made. This led to me meeting one nursery manager, and then assessing one child and running a staff training session. So, it wasn’t a complete waste of time, but didn’t keep me very busy.

This post is part of a series about Becoming Independent. Next up, choosing where to work.

Several therapists working in the NHS have emailed me to ask my advice about starting their own therapy business. I thought I’d share what I tell them here, in a series of posts. I started working independently about 18 months ago, I’m not claiming to have all the answers! I’ll write about what works (and doesn’t) for me, here in London; you can decide if it’s relevant to you and your situation.

How do potential clients contact you?

I already had an email address I used for work, so I kept using it. My work phone number was more complicated. I see my clients in a rented therapy room (more on that coming soon) and do my admin at home. We don’t have a landline phone, and I didn’t feel happy putting my mobile number on the internet. So I bought a Skype phone number. I selected a London area code, and for £3.35 a month I have a work phone. When someone calls the number, Skype rings on my desktop computer. If I’m out and about and expecting a call, I can open the Skype app on my mobile, and that’ll ring too. The number has an answer phone, and Skype emails me when someone leaves a message.

When a family books a therapy session I give them my mobile number, so I know they can reach me if they’re running late. This set up is working well at the moment.

I only use this number for work so I’ve made my answer phone message specific. I ask callers to tell me where they live and how old their child is. This helps me filter my enquiries. I’m able to call parents of older children straight back and explain I only work with under 7s. As well as check my availability in a particular location (I work in 2 different places) before returning a call.

Short form on the website

I also have a form on my website that parents can fill out to get in touch with me. It’s a free service by Wufoo. One of the questions on the form is: What are you concerned about in terms of your child’s speech, language and communication skills? The way a parent answers this question sometimes gives me an indication of how involved they’d like to be in the therapy process. 

This post is the first in a series about Becoming Independent. I’ll write about how potential clients find my details in the next post.

Photo by Álvaro Ibáñez