When Rachel McCrickard began working as a marriage and family therapist in Chattanooga, she still needed to complete hundreds of hours of clinical supervision before she could be licensed as an independent clinician. Because there were no supervisors available to her in Chattanooga, Rachel had to drive back and forth weekly to Atlanta to complete the supervision hours required for her licensure.
Rachel knew that thousands of new behavioral health clinicians faced the same quandary: before they could be licensed as professionals by the states where they practiced they had to complete extended periods of supervision by a licensed clinician. But for many of them – particularly in rural America or in other underserved areas – no local supervisors were available.
They faced a hard choice. Either travel long distances and pay high out-of-pocket costs to obtain legally required supervision, or reconsider whether they could start a viable practice in an area that desperately needed them but didn’t have the resources to get their work off the ground.
The magnitude of the mal-distribution of behavioral health clinicians in the U.S. is profound. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 75% of all U.S. counties are mental health shortage areas, and half of all U.S. counties have no mental health professionals at all.
Rachel found a solution for the lack of available clinical supervisors. It came too late for her, but not for the large market of supervision-stranded behavioral health workers across the country, a demand that’s suddenly intensified during the spread of COVID-19 and its attendant mental health problems.
In 2017, Rachel started Motivo, the nation’s first HIPAA-compliant video platform that pairs pre-licensure clinicians with licensed professionals who provide the supervision required for licensure. She recently told me her motivation for Motivo was the basic recognition that “underserved areas of our country are in desperate need of more mental health professionals. I started Motivo to remove barriers that many therapists face during the licensure process.”
Telesupervision had found a launching pad, and with $2.2 million in seed financing in 2019, Motivo took off. The company’s start-up capitalized on the growing trend of the past decade that saw many states update their supervision laws by allowing for clinical supervision to take place remotely through video meetings rather than requiring it to be face-to-face.
Here’s how Motiv0 works.
Licensed clinicians submit their credentials to Motiv0, which checks and authenticates their eligibility to serve as supervisors in a given state. Currently, about 700 supervisors – at least one in every state – are on the roster.
New therapists who’ve earned their degrees, but who have not met pre-licensure supervision requirements, then search the supervisor list, filtering their search by state, type of licensure, and any subspecialty (e.g. working with children or a geriatric population). At this point, more than 1,000 pre-licensure therapists in 35 states are receiving Motivo-provided supervision.
Motivo arranges a free video call for the clinician and the supervisor to meet – a blind date of sorts – to see if they feel compatible and want to begin formal supervision together. In the vast majority of cases, the match is made, and the supervision begins.
The video sessions are all encrypted but not retained. Motivo documents the supervision sessions so that clinicians can keep an up-to-date count of the hours they’ve completed and provide that documentation to licensure boards.
In order to facilitate accurate understanding of which states permit telesupervision, Motivo maintains a landing page containing state-by-state rules and regulations for the supervision of the three main types of clinicians it serves: professional counselors, social workers and marriage and family therapists.
The business model is based on a shared revenue structure between Motivo and supervisors, with supervisees paying $65/hour for individual supervision, $55/hour for dyadic supervision, and $45/hour for group supervision.
Although Motiv0 was started well before the coronavirus pandemic ravaged the nation, bringing with it a host of mental health problems, McCrickard acknowledged that the pandemic has created critical gaps that Motivo was immediately well-positioned to fill.
For example, although Motivo has historically focused on post-degree therapists, the pandemic has so disrupted existing graduate degree programs that universities are beginning to explore whether Motivo might be used for the supervision of their practicum students.
Likewise, McCrickard is considering branching out from behavioral health to other health care providers – like occupational therapists, dietitians, and speech-language pathologists – all of whom must complete pre-licensure supervision. In the midst of the pandemic, states are quickly liberalizing their supervision requirements so telesupervision of these providers is now becoming accepted practice.
Motivo’s payroll has consisted of five full-time employees, but McCrickard told me that two more full-time employees are now being added to support the recent surge in demand.
And that demand is likely only to grow, revealing that telesupervision’s time is fully now. It’s become one of behavioral health’s “must have” solutions.