In the seventh episode of Telehealth Heroes, we interview Dr. Sarah Serrano, a licensed clinical social worker. Join us to learn about the causes of burnout, the different ways it manifests in people, and how Dr. Serrano avoids getting burnt out herself by using telehealth.
Episode transcript
Brandon:
On today’s episode, we get to listen to Sarah Serrano. Sarah Como estas? Yeah, if you, so that’s about the extent of my Spanish that I know. So I’m going to use it all there. So Sarah, welcome to the show. Tell us a little bit about yourself and your practice.
Dr. Serrano:
Hi, I’m glad to be here. Thank you for the invite. Well, I have been a for, for licensed since 2009, and I’ve been working in social services for about 18, 17, 18 years now. And I have a private practice that I started four years ago. A tele-health private practice that I started four years ago. It’s called Bienestar counseling and education and all through telehealth. And I’m loving it.
Brandon:
Were you practicing by yourself previous to this or were you working somewhere else? And then you went independent because of this?
Dr. Serrano:
We went independent when I had kids and I was doing contract work and I just needed flexibility and I need to be at home with my babies. So I was doing some contract work, but that still required me to leave my house and get a babysitter. And so that’s when I started to research, what can I do with my clinical skills? That’s gonna allow me to work from home. And that’s when tele-health started popping on my radar. And I started doing research about it, which took me quite a bit of time before I kind of make the dive into it, but definitely doing tele-health before the pandemic, before everybody thought it was cool and necessary.
Brandon:
Yeah, definitely. Now, when you were researching, how did you first find out about tele-health and what were some of the biggest questions that you had to please yourself?
Dr. Serrano:
I had so many questions and I actually set myself a goal. I said, I’m going to do six months of research before I jump into this. Right. Because then I had to do my, you know, I had to open a business and if I was going to invest in that, I needed to know that I could make this work. And so I just started looking at, you know, can I work from home? You know, what can I do from home? You know, doing counseling, doing, you know, any, any type of clinical work. And I came across these platforms, especially they contractors, right. That were, that were getting clinicians into them. And, and I was like, okay, but can I do that by myself? Do I have to have a contract with somebody to do it? And can I run this myself? And that’s when I started researching. And that’s when I started seeing the people were doing this on Skype and then that was not HIPAA compliant. And I was like, oh my goodness, there must be other ways of doing this. And that’s when I ran into a doctor, it was the first one that I ran into actual.
Brandon:
Right. And there’s plenty more. Now, a lot of people, you had the luxury of spending six months figuring out does this work or not most people who use telemedicine now had about six minutes to figure it out, pretty much figure it out. And so with that additional research and knowledge again, what recommendations have you given or do you give to people who have entered into telemedicine more recently?
Dr. Serrano:
It’s funny, you mentioned that because I had helped a lot of my colleagues jump in a lot of my, you know, just people that I know in the community. We do a lot of networking. I, you know, it’s important as a clinician to know right. Who to refer to. And so I was already involved in a, in a large network of other clinicians. And so I did prior, prior to the pandemic, I had done a, a training for a group of clinicians on tele mental health. Cause you know, I was the only one in a directory, in a local directory that was doing tele-health. And so they asked me, you know, can you come and talk about it? You know? And I did. And I talked about the laws and, and all of that stuff. And then when this happened, a lot of people didn’t know that I was one of the people that was a school Sidley doing just telehealth. And I did another training on, on that and how people get on there. And I did a lot of one-on-ones with people just to get them, you know, set settled into during the pandemic. A lot of people were losing income and losing clients, all that stuff.
Brandon:
So let’s talk a little bit about your practice. So you, you speak Spanish and do you, do you work exclusively with Spanish speaking population? What type of clients you have? What do you serve?
Dr. Serrano:
I love the Spanish population. It is near and dear to my heart. I am fluent in a fully fluent in Spanish. And so I do have a heart for that. And people do refer a lot to me due to, you know, my Spanish speaking skills. However, I don’t do exclusively Spanish. My niche is actually burnout. My niche is actually helping the helpers. We have anybody who is in a high burnout field that is, you know, medicine, it could be mental health, it could be, you know, crisis care, anything like that. I do work with those individuals on a burnout. And it’s interesting that it’s not just high burnout fields anymore. The, you know, what we thought of high burnout fields. But during that pandemic, other fields that were not high burnout fields have become high burnout hospitality teaching among others. So there’s quite a bit of work out there for this. I do trainings on burnout also for corporations through AP. And so it’s, it’s it’s happening.
Brandon:
So, you know, with burnout, we’ve heard a lot about burnout in the medical field, especially during this COVID era, there’s a lot more requirements, a lot additional burden on them. What are, what are, what are you seeing and what are some of the recommendations you provide to address that burnout? Yeah.
Dr. Serrano:
Yeah. So, you know, there’s the burnout a lot of times. Well, there’s a difference between, you know, by what we call vicarious or secondary trauma is just like, you’re constantly listening and dealing with this crisis all the time, you know, and burn out. It’s just, you know, kind of occupational it’s felt more in the physical sense. There, there are differences, but they’re kind of merged together. However, however, before you had these mental health, it could be medical practitioners, emergency responders. There’s always a degree of separation. This is happening to them. I’m here, I’m listening to this. It does affect me, but there’s a degree of separation now with the pandemic everything’s happening to all of us, right? So it’s, you know, there, that degree of separation is not there anymore. And so that is why a lot of individuals are really struggling because what’s happening with our patients might be happening in their home with a loved one. And so that is what we are pretty much seeing right now, plus a lack of, you know, the lack of workers, people going home, they’re quarantining for two weeks now. We’re, short-staffed, there’s a lot of, there’s been an Exodus from the medical field too. We have a local hospital here who lost 72 nurses last year. Wow. They just couldn’t, they just couldn’t do it. So,
Brandon:
And what are you seeing in the hospitals related to burnout?
Dr. Serrano:
We’re seeing a lot of individuals just really struggling to keep it together, right? When you are in a state of burnout, you see a lot of lack of focus. You see a lot of physical manifestations, so we’re, we’re talking about literal physical fatigue. We’re talking about people calling sick a lot. We’re talking about a lot of fear and anxiety. That’s mixed into all of this. We’re talking frustration with a system that is trying to do their best, but it is overwhelmed at this point in time. It depends on, you know, where the we just had in south Florida, big spike throughout the summer. And so it is now coming down, but now we’re going to see other systems maybe in the north go through this. And the necessary staffing requirements are probably not going to be there. It’s going to be a lot of frustration depending on who are you treating? We’re seeing this a lot too, a lot of anger towards and frustration towards people’s personal choices. This all impacts, you know, how somebody does their job, that’s their job. So we’re, we’re looking at a lot of individuals who are maybe even turning to substance abuse to cope with this, this situation. And so that is a, that’s a big deal. And the substance abuse is already high an issue in the medical field, right?
Brandon:
They don’t have the techniques to, to cope with it. So they, they self-medicate through different
Dr. Serrano:
David, but poor coping skills can lead to anger, anger, and, and the way you manage it, it could be, you know, the bad bedside manner. It just, it can translate into a lot of different things that are going to affect their career also, and obviously affect the way that they treat their clients. Right.
Brandon:
How do you manage burnout personally?
Dr. Serrano:
That is a good question. That is a good question. We all have to find our way, right? This is a personal thing. This is, we all have been trying to find our way, just like everybody else. I struggled in this area because as you can, well, imagine also there has been a high utilization of mental health services. Okay. So I have a waiting list that is very long right now. And so how do, how do I attend to the individuals that are in need while at the same time, keeping myself healthy, get myself healthy. So, you know, I do travel a lot. So I do travel. I try to, when I’m done with work, I’m done with work. I try to stick to the hours that I have committed to. I don’t overbook myself. I try not to overwork myself. Sometimes there is those issues. Right, right. I do that. I really try to, to make time for the hobbies that I enjoy and not prioritize things that are going to overwhelm me. And so, but I have my days. Right. And so it’s a constant assessment and reassessment, what am I doing? How am I doing? How am I feeling? And also the accountability I asked my husband, what are you, what do you think? What do you see? Right. And he will also kind of keep me accountable in that area.
Brandon:
How has, how has, you know, you’ve been doing telemedicine for yourself for four years, how has that been able to help manage your ability to avoid burnout?
Dr. Serrano:
It’s been, it’s tricky because when you work from home, there has to be a very clear boundary. And I do work with a lot of people that are been, have been working from home. And so the computer’s always open. The computer is always accessible, you know, where’s your office where’s. And so it’s really drawing a line that even though I’m working from home, this is work and this is my personal life. And so it, when, when that is said, and you’re consistent in that, then that is something that is very helpful. I like the flexibility. I schedule my, my appointments throughout the day. I don’t do back-to-back right. And that helps me because I can do a client and then I can just go be with my family, be with my boys and I homeschool and then come back two hours later and do another session. And so it’s, you know, I’m, I’m not constantly like immersed in it. There’s that flexibility with it.
Brandon:
Right. It gives you that flexibility to go from mom to a counselor back to mom. And it, it, it, it bounces you’re out. So you don’t really burn out because you’re not overwhelming with one
Dr. Serrano:
Thing. Exactly. If I manage it well, if I monitor it well,
Brandon:
And it sounds like that’s the key really
Dr. Serrano:
Expectations.
Brandon:
Right? So as, as you’ve moved to telemedicine and it sounds like you’re able to be a mom, but still be a counselor. What are some of the other things that you’ve been able to do because you’ve been able to practice telemedicine?
Dr. Serrano:
Absolutely. So I, we travel a lot. Like I said, I’m actually, my office is a camper. My office is a, yes, it is. So it is parked right outside my home. It is where linked to, you know, the electricity. This gives me also the, the ability to have more privacy. Right. Cause I do have an office in that house, but the kids are there and all of that. So this is a good thing for us, but we do travel a lot. I do tell my clients, every single client I have. I said, I traveled, if you don’t mind me meeting you from other state one day, or sometimes I’ll meet with them from my car and I will set it up as a, as an office. And they really enjoy, they get a kick out of it, but I enjoy it too. I get to travel. I still get to work. I don’t miss work days. And it’s just been so, so great to do this. I don’t regret it.
Brandon:
So, I mean, that’s incredible. I’ve never heard that an office as the camper. So I’m really curious now, where have been some of the most interesting places you’ve been able to do a telemedicine call for?
Dr. Serrano:
So we have been, and into summer, specifically, we were in Utah and we were doing the mighty five. And so I would, you know, I would make sure that I would call ahead of time. How is the internet? Because that’s something that’s necessary, obviously, what is the internet and how is internet like over there? And so we’ve been, we’ve, I’ve done the sessions off of Zion. I’ve done sessions off of Moab. I spent a whole summer in Frisco, Colorado, and that was a lot of fun and doing sessions from there, state parks, you know, a lot of sessions from state parks and the clients get a really get a kick out of asking me, where are you today? Where are you? What are you doing? Where is Sarah today?
Brandon:
So yeah. What, what do your patients think about seeing you from, you know, who knows where in the United States?
Dr. Serrano:
I love it. I have not had a client who gets bummed out about that, you know, and it’s, it’s a great icebreaker too. They asked me what, what I’ve been up to. And I tell them, Hey, you know, you should, if you ever come here, you should visit this and this. So it’s been, you know, they really, really appreciate the fact that, you know, they get to talk to me and I’m in different places. And I can talk a little bit with them about where I’ve been and what I’ve been doing. So,
Brandon:
Yeah. I mean, have you seen any hindrance or detriment to your ability to provide counseling by doing this?
Dr. Serrano:
Well, again, the internet is the biggest thing. The internet is the biggest thing I do tell my clients that I, you know, I’m a traveling this week, I’m traveling month and best case scenario is that I can meet with you worst case scenarios that we’re going to have to kind of, you know, find a way I have had to drive out of, you know, a certain area to find a signal and me with my clients, but it’s, you know, it’s all good. I, it doesn’t happen often. And again, the clients, I always make sure that the client is okay with that is okay with that because it is their treatment. I don’t see many clients that are in super crisis. It’s telehealth is not the best platform for that. So there there’s also that if I had a clientele that was always in, you know, just a high crisis state, then this probably I would have to probably just amend some of my ways.
Brandon:
Right. It’s amazing. You’ve got that freedom and flexibility to travel while still working and you have a session then just walk out and go look at some natural arches. And Moab is just amazing. Yeah. Or go hiking. Right. Exactly. I love it. So, so you’ve also got the freedom and flexibility to move. You’ve you’ve been in south Florida, but you’re you’re you have an upcoming move. And how is that going to impact your, your clients?
Dr. Serrano:
Well, it should not impact my clients, any the laws at this point in time, or are that we are, have to see clients in the states where we’re licensed in and it is the clients has to be in that state at that moment. There’s very few states that require the clinician to actually be in the state where the client is or the, or the state where they’re licensed. And so that gives me a lot of flexibility. I will be moving in a couple of months. I just take my whole practice with me. I’m keeping my licenses where I am at. And so the clients are not going to be affected by this at all.
Brandon:
Do you plan to expand your practice among patients in the place that you’re moving to?
Dr. Serrano:
I have not thought about that yet. I’m not there yet, but maybe, maybe as my kids get older too, I have, I add more hours to my, to my work. So every year I find that I add one or two more hours to my caseload because they’re more independent because they’re doing stuff on their own. And so maybe in five to 10 years, I will have a full time, you know, five days a week practice. Right.
Brandon:
Right. And you keep growing. What, what recommend, what recommendation do you have for other providers who are considering following your footsteps and being like, you know, I’m going to go completely remote and do my practice out of a camper. Like what recommendations do you have for something like that
Dr. Serrano:
Your space, Facebook, Facebook groups, or this, I am part of a therapist, RV life, Facebook group, which is so fun. Oh yeah. So fun where they, you know, we just talk about, you know, what works for me, what works for you? So doing your research, doing your homework, there are certain populations that don’t do very well through tele-health including substance abuse is one of those substance abuse is one of those. And that was actually one of my specializations, so that I had to kind of, you know, really shift my focus on substance abuse. It’s now a different focus. I do more aftercare. I do people that are, have had sobriety for a little bit. And they’re looking for maintaining that as opposed to somebody in active addiction. And so you have to know what your niche is. You have to know what your forte is.
Dr. Serrano:
If you like working crisis, if you like working with individuals who are high needs, telehealth might not be the thing for you. And so do your research. There are so many platforms, so many options. Now that it’s incredible. It’s actually hard to pick. It’s actually hard to pick because there’s so many, you know, different places, the bells and whistles, all of the things, but it is so flexible, especially for individuals, men, and females, right. That have small, you know, small kids. And one more flexibility during the pandemic. Also the clients themselves are asking not to go into the office. And so do you have the ability to say, Hey, you can come to the office in person or we can meet through tele-health. Do you know the research? Can you tell a client whether the research says that the outcomes are the same, if you do in-person or through telehealth, do you know that information? So you can confidently talk to a client about the option of telehealth.
Brandon:
Have you actually done an in-person session with any of your clients?
Dr. Serrano:
Not since I started private practice, not.
Brandon:
Yeah. So I mean, most of these people, you have long-term relationships with, you’ve never actually met in person
Dr. Serrano:
In person. I’ve never met him prior to actually, I, I did meet somebody in Colorado. I do have my license in Colorado when I was there for a month. I did meet with this person at their office. I went to their office. So that was pretty neat. But other than that, yeah. I don’t know my clients in person and my clients seem to be fine with it. They, I really, we really have a long conversation about the benefits and merits of it. And also, you know, the, the downside of it and really clients get to choose, you know, they’re, well-informed, they come in with eyes wide open because I want them to have all the information. And what’s interesting is when I first started this practice, I thought I was going to have a younger population in my, at my caseload. And it has not been the case and many of them when they talk to them and they say, well, you don’t have any in-person you’re, I’m talking about like early thirties. And even in their twenties, they tell me, I just, I’m always online. I want to see somebody in person. And I thought that was extremely interesting because I thought those were the people that I was really going to be flooded with. I was trying to prepare myself that that was kind of be a population. And it’s not, it’s the busy career fees and up that is, you’re looking for tele-health, it’s been interesting.
Brandon:
Yeah. Looking for the convenience more than
Dr. Serrano:
Right. And then there’s the people always online that are looking for the connection, the human connection, and that’s what they want. In-person I, you know, it’s, I’ve learned that throughout the, throughout the four years,
Brandon:
What’s, what’s the biggest success that you’ve had with a patient or, or throughout your time doing teletherapy.
Dr. Serrano:
Yeah. I’ve had great clients. I do mostly brief therapies. You know, I’m the type of person, Hey, I’m going to give you the skills you need. My job is for you not to need me anymore. I’m really gonna equip you and you’re, and you’re going to be on your way. And I try to do that a lot, but I have some long haulers. I have some clients that are just been with me. They’ve had very serious issues and I do have one in particular. She’s actually not even a video client. She is a telephone only. She is not well-versed in technology. And although we tried it, it just doesn’t work for her. And so her insurance company agreed to just do it over the phone. So I do that over the phone with this person, this person, when I first started with this person, they said, maybe I’ll talk to you again.
Dr. Serrano:
Next time they were not convinced at all. They had so much trauma. And so the next time it would be, I’m going to bring the phone. Are they going to pick up? And they would pick up and then the person would tell me, maybe I’ll talk to you next time. And it’s been a year and a half. And the growth that this person has had, this person has really done a lot of work with their trauma. They have reestablished relationships, they have forgiven. They have, this person is also an end of life stage. That is one of the reasons why they wanted to at least try working. They, this person, their goal was to just die with peace and a year and a half later, her health has stabilized because as she has worked on her trauma, the impact of trauma on health, there’s a lot of research on that. And so I am so happy for this person. And it’s been kind of like one of my, my best clients. And I just love, love the progress that this person has.
Brandon:
It must be so satisfying seeing the work and effort you put in and to see somebody’s growth, and then to be able to see that they are continuing to live in and thrive in some ways. And it impacts her health. It’s absolutely incredible what an awesome opportunity as well for you as a provider. So what is, what is your, let’s say long-term goal as a provider
Dr. Serrano:
Long-term goals. I, I do work burnout field. That is something that’s near and dear to me as a mental health practitioner, but I am also a Christian and I have been working for quite a long time in on the side, you know, with different taskforce and working with my local place communities here where I, where I work. And even in other places on getting the church to understand mental health, getting the church to together with practitioners in the community, to collaborate on that research is very clear that somebody will first go to their pastor before picking up the phone and calling for any other type of help. And so to get somebody to church with who is maybe has an addiction, or is bipolar, or is going through a substance, any other type of substance abuse, or is going through abuse and to have a person in the church, not well-versed in mental health and what options there are.
Dr. Serrano:
And to have that door closed, where that person could have been referred out is, is something that’s to me tragic. And so I have been working with several different taskforce groups for my personal denomination. I am in a, in a task force, I’m a contractor, I’m a consultant with them. And I do work in the local level level, bringing education to leadership in churches so that they can better help their, their parishioners to access the care that they need. And so my goal is to eventually work in this more fully, I have a, a, a heart for the ministry and pastors who are burnt out. It is, it is hard being a minister of any of any religion. And the pandemic has just had such an awful traumatic effect on ministers who now can’t even go to hospitals and, and be with their, you know, can perform last rights.
Dr. Serrano:
They can’t be with a family in the hospital when somebody’s passing away. They, you know, the, the home visitations for the shut-ins has been completely changed and reduced people not showing up to church anymore. This has been yes, serious season, and we’ve seen a lot of burnout. We’ve seen a lot of depression. We’ve seen a lot of hopelessness within the clergy. And so we’ve been working really hard and providing resources for the clergy, not only at the local level, but at the national level and making sure that we are able to plug the clergy into even them receiving the mental health care that they need.
Brandon:
And it’s, it’s interesting that you are serving those who serve others in many ways, both in the, the ministry, but also in the health profession as well. And those who do serve often give their all and many times, they’re the ones who, and if they’re not taking care of their own mental health or leading to burnout, and those are the people we need not burnt out and actually get the hall. And so it’s, it’s kinda like you’re there to serve those who serve, which is phenomenal. Yeah. One last question. What does the future of healthcare look like?
Dr. Serrano:
Oh, what is the future? What is the future of healthcare look like? Or what is it, what would I like the future of healthcare to look
Brandon:
Like the future
Dr. Serrano:
Butterflies, right. I would love for there to be a massive reduction of stigma I would love in, and, and in every sense of healthcare, because there’s stigma in the medical side of it, there’s stigma in the mental health side of it. I would love for people to openly talk about situations that are leading to poor health outcomes in every sense of the word. But I also would like to talk about people to openly talk about the things that lead to better and quality in, in people’s health outcomes, without judgment, without individuals feeling like, well, if I talk about this particular subject, then I’m going to be shunned or I’m going to be, I’m going to be judged for it. And so I would love for that to, to be something that is normalized, that we can talk about poor choices that I’ve made. And I ended, okay, because now from that one, I can make better choices and I don’t have to be just labeled as all the poor choices that I have made the fair regarding my physical and mental health.
Dr. Serrano:
I would also love it if in our mental health field and in our, even in our medical field, if there was a more proactive front end approach to treatment, that is something that I would love to see as a social worker. We are trained in, in, in, in graduate school, in a, in a strength based approach, looking at somebody’s strengths, as opposed to looking at deficits and our medical model at this point in time only looks at deficits. It only opens the door for somebody to receive treatment. If they already have something that’s diagnosable, and to get somebody in the door, especially if they’re going to use their mental health, the benefits, and they’re going to use their medical benefits only when there is already something wrong, to me, it’s a disservice. If we could, as part of all everybody’s mental health benefits, do what we call preventative care. If somebody could go into counseling when their little signs are there, right? If somebody can receive full benefits for doing premarital counseling, as opposed to waiting until I don’t know what I’m doing, and we’re messing up here that would change the landscape of, you know, people’s health outcomes across the board. So that those are my two main things.
Brandon:
It’s an aspirational goal. And I think it’s very worthwhile
Dr. Serrano:
If enough people advocate for it.
Brandon:
Absolutely. Absolutely. Well, Sarah, thank you so much for your time. Had a great time chatting with you today, and I appreciate your time.
Dr. Serrano:
Thank you. I appreciate it. Being here and thank you for the opportunity.
