RE: Phone/email consultation

[Guest guest]

I wrestle with this myself since I get a LOT of similar

requests. I'm coming to the conclusion, though, that it isn't

ethical unless I get the physician's contact information so that I can

write and send a report. The reality, of course, is that we can

also not do a very thorough job by phone or email. That bothers me

more than anything. I've never worked out a good way to gracefully

arrange payment by phone.

I'll look forward to everyone's comments.

Thanks everyone for your help on

the weight calculations.

Here's another question: A mom on a support board I'm on emailed

me

and asked if I'm available for phone consultation. I would

really

like to help this mom, but is it ethical to charge? I would be

happy

to do this for free, but I do anticipate that it will take a lot of

time. There are obvious drawbacks to not seeing the baby and

mother,

aside from digital pictures, but the mom has exhausted her

resources

in her area. The baby is 5 months and not latching. What are

your

thoughts on this situation?

Lynnette Hafken, IBCLC, in land

[Guest guest]

The baby is 5 months and not latching. What are your thoughts on this situation?

How do you do a latch consultation by phone? I've been in the biz for over 20 years, and I'm not sure I'd tackle this kind of problem without seeing the mom and baby in person. Though it really is tough if they've exhausted all the resources in their area.

Phone consults are tricky, as are charging for them. I don't -- but out of laziness, not altruism. However, if I felt a mom was overstepping her bounds in calling me a lot for advice, and wouldn't come in, then I would certainly charge.

Lawyers do.

(\__/)(='.'=)(")_(") Jan BargerLactation Education Consultants My Mother of the Bride Blog Torrey's Blog

[Guest guest]

I think it is tricky to answer calls or e-mails without seeing the mom. I try to do a short answer and then make in-home appointments. If the person is not near you I would suggest having their LC or LLLL contact you so that the consultant person can better explain all of this in person? I like the idea of having the information on pages on your website so you can just say, "refer to this page..." I like to refer to web links. How are these people getting your personal e-mail address? Or explain to the person that calls that you normally charge for a in-home consult. Suggest that she send a "donation" to your website to keep up the website with current information. On the website they can click on a link to add funds? I have no idea if this would work. I have had plenty of people send my LLL group donations for helping them out as a volunteer.

Annette Leibovitz

[Guest guest]

When I began my private practice a few months ago (www.lifecirclecc.com), I did not envision working significantly with mothers over the phone. Yet, I am doing this under certain circumstances. I do not focus solely on lactation consulting, nor really on "traditional" lactation consulting. I am a dual professional (clinical counselor and lactation consultant) who primarily (so far) provides mental health care to primarily (so far) breastfeeding mothers. (I also provide services to professionals, but that's a different topic.) Few dual professionals like me exist in the US (or elsewhere), so if a mother has a psychological issue (e.g., traumatic birth experience, pospartum depression, postpartum anxiety...) which significantly impacts breastfeeding or a breastfeeding issue (e.g., chronic low supply, loss of breastfeeding, threatened loss of breastfeeding, chronic pain with breastfeeding, chronic difficulty with breastfeeding due to maternal and/or infant factors, ...) that significantly impacts her mental health, she may have a very hard time finding someone in her area with the kind of background that she needs. Also, mothers can be on bed rest during a high risk pregnancy, may be virtually housebound due to the challenge of going anywhere with newborn twins or triplets..., etc. At any rate, as long as I and the client both believe that telephone sessions would be beneficial to the client, we engage in them. I mail or email all the forms I would normally give to an in-office client (e.g., information explaining my practice, financial agreement, health questionnaire, etc.) so that they can be completed and returned to me before our first session. The first session is spent largely on going over this information, in part, so that I can determine if I believe the mother really needs to be seen by someone in person. I usually am part of a mother's team of health care providers. I ask for contact information for other health care providers and communicate with them as needed. The mother is often already working with a primary health care provider, a local lactation consultants, a local mental health care provider, etc.--but has found that none of the people on her team are able to work in the multidisciplinary way that she needs and that I can do. A mother might find me by word of mouth, an internet search, or by being referred to me by one of the members of her health care team. I have a very simple page on my website through which I can accept PayPal and credit card payments. (I use basic storefront tools provided by Yahoo which hosts my website.) This page is invisible to visitors--there is no link anywhere on the other pages of my website that would take a person there. I use this page myself to process payments electronically. I charge a flat hourly rate for services--the same for in-person sessions and telephone sessions. I do not provide services by email. I use email only for business-type communication (e.g., transmitting forms, confirming an appointment). I have a business telephone line (not yet toll free, but if the demand for telephone sessions continues, I will definitely look into that). There are certainly many situations in which I would not feel that telephone sessions would be a good choice--and I tell mothers up front (verbally and in forms that a mother signs) that if this kind of situation arises, I will refer her to local health care providers. My practice is not the same kind of practice that most lactation consultants would have. So, I'm not sure how applicable any of my thoughts and experiences would be for other LCs. But, I thought I would briefly describe how I engage in counseling/consulting sessions over the phone, just in case something was useful.

-- Good Mojab, MS clinical psychology, IBCLC, RLC, CATSM LifeCircle Counseling and Consulting, LLC Website: www.lifecirclecc.com Phone: Email: admin@... Ammawell Website: http://home.comcast.net/~ammawell Announcement only email list: ammawell-subscribe

[Guest guest]

I'm so glad we are talking about this. It is a really

growing concern. Lately I've been inundated with mothers emailing

me with desperate pleas for help with low milk production

situations. Most of them have been through several local lactation

consultants, but have not found the answers they need, so I can't just

turn them back to their local LC(s). In most cases, I do have some

information I can share with them that is helpful. But more and

more I find myself " giving away " information and spending a lot

of time carefully crafting answers to make sure I am covering

bases.

I plan to redo my BFAR website and create a new one with Marasco

just for low milk production situations, and ideally mothers will find

the information they need there and not feel a need to contact me

personally. But I bet they still will. I worry that when the

new book comes out even more will seek me and out. I can't

picture turning them away and I can't change my email address. I

also can't picture saying " I'll answer your email for

$XX. " So what to do? I just can't figure out how to

handle this. And I worry a lot about that ethical line whereby I am

required to write a report to their physician.

I bet a lot of you get emails from mothers seeking answers online.

How do you handle it? Is it ever overwhelming for you?

[Guest guest]

, I can really relate. It seems that any time I get something new published, I get an unbelievably large number of emails from mothers and professionals asking for information on that topic. I was absolutely overwhelmed by the number of inquiries I received during the several month time period during and after which I had published several articles on sunlight deficiency and breastfeeding. I don't think people realize how very much time it takes to answer an inquiry well. I can't count the times I have spent an hour or even more on my reply to someone's email. Only a small percentage of the time have I even received a "thank you" in reply! When those emails add up, the time adds up. Posting information on my websites has helped, but I still receive inquiries. Most people have no idea that I am the homeschooling mother of a young child and that I have very little discretionary time into which I am trying to pack research, writing, creating presentations, speaking engagements, and, now, my private practice, etc. I have made it clear on the website for my private practice that I do not use email for anything other than business-related inquiries, and on my other website, Ammawell, that I cannot answer breastfeeding questions by email due to limits on my time. (I do, however, answer breastfeeding and maternal health related questions via the expert panel of Mothering magazine's website.) And, yes, I still do get email inquiries. Anyway, I think it helps to figure out what my own needs are and to respect them myself, to communicate via my websites what I can and cannot do, and to intentionally chose where I will and will not spend my time and energy in the role of a volunteer. I don't have all of this perfectly balanced out--it really is a dynamic kind of thing that changes with my own changing needs, my family's, my private practice's, my writing projects, etc. It is hard to say "no"--especially when I know a mother may be very unlikely to find the information/care elsewhere. And, at the same time, if I burn out, I won't be able to say "yes" to anything or anyone, including myself and my family. I also keep in mind that I have a right to earn a living. I am proud of the countless hours I have spent volunteering in my life and I cannot justly be faulted by anyone for not being able to say "yes" to everything.

Hoping something here helps,

-- Good Mojab, MS clinical psychology, IBCLC, RLC, CATSM LifeCircle Counseling and Consulting, LLC Website: www.lifecirclecc.com Phone: Email: admin@... Ammawell Website: http://home.comcast.net/~ammawell Announcement only email list: ammawell-subscribe

-------------- Original message -------------- I'm so glad we are talking about this. It is a really growing concern. Lately I've been inundated with mothers emailing me with desperate pleas for help with low milk

[Guest guest]

FWIW, mental health professionals have done phone/email consultations for

quite some time. I recognize that it is quite different, as there is not as

great a need to actually see the individual being treated. Also, you miss

the information you would gain from pre-post feed weights, etc. However, if

the mother was in a remote area, it was winter and she was snowed in, etc.,

etc. this could be the only option she has. Also, you could ask for some

specific pictures. Again, the information is only as good as what is

provided. Your assessment would have to be very specific and communication

would have to be quite clear. You'd have to ask a lot of questions that

would help you " see " the dyad. While not ideal, it is probably workable,

probably easier/more effective for follow-up than for initial consultations.

Remember that some people are much more visual learners than others. While

I gain a lot of information by seeing someone, others gather that

information by hearing or feeling.

Wagner-

[Guest guest]

Since there's more discussion, here's a link to an online psychotherapy site

<http://www.mytherapynet.com>. If you do a goodle search, you can find

others; this just happens to be one I attended training for. At this

particular site, they have a network of providers so you can get immediate

help.

Anyway what these sites seem to have in common is some kind of self-help

library and information about the fact that they charge for consultations.

You plug in your credit card number and they charge by the minute. They do

this in a chat format. I know this doesn't resolve the problem with

carefully crafted email responses. Honestly, I stopped answering LLLI Help

Forms for awhile because I was spending *so* much time responding. It

seemed so much more time consuming than talking on the phone.

Wagner-

[Guest guest]

, thank you SO much for sharing your

experience. It's awfully nice to know that there is someone else

out there working through the same challenges.