There’s no “i” in “team,” but there is a “team” in “mental health.” (Feel free to steal that one for a motivational poster to hang in your office. 😉)
Cheesy mantras aside, client-provider collaboration is a main ingredient in the recipe for effective behavioral healthcare. When clients have ownership over their care journey, they are much more likely to stay engaged in the process—and to develop a trusting relationship with their provider.
Collaborative documentation can be an excellent tool for nurturing this type of relationship. And it’s a win-win for time-strapped providers looking to keep documentation backlogs to a minimum. Yet it can be a hard sell for providers who are reluctant to bring note-writing into the therapy room out of fear that it will detract from the client experience.
Add AI to the mix, and providers might become doubly resistant to changing up their current documentation workflow—no matter how many evening and weekend hours they spend catching up on notes.
But, as Scott Lloyd, President of MTM Services; Jessica Gentry, LPC-S, LMHC-S, Senior Director of Behavioral Health at Gulf Coast Center; and Dr. Denny Morrison, Chief Clinical Officer here at Eleos explained during our joint webinar earlier this week, AI-supported collaborative documentation and exceptional client care don’t have to be at odds. In fact, this process-and-tech-powered combo packs an unprecedented punch when it comes to boosting productivity, provider satisfaction, and care quality.
Missed the webinar or want to refresh your memory on everything we discussed? Watch the full on-demand recording here.
What is collaborative documentation?
Collaborative documentation is a process where behavioral health clients actively participate in writing notes for their care sessions. This typically occurs in the last 10 minutes of the session, when the provider fills out the note sections and reviews the content with the client (or clients, in the case of group sessions) in real time.
As Lloyd explained, the provider might ask the client questions like, “Here’s what I heard during our session today. Do you agree?” Or, “Here’s what I believe we accomplished today. Is that what you think we accomplished today?”
The idea is that the client is contributing—and agreeing—to whatever is being recorded in their chart, giving them a voice and a sense of partnership in their treatment plan.
Collaborative Documentation vs. Concurrent Documentation
The term “concurrent documentation” is often used to describe this type of real-time documentation process, but it’s important to distinguish between traditional concurrent documentation and collaborative documentation.
Whereas concurrent documentation might conjure up images of typing or scribbling notes throughout the entire session (potentially hurting client engagement), collaborative documentation should mostly occur near the end of the session. Furthermore, concurrent documentation typically does not allow for client participation in the notewriting process—and that participation is at the heart of collaborative documentation.
“How we describe the practice matters,” Lloyd emphasized. “In the old days it used to be called concurrent documentation, which meant the client sat there while I did my documentation. We intentionally call it collaborative documentation now, because it’s about me engaging with the client.”
What are the benefits of collaborative documentation?
More Engaged Clients
The more involved clients are in the care process, the greater their buy-in—and collaborative documentation is one way to accomplish that. It’s also a good tool for building rapport with clients, because there’s more transparency around what you are recording about them, their treatment, and their progress.
“What do your current actions say to your consumers?” Lloyd argued. “If we’re not including them in documentation, are we really valuing their opinion? Are we really including them in their own care? Is it really client-centered? For most teams, what they’re finding is that it’s not. And by switching to collaborative documentation, it’s making a huge difference.”
He went on to say that there’s often a lot of initial pushback from providers who assume collaborative documentation will have the opposite effect on engagement—largely because it conflicts with what they learned in school.
To help dispel that myth, MTM Services actually surveyed more than 30,000 clients about their experience with collaborative documentation, finding that about 97% reported a positive or neutral impact on engagement levels.
“What we’re seeing from the consumers themselves is that they really do like this and that the concern around engagement is not the problem that we’re seeing,” Lloyd said. “It’s actually quite the opposite.”
Higher-Quality Care
Greater engagement typically leads to higher-quality care—for a variety of reasons, one of which is increased session attendance. Lloyd also noted that based on data collected by MTM Services, providers used 40% less sick time after switching to a collaborative documentation model—likely due to decreased burnout and less pressure to pause direct care work so they could catch up on notes. And less disruption to care also leads to better, more efficient outcomes
More Defensible Notes
In Lloyd’s words, “There’s no more compliant documentation than real-time documentation.” Considering that 65% of federal audit paybacks are due to missing or inadequate documentation, this benefit of collaborative documentation cannot be understated.
Qualitative note reviews are designed to answer the question, “Does the documentation quality justify the intensity, duration, and frequency of services?” In other words, auditors are looking for consistent representation of the Golden Thread, which clearly ties the services delivered to the client’s care plan. And involving clients themselves in the documentation process is like having an added safety net to ensure it adequately reflects those elements.
Curious how Eleos improves note compliance? Check out our compliant progress note examples here.
Less Administrative Backlog
This is a big one. Both Lloyd and Morrison shared data speaking to the gravity of the documentation problem in behavioral health. National surveys conducted by MTM Services consistently point to three documentation-related issues as the top three reasons providers leave their jobs:
- There’s too much of it.
- It’s poorly laid out or unusable.
- It makes them feel hopeless.
That sentiment is reinforced by a recent National Council survey on administrative burdens in behavioral health, which revealed that:
- More than 33% of behavioral health providers spend the majority of their time on administrative tasks.
- More than 66% report the time they spend on administrative tasks takes away from time that could be spent on direct client care.
- 43% say they are not able to manage these demands without working extra hours.
But with collaborative documentation, these problems are all but eliminated. In one extreme example Lloyd shared, a provider was submitting over 90% of their notes 10–50 days post-session. Once that provider shifted to a collaborative documentation process, they were completing 94% of their notes the same day as the client session. Furthermore, that staff member revealed that they were on the verge of resigning before transitioning to the new system. It literally saved them from quitting.
That’s a powerful testament to Lloyd’s belief that productivity—in terms of both sessions logged and notes completed—is more influenced by organizations than individual providers. “Productivity is not a measure of how hard staff are working,” he said. “It’s a measure of how well our systems are working to support our staff.”
How does AI fit into all of this?
Retaining more of the current workforce is one thing—but as Morrison pointed out during his portion of the webinar, making up for workforce shortages is a whole other can of worms.
According to projections from the National Center for Health Workforce Analysis (NCHWA), there will be a nationwide shortage of more than half a million behavioral health providers by 2036.
“Fifteen years out, we are going to be way understaffed for all aspects of behavioral healthcare,” Morrison stated.
In most behavioral health fields, it is literally impossible for employers to “hire themselves out of” that gap. So in addition to keeping burnout at bay and doing everything they can to promote the satisfaction and wellbeing of current staff, organizations absolutely must turn their attention to:
- Leveraging “force multipliers” like group therapy and digital therapy tools to expand the impact of the current workforce.
- Optimizing the existing provider base, which means empowering them to do more of what only they can do—and to spend more of their day “working at the top of their license.”
That’s exactly where AI tools like Eleos—which are designed to free up more time for providers to focus on direct care—come into play. And paired with system changes like moving toward a collaborative documentation framework, AI can make an even larger impact.
Artificial Intelligence vs. Augmented Intelligence
That said, Morrison urged behavioral health organizations to be discriminating about the types of AI tools they bring into the treatment room, because not all AI is created equal—even in the healthcare space. He specifically pointed to the concept of augmented intelligence as an important point of consideration.
Supported by the American Medical Association, augmented intelligence is a flavor of AI that complements—rather than replaces—the work of human experts. In the case of behavioral health, this means the AI creates more time and space for providers to deliver care (i.e., chip away at that 33% of time currently directed away from care due to administrative demands).
“Augmented intelligence is a tool to help you do your job a little bit easier or faster,” Morrison said.
This type of AI isn’t meant to take over for providers, he explained. Rather, it assists with documentation and data analysis, offering clinical decision support—not clinical decision-making. Eleos, for example, can take a 6,000-word therapy session and turn it into a 300-word progress note summary within a few minutes.
But that summary isn’t meant to be blindly accepted as a final progress note. “No more than 80% of the AI-generated content should make it into the note,” Morrison said. That’s because the provider still must use their clinical judgment and expertise to ensure that the note is complete, accurate, and clinically relevant—and make edits and adjustments accordingly.
But having something to work from—especially something that is unique to the individual session that just occurred—can be a huge help to providers at both ends of the experience spectrum. Newer providers get a sense of what should be included in a note—and how different clinical concepts should be phrased. And more senior providers avoid getting stuck in a pattern of using similar verbiage across notes—a common issue that comes up in compliance audits.
Collaborative Review of AI-Generated Note Content
This review process offers the perfect opportunity for collaborative documentation. Once the note is generated, the provider and client can spend the last few minutes of the session going over it together prior to submission—preserving the collaborative nature of both documentation and the care process.
It also greatly enhances the quality of the note, meaning supervisors can dedicate more time to discussing the implications of the care documented rather than the documentation itself.
“The combined efforts of collaborative documentation and Eleos have allowed the conversation between a clinician and their supervisor to focus on what is in the note,” Gentry explained. “Are the therapeutic interventions actually working, or should we be shifting? Instead of discussing where is the note, why are your notes so late, what are the barriers to getting your notes done—it allows for so much more time to be spent on clinical excellence.”
Impact on Staff Burnout and Retention
Both of those benefits together—less late or missing documentation and greater focus on improving care itself—have done wonders for staff satisfaction and retention at Gulf Coast Center.
“We’re definitely seeing an improvement in so many aspects since adopting collaborative documentation and Eleos’ AI platform,” Gentry said. “Specifically in relation to productivity and staff staying on board with us. We do exit interviews, and we ask staff why they’re leaving—and documentation and the expectations around documentation are not coming up. Individuals leave on their own accord for new opportunities, but feeling burnt out on documentation and productivity is not the reason.”
What is the “Write” Recipe for Success?
In behavioral health, client-provider relationships are key to achieving the best possible therapy outcomes. Without trust, you can’t generate buy-in—and without buy-in, you can’t foster engagement. Collaborative documentation offers a huge—and often underleveraged—tool for creating transparency in the care process and allowing that relationship to flourish. And AI offers a low-lift way to embrace a collaborative note workflow with virtually zero disruption to the session itself.
Looking for expert support in managing change and optimizing operations in your behavioral health organization? Check out MTM Services’ consulting offerings here.
Want to learn more about how our specialized AI platform makes collaborative documentation a cinch? Request a personalized demo of Eleos now.
