Brooke Buck's journey from solo practitioner to founder of an award-winning mental health practice offers a fascinating window into the challenges and triumphs of today's behavioral healthcare landscape.
Ten years after founding Cloudbreak Therapy in Alexandria, Virginia, Brooke has built a thriving practice with 14 staff members offering trauma-informed care across multiple states. Her approach balances clinical excellence with business savvy, especially when navigating the complex challenges facing small private practices today.
The emotional weight of trauma work combined with technology's blurring of professional boundaries has made clinician burnout a pressing concern. Brooke's practice addresses this through intentional boundary-setting, regular supervision, and creating a culture that values self-care. "We can't fix anyone," she emphasizes, highlighting how the "imposter syndrome" many therapists experience contributes to burnout.
When COVID struck, Cloudbreak quickly pivoted to telehealth while experiencing an uptick in demand. Today they maintain a hybrid model, recognizing that some clients—particularly children and those requiring higher levels of care—benefit most from in-person sessions, while telehealth remains essential for reaching rural populations.
Perhaps most revealing is Brooke's candid discussion of the financial realities facing insurance-based practices. Some insurers haven't increased reimbursement rates in eight years, effectively creating a 30% pay cut when adjusted for inflation. Despite this challenge, Cloudbreak remains committed to insurance accessibility while advocating for fair compensation through persistent value proposals and formal complaints.
Looking forward, Brooke is launching TheraGrace, a nonprofit aimed at funding therapy for individuals facing financial hardships. This initiative reflects her mission to dismantle barriers to mental healthcare while addressing growing demands for specialized services, particularly in ADHD and autism support.
Ready to explore innovative approaches to sustainable mental healthcare delivery? Listen now to gain actionable insights from a leader who's successfully balancing clinical excellence with business sustainability in today's complex healthcare environment.
📇 Guest Contact & Social Links
Name: Brooke Buck, MA, LPC, ADHD-CCSP
Role: Psychotherapist and Founder, Cloud Break Therapy + Cloud Break Kids
Website: www.cloudbreaktherapy.com
Email: brooke@cloudbreaktherapy.com
LinkedIn: https://www.linkedin.com/in/brooke-buck
Phone: 703.855.4330
States Licensed: VA, DC, MD, SC
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:04):
Okay, so welcome to Voices in Health and
Wellness, where we speak withpassionate leaders transforming
care in their communities.
Today, we're joined by BrookeBuck, a licensed psychotherapist
and ADHD certified clinicalservices provider and the
founder of Cloudbreak Therapyand Cloudbreak Kids, two
practices based in Alexandria,Virginia, that provide
trauma-informed care acrossmultiple sites.
(00:26):
Brooke's clinics are known fortheir focus on neurodiverse
clients and innovativeapproaches to accessibility in
behavioral health.
We're going to explorereal-world challenges facing
small private practices today,from clinic burnout, clinician
burnout and access issues torising expectations from clients
and everything in between.
So thank you very much, Brooke,for joining us, and you're
(00:48):
calling from Alexandria today, Ibelieve.
Is that right?
Brooke Buck (00:51):
Yes, alexandria, virginia, and we're right
outside of the Washington DCmetro area.
Dr Andrew Greenland (00:56):
Wonderful.
Could you perhaps start bytelling us a little bit about
what you've built in terms ofCloud Break Therapy and Cloud
Kids and what your current roleis within these clinic settings?
Brooke Buck (01:07):
Sure, sure.
Actually, next month we'regoing to be celebrating our 10th
birthday for Cloudbreak Therapy.
I started in 2015.
And it was just me as a solopractitioner.
Prior to this, I had been partof a group practice and I
decided that I was ready and hadthe knowledge and training to
go out on my own.
So I started it and then all ofa sudden be known to me.
(01:29):
It started to grow and more andmore clinicians came aboard.
We had to then hireadministrative assistants to be
able to help us manage takinginsurance, the billing, all the
things behind the scenes.
Now we are 14 individualsbilling all the things behind
the scenes.
Now we are 14 individuals andwe also.
One of those individuals is apsychiatric mental health nurse
practitioner.
We have on staff to helpmedication management.
(01:50):
Other therapists range fromresidents, so they are pursuing,
they're getting their hours.
It's kind of like a postdoc inour kind of mental health world
for counseling.
It's they're getting theirhours to be able to get state
licensed.
We have some residents and wealso have LPCs and also licensed
(02:10):
clinical social workers LCSWsas well and they see a variety
of different populations,everything from children through
adults.
We also see families as well ascouples.
Dr Andrew Greenland (02:23):
Amazing.
And what's your sort of currentrole in the business, I mean in
terms of whether it's ofclinical or leadership admin, or
a bit of all of the above?
How do you spend your time?
Brooke Buck (02:34):
Honestly, a bit of the all above.
I rarely work less than 40hours a week.
I do have my client caseloadthat I refuse to give up because
seeing people and making adifference means so much to me.
I do administrative things onthe side not as much, because I
do have assistants and I dosupervise.
I am also a supervisor in thestate of Virginia and other
(02:55):
areas as well, and so I do helptrain the next therapist that
we're going to go out into thefield and see people as well.
So I've trained about eight ornine people to this point over
the past 10 years.
Dr Andrew Greenland (03:11):
Amazing.
So you're a multi-stateprovider from.
You've got the clinicseverywhere.
What are the big changes thatyou're seeing in mental health
care today from your perspective?
Brooke Buck (03:20):
Yes, given that we're in the Washington DC metro
area, it's kind of hard to justbe licensed in one spot because
they're so close.
So yes, washington DC, marylandand Virginia what we're really
seeing we do see clinicalburnout and I do experience that
with our staff.
You know, is it the heavinessof what the individuals coming
(03:42):
to us are going through.
When you talk about trauma work, it can definitely be a lot,
and for that therapist to be ina good mental head space
themselves to be able to workwith the individual.
So we are definitely seeing thatBoundaries sometimes can be a
concern, given the moderntechnology we have today.
People do text, people do sendemails after hours and if
(04:05):
therapists don't have good setboundaries it can be difficult,
leading to quicker burnout.
So we really really encourageour therapist and our team to
make sure that they are takingcare of themselves.
They are scheduling time off,they're setting boundaries with
when they won't look at any moretexts or emails, when they are
(04:26):
needing a vacation, some timeoff and really being able to
detach, making sure that theyhave good things outside of
their.
They're seeing their clientshobbies, exercise.
What are they doing to takecare of themselves?
So we really try to focus onthat.
We are seeing an intake andsome clinical burnout.
(04:47):
We are doing everything we canto address it, to make sure the
provider can not only show upfor their clients but also show
up for themselves.
Dr Andrew Greenland (04:54):
Excellent.
I'm guessing this is not uniqueto your particular practice.
I guess this is a niche wideproblem.
Brooke Buck (05:00):
Yes, yes, there are .
You know there's.
Think about the rural areas.
There's not a whole lot ofproviders, so those providers
are having a hard time.
And then even in the DC metroarea you know there's so many
practices At the same time it isstill a lot of people coming in
wanting services, needingservices.
So trying to find that balanceof how many is just the right
(05:23):
caseload number and where can Itake more clients on, do I offer
telehealth for someone in ruralVirginia because they can't
find an in-person provider?
You know we're trying tobalance.
All that can be quite a bit.
So I definitely work with theteam to talk about that.
We have group supervision.
I have individual supervisionwith everyone that is needing
that right now and we talk a lotabout that how to make sure we
(05:45):
take care of ourselves which isso important, and sometimes it's
just the peer-to-peer supportcan be helpful.
Like I'm not the only oneexperiencing this.
Dr Andrew Greenland (05:53):
Of course.
I mean, do you think yourapproach has made an impact on
the clinical burnout, certainlyin your practices, having this
sort of more caring approach andbeing mindful of the kind of
contributory factors that leadto it?
Do you think you're making amaking a dent in this if it's an
industry-wide problem?
Brooke Buck (06:10):
trying our best to make a dent in it every which
way we can.
The more we can educateourselves about it, the more we
can stop trying to.
I tell this to every personthat works with me we can't fix
anyone.
We can give them the tools work.
Work with giving them insight,helping them see patterns that
they're developing that arehealthy or not healthy.
(06:30):
We can't fix something.
So one thing is really peoplereally struggle with in this
field is the imposter syndrome,and that I need to do it.
I need to fix it.
I need to.
Just if I just need one morething, I could help this person,
and that is a big struggle weare also seeing in just trying
to reiterate you're here to helpand what does helping look like
?
So many different facets tohelping someone.
(06:52):
It doesn't mean taking care ofit for them.
Dr Andrew Greenland (06:55):
Got it, COVID.
I mean it seems like a longtime ago and yet it seems like
yesterday.
But how did that kind of shapethe way that you run your
services?
I guess, like many practices,you had to shift to an online
model.
I don't know, and I don't knowhow much of that has kind of
carried on since the wholelockdowns disappeared.
(07:16):
But how did that whole shift,your practice and the way that
you do things?
Brooke Buck (07:21):
It was very interesting how quickly it
happened.
I had just had my third childjust come back from maternity
leave and then everythinghappens and everything starts to
shut down.
So we easily pivoted, thankgoodness, because that's why we
have such a great administrativeassistant.
We actually call her a creativedirector because she does
everything behind the scenes forus.
So blessed to have her with us,she was able to get everything
(07:43):
kind of easy to go.
We used to use a system, atfirst called Doxyme, that was
HIPAA approved.
That seemed to go really well.
We started to hire moretherapists because we saw an
uptick, very much so, and peopleneeding services within our
community actually hired sometherapists, some of which you
know were completely remote andI didn't meet them for a year
(08:05):
because of the lockdown andeverything.
So we were able to pivot.
It was hard as a parent andbusiness owner to be able to
figure out how to work from homebecause we weren't having
clients in person.
So that was a big shift forpeople making sure you have a
safe environment that's alsoprivate and quiet, as much as
you can possibly do.
(08:26):
So we saw a lot during COVIDvery much an uptick in people
wanting services.
We also hired several peopleduring that time, so I think we
were very lucky to weather itfairly well.
Dr Andrew Greenland (08:40):
And several years down the line you still
have a sort of a hybrid approach.
You know now that we can stillsee people in person.
We can see people in personthese days, but I just wonder
whether the demand for onlineservices has kind of stayed and
people want to have caredelivered in that way, even
after lockdown finished.
Brooke Buck (09:02):
Yes, most of our therapists do some sort of
hybrid approach.
We do have several that arecompletely telehealth, given
where they are located.
So we are seeing very much atrend of people people, more and
more people wanting to be inperson, and I've owned a lot of
facebook different groups forlpcs, therapists in general,
virginia-based, around the us,world-based and they have also
(09:27):
the comments I read a lotrecently they have also seen an
uptick of people wantingin-person services again.
So it's very much both butsomeone that started services
with us living in possibly arural area.
They're going to probably mostlikely stay telehealth just
because they don't want to haveto then commute, and we wouldn't
require that of any of ourclients if they don't want to.
Some it depends on the day.
(09:48):
With so many people going backinto the office, we are seeing
it becoming a little moredifficult for scheduling
purposes.
So I'm really working with ateam to be flexible with those
individuals while they areemployed.
Dr Andrew Greenland (10:06):
And what's the dynamic like?
I mean obviously the nature ofthe work that you do and it's
really intense and traumafocused stuff.
How does that dynamic change,you know know, in the remote
setting versus in person, andhow do your team show up for
both?
I mean, how do they show up forsomebody who's online, where
you kind of lose a little bit ofthat connection, versus in
(10:27):
person?
Brooke Buck (10:29):
we try our best to make sure we're building rapport
with our clients.
We're open with our clients.
Is this working for you?
Is clients Is this working foryou?
Is this not working for you?
Do you need, instead of atelehealth provider, do you need
an in-person provider?
And sometimes, depending onwhat they're going through and
their level of care, their levelof need, they do need to see
someone in person.
For example, the younger agedindividuals, children, teenagers
(10:50):
, even we really prefer to seethem in person because that's so
much more impactful.
Like you were talking about,some people actually prefer
telehealth as adults.
So it really just varies thepersonal preference.
So we try to be flexible witheveryone.
We do with medicationmanagement, especially if
someone needs to be higher levelof care, needs to be seen a lot
(11:11):
more regularly, we do encouragein-person services and the
younger they are, we doencourage in-person services.
Just, to make sure it's the bestfit for everyone.
Dr Andrew Greenland (11:23):
So what's going really well for you and
your team at the moment in thepractices?
What's something you're kind ofreally proud of that you've
managed to do?
Brooke Buck (11:30):
We're really proud of we were just awarded the best
counseling therapy practice forNorthern Virginia by Virginia
Living Magazine.
So we're very, very proud ofthat.
So we kind of feel like we'redoing something right.
So we were voted that and thenit just came out this month.
Dr Andrew Greenland (11:45):
And what is it you think that you do, over
and above, perhaps, what otherpeople in the space are doing?
What do you think was the thingthat made you win the award?
What was the thing?
Brooke Buck (12:00):
Well, I think, hopefully we're providing good
services and people want tocontinue working with us and we
are able to retain our clientsthat are still needing services,
that they feel that they have arapport with us.
We have built that connectionand that's really important
because when someone comes totherapy, they're probably not in
the best headspace,unfortunately, because they
don't come to see us becauseyou're doing really great.
So we kind of have to take astep back and be like they're
coming for services, they'recoming for support and what can
(12:22):
we do to make sure we are doingwhat we need to build that
rapport to help them, to breakthings down with them and
involve them in their treatmentprocess.
We do treatment plans with ourclients so they know their goals
, just like we know their goals,so they're not coming in every
session and saying, okay, well,I did this this week and this
happened over the weekend.
We're trying to make sure wetie it to those goals every
(12:45):
session, at least one of them,and this goes for all ages.
Dr Andrew Greenland (12:49):
Brilliant.
What part of running amulti-state practice has
surprised you the most?
Brooke Buck (12:53):
Obviously, you've been doing this for a while, but
what's the things that surpriseyou about this whole operation?
It's a lot of juggling.
The bigger it gets, it can be alot to manage and a lot to
support.
So we're not.
We only have one physicallocation, but we are seeing
clients in a variety ofdifferent areas and different
states.
So it's just continuing to makesure I check in with myself
(13:18):
when are we at?
What does the practice need?
Do we need to shift?
For example, our creativedirector is now finishing up
graduate school to be atherapist, so we're definitely
going to have to be shifting.
Do we outsource things now?
Do I take more onadministratively?
And where do we balance?
Because we are aninsurance-based practice?
Unfortunately, we're a dyingbreed being an insurance-based
(13:39):
practice.
Dr Andrew Greenland (13:40):
Got it and how do you maintain that sort of
consistence, culture acrosslocations?
Like you said, you've got onephysical location, lots of means
of patients accessing yourcolleagues, but how do you kind
of maintain the culture acrossyour business?
Brooke Buck (13:57):
Culture with the team.
Dr Andrew Greenland (13:59):
Yeah, yeah.
Brooke Buck (14:01):
Actually we try to do virtual team building
exercises and events.
We actually have one coming up,not this Friday, but next
Friday we're doing a murdermystery virtual experience.
So we try to do those tocontinue to build team morale,
check in with each other.
We have monthly meetings, wehave lunch and learns, to make
sure that we're continuinglearning and engaging and that
(14:22):
we have that connection witheach other.
Also, with the groupsupervision and individual
supervisions or so with thegroup we were able to come
together, collaborate.
I'm struggling here.
I had a win here.
This person had a breakthrough.
I'm so proud of them.
So we're trying really hard tomake sure no one's feeling like
they're isolated on a littleisland.
Dr Andrew Greenland (14:41):
Got it.
You talked about your award,which is amazing, well done.
But on the flip side, what'ssort of being hard or
challenging in the business?
What things are operationallycause you sleepless nights or
things that you worry about?
Brooke Buck (14:56):
Insurance Insurance being an insurance-based
practice that we do acceptseveral different insurances and
we've added throughout theyears.
There are some insurancecompanies that are really
wonderful to work with who arereasonable with their rate
increases for us annually.
Or if we do a value proposalonce a year and send it
(15:17):
requesting a raise, they reallytake that into consideration and
they work with us.
And then we have the insurancecompanies who refuse.
They won't change their rate,they haven't increased their
rate in eight years, so actuallywe're taking about a 30% pay
cut from that insurance company.
Dr Andrew Greenland (15:33):
Wow.
Brooke Buck (15:33):
And they are a dominating factor on the East
Coast.
So we are constantly trying tosee what we can do to make
things work.
We will take insurance, we willalways accept insurance, but
that can be a big barrier.
The insurance company's denyingclaims, the insurance company's
not increasing any of our rates, because it's kind of like how
(15:54):
I describe it to people Imaginethe insurance company is your
boss.
So we are, as practitioners,going to our boss, the insurance
company, saying, hey look,we've done all these great
things and served the community.
We would like this, we wouldlike a raise, and they just
either ignore us or say, no,we're not making enough money.
Dr Andrew Greenland (16:14):
It's funny because I'm UK-based.
We don't really have this kindof thing going on quite so much.
In the uk.
We have a health service whereeverything is free at the point
of delivery for patients in theservice, um, but everyone I talk
to in the us the insurancething is always crops up on
these calls.
It's really, really interesting.
I mean, how do you navigatethis?
I mean, do you have you foundsolutions to kind of work around
(16:36):
all these different things,because you've mentioned some
nightmare things in terms ofthings that affect your income
as a practice?
How do you kind of get aroundall of this?
Brooke Buck (16:44):
We try our best to increase our referrals with the
other insurance companies asmuch as we can.
We file complaints to get theinsurance company that I was
mentioning speaking about thatunfortunately I will not name.
We try our best to see what wecan and can't do.
We try to cut our costs inother areas.
We try our best to make surewe're aware of it and we're not
(17:07):
going to just go away.
We're going to keep doing thevalue proposals.
We're going to keep filing thecomplaints.
We're going to keep doing whatwe need to do to make sure that
we're trying to change whathappens with a lot of practices
and several that I know ofpersonally that I have
colleagues, friends, that ownpractices.
They've just said no, I'm notdealing with it.
So then they go self-pay and alot of people can't afford
(17:30):
self-pay and I know, being inthe Washington DC area.
There are a lot of high-payingjobs, highly educated
individuals, but that doesn'trepresent the whole population.
There are a lot of people whocan't and unfortunately, with
the political climate that we'rein, more and more people need
to be able to use theirinsurance or be able to have a
(17:50):
lower sliding scale rate becausethey've unfortunately have lost
their jobs or gotten laid offor ripped.
Dr Andrew Greenland (17:56):
Got it?
Have you noticed anything interms of client expectations
that you see coming through, andhow has your practice sort of
managed to adapt for what you'reseeing, what people are asking
for?
Brooke Buck (18:10):
Client expectations you know, making sure that you
have in-person availability.
They want to be scheduledfairly soon, especially because
they have something probablygoing on right then and there.
So we try to get people in asquickly as we can, not having
them wait months.
At some points We've had to,unfortunately, do that, trying
to make sure we offer differentservices for the client's
(18:30):
expectations, everything fromlike the medication management
side to maybe a provider thatsees young children, as young as
three.
So we try to make sure we'reoffering those services that
we're seeing people want andrequest.
In the area.
We've also started to offergroups.
We've done a parenting group.
We've also done a women'sempowerment group that people
have really taken hold of andreally seem to like that we also
(18:57):
have.
Every once in a while we'llsurvey our clients, our
population that we have rightnow that we're serving, and like
what are you looking for?
What would you like to see?
What is the most importantthing to you right now as far as
if we're mental health andtherapy, so we do that as well.
That way we can get somefeedback from them.
So we kind of know do we needto pivot and turn somewhere else
(19:17):
?
Dr Andrew Greenland (19:19):
interesting on that point.
Are there any sort of servicesthat families are asking for now
that they weren't sort of twoto three years ago?
Brooke Buck (19:25):
adhd and autism are definitely coming up more and
more.
It wasn't that it didn't existprior.
People are questioning, they'reasking and we're seeing links
and we're like okay we mightneed to consider getting tested.
We also see that in adults, sowe are seeing a big push from
(19:45):
families.
It's like what is going on withmy child.
Is it anxiety or is itsomething such as ADHD that you
know is creating that anxietyfor that person?
We are seeing a lot morediagnosis in autism and autism
spectrum, adhd, theneurodivergent population.
Dr Andrew Greenland (20:04):
Is there a?
I mean certainly in the UK thewait time to get an assessment
in the health service is aroundtwo to three years.
I mean, do you have anythinglike that level of burden in the
US or because of the?
I don't know, because there aremore practices doing what you
do?
Is that something that you canservice?
Brooke Buck (20:22):
We don't necessarily do as much in
testing in-house.
We are constantly networking.
I have a networking eventFriday with other therapists and
oftentimes when I go to thesenetworking events I will meet
individuals who just started apractice with medication
management.
So we can refer people thereand they can do testing.
Or we don't necessarily.
(20:43):
There might be something thatwe don't necessarily do.
So I'm constantly linking upwith people in the community
other therapists, otherpractices.
What do we need to do tocollaborate?
Because we want someone to feel, like they come to us, even if
we can't necessarily supportthem at the moment, that we can
try to link them up with someonewho can.
So these networking events areso important to go to in our
(21:03):
community to make sure that ifwe can't support someone, we can
figure out who can.
And I have my nice little bookof business cards with everyone
in there, so I can look throughgreat.
Dr Andrew Greenland (21:14):
Are there any um in terms of you managing
this as a business?
Are there any particularmetrics or things that you look
out for to kind of gauge howwell you're doing the kind of
things that you focus on as abusiness owner?
Brooke Buck (21:27):
I just want to make sure my staff is happy.
So if they're happy and I cangive them the rate increases
annually that I would like to, Iconsider the business doing
good.
Dr Andrew Greenland (21:37):
So at the end of the day.
Brooke Buck (21:38):
I just want to make sure we have a little bit of
reserve in the bank accounts.
I just want to make sure thestaff is happy, make sure that
they are feeling seen and heardchecking on them with their
mental health.
Feeling seen and heard,checking on them with their
mental health, Do they feel?
we do live in a very pricey area, making sure that they feel
that they can afford the thingsthat they need to be able to
(22:02):
have a place to live, eat allthose things.
So at the beginning of the yearI did ask everybody.
I was like how are you feelingabout what you earned last year?
What would you like to see thisyear?
Dr Andrew Greenland (22:15):
Let's talk about if it's doable what would
put you in a good position,financially Brilliant, and then
thinking about the future, sothinking about the next sort of
six to 12 months.
What are you hoping to build orevolve within the practice?
Brooke Buck (22:25):
Well, actually, Cloudbreak Therapy is partnering
with TheraGrace and that is a501c3 mental health nonprofit
that I've started.
That's going to start with thefunding we're fundraising right
now to be able to fund peoplewho can't afford therapy
services, balance the two ofthose so that we can start to
(22:50):
for the people who have losttheir jobs, having other
financial hardships, that theywill still be able to get
services, because we'll find abalance between practices in the
area for their providers to seeindividuals.
We'll offer a kind of ascholarship program that will
help with the payment of therapyfor individuals for X amount of
time.
(23:11):
So we're in the process offundraising, working with the
board, getting everything kindof up and established.
Dr Andrew Greenland (23:17):
Brilliant.
I was going to ask you.
I was going to ask you if youcould wave a magic wand and
solve one issue.
What would it be?
I think the answer is going tobe the insurance Is there.
Is there anything else, though?
That is like a sort of a blockin what you try to do for your
patients.
Brooke Buck (23:32):
I would love yeah, I would hit the nail on the head
Insurance.
I wish the insurance wouldaccept mental health as much as
they do physical health in theUnited States and work with us
to make sure we're paid areasonable rate for our areas.
I would love that to be moreaccessible for people and
basically making sure that ifsomeone wants services, they
(23:54):
don't have barriers to getservices.
We want to make sure that theyfeel that I live in this area,
there's no therapist, I can'tget services.
We want to work with thoseindividuals.
Yes, you can.
What's your barrier?
Is it finances?
Is it your location?
What is going on that youaren't able to get services?
And also reducing that mentalhealth stigma.
That therapy is not helpful.
(24:15):
It's not helpful to kind ofwork on yourself.
It can be very generational attimes.
Dr Andrew Greenland (24:24):
Brilliant Brooke, thank you so much for
spending the time talking to ustoday about you, your business,
what you achieve, what you've,what you've built really, really
interesting to hear.
Really interesting to hearabout the whole burnout thing
and how you look after yourstaff, um, and also to hear
about the, the common stumblingblock of the insurance, which
seems to be a universal us themethat I'm hearing on these calls
.
But it's interesting becausewe're all trying to learn from
(24:46):
each other as practitioners andit's useful to know what
challenges that other peoplehave in different parts of the
world in different space.
But thank you so much for yourtime today.
Really appreciate your opennessand giving us a sort of candid
insight into your clinic great.
Brooke Buck (24:59):
Thank you so much thank you.
Okay, so welcome to Voices in Health and
Wellness, where we speak withpassionate leaders transforming
care in their communities.
Today, we're joined by BrookeBuck, a licensed psychotherapist
and ADHD certified clinicalservices provider and the
founder of Cloudbreak Therapyand Cloudbreak Kids, two
practices based in Alexandria,Virginia, that provide
trauma-informed care acrossmultiple sites.
(00:26):
Brooke's clinics are known fortheir focus on neurodiverse
clients and innovativeapproaches to accessibility in
behavioral health.
We're going to explorereal-world challenges facing
small private practices today,from clinic burnout, clinician
burnout and access issues torising expectations from clients
and everything in between.
So thank you very much, Brooke,for joining us, and you're
(00:48):
calling from Alexandria today, Ibelieve.
Is that right?
Brooke Buck (00:51):
Yes, alexandria, virginia, and we're right
outside of the Washington DCmetro area.
Dr Andrew Greenland (00:56):
Wonderful.
Could you perhaps start bytelling us a little bit about
what you've built in terms ofCloud Break Therapy and Cloud
Kids and what your current roleis within these clinic settings?
Brooke Buck (01:07):
Sure, sure.
Actually, next month we'regoing to be celebrating our 10th
birthday for Cloudbreak Therapy.
I started in 2015.
And it was just me as a solopractitioner.
Prior to this, I had been partof a group practice and I
decided that I was ready and hadthe knowledge and training to
go out on my own.
So I started it and then all ofa sudden be known to me.
(01:29):
It started to grow and more andmore clinicians came aboard.
We had to then hireadministrative assistants to be
able to help us manage takinginsurance, the billing, all the
things behind the scenes.
Now we are 14 individualsbilling all the things behind
the scenes.
Now we are 14 individuals andwe also.
One of those individuals is apsychiatric mental health nurse
practitioner.
We have on staff to helpmedication management.
(01:50):
Other therapists range fromresidents, so they are pursuing,
they're getting their hours.
It's kind of like a postdoc inour kind of mental health world
for counseling.
It's they're getting theirhours to be able to get state
licensed.
We have some residents and wealso have LPCs and also licensed
(02:10):
clinical social workers LCSWsas well and they see a variety
of different populations,everything from children through
adults.
We also see families as well ascouples.
Dr Andrew Greenland (02:23):
Amazing.
And what's your sort of currentrole in the business, I mean in
terms of whether it's ofclinical or leadership admin, or
a bit of all of the above?
How do you spend your time?
Brooke Buck (02:34):
Honestly, a bit of the all above.
I rarely work less than 40hours a week.
I do have my client caseloadthat I refuse to give up because
seeing people and making adifference means so much to me.
I do administrative things onthe side not as much, because I
do have assistants and I dosupervise.
I am also a supervisor in thestate of Virginia and other
(02:55):
areas as well, and so I do helptrain the next therapist that
we're going to go out into thefield and see people as well.
So I've trained about eight ornine people to this point over
the past 10 years.
Dr Andrew Greenland (03:11):
Amazing.
So you're a multi-stateprovider from.
You've got the clinicseverywhere.
What are the big changes thatyou're seeing in mental health
care today from your perspective?
Brooke Buck (03:20):
Yes, given that we're in the Washington DC metro
area, it's kind of hard to justbe licensed in one spot because
they're so close.
So yes, washington DC, marylandand Virginia what we're really
seeing we do see clinicalburnout and I do experience that
with our staff.
You know, is it the heavinessof what the individuals coming
(03:42):
to us are going through.
When you talk about trauma work, it can definitely be a lot,
and for that therapist to be ina good mental head space
themselves to be able to workwith the individual.
So we are definitely seeing thatBoundaries sometimes can be a
concern, given the moderntechnology we have today.
People do text, people do sendemails after hours and if
(04:05):
therapists don't have good setboundaries it can be difficult,
leading to quicker burnout.
So we really really encourageour therapist and our team to
make sure that they are takingcare of themselves.
They are scheduling time off,they're setting boundaries with
when they won't look at any moretexts or emails, when they are
(04:26):
needing a vacation, some timeoff and really being able to
detach, making sure that theyhave good things outside of
their.
They're seeing their clientshobbies, exercise.
What are they doing to takecare of themselves?
So we really try to focus onthat.
We are seeing an intake andsome clinical burnout.
(04:47):
We are doing everything we canto address it, to make sure the
provider can not only show upfor their clients but also show
up for themselves.
Dr Andrew Greenland (04:54):
Excellent.
I'm guessing this is not uniqueto your particular practice.
I guess this is a niche wideproblem.
Brooke Buck (05:00):
Yes, yes, there are .
You know there's.
Think about the rural areas.
There's not a whole lot ofproviders, so those providers
are having a hard time.
And then even in the DC metroarea you know there's so many
practices At the same time it isstill a lot of people coming in
wanting services, needingservices.
So trying to find that balanceof how many is just the right
(05:23):
caseload number and where can Itake more clients on, do I offer
telehealth for someone in ruralVirginia because they can't
find an in-person provider?
You know we're trying tobalance.
All that can be quite a bit.
So I definitely work with theteam to talk about that.
We have group supervision.
I have individual supervisionwith everyone that is needing
that right now and we talk a lotabout that how to make sure we
(05:45):
take care of ourselves which isso important, and sometimes it's
just the peer-to-peer supportcan be helpful.
Like I'm not the only oneexperiencing this.
Dr Andrew Greenland (05:53):
Of course.
I mean, do you think yourapproach has made an impact on
the clinical burnout, certainlyin your practices, having this
sort of more caring approach andbeing mindful of the kind of
contributory factors that leadto it?
Do you think you're making amaking a dent in this if it's an
industry-wide problem?
Brooke Buck (06:10):
trying our best to make a dent in it every which
way we can.
The more we can educateourselves about it, the more we
can stop trying to.
I tell this to every personthat works with me we can't fix
anyone.
We can give them the tools work.
Work with giving them insight,helping them see patterns that
they're developing that arehealthy or not healthy.
(06:30):
We can't fix something.
So one thing is really peoplereally struggle with in this
field is the imposter syndrome,and that I need to do it.
I need to fix it.
I need to.
Just if I just need one morething, I could help this person,
and that is a big struggle weare also seeing in just trying
to reiterate you're here to helpand what does helping look like
?
So many different facets tohelping someone.
(06:52):
It doesn't mean taking care ofit for them.
Dr Andrew Greenland (06:55):
Got it, COVID.
I mean it seems like a longtime ago and yet it seems like
yesterday.
But how did that kind of shapethe way that you run your
services?
I guess, like many practices,you had to shift to an online
model.
I don't know, and I don't knowhow much of that has kind of
carried on since the wholelockdowns disappeared.
(07:16):
But how did that whole shift,your practice and the way that
you do things?
Brooke Buck (07:21):
It was very interesting how quickly it
happened.
I had just had my third childjust come back from maternity
leave and then everythinghappens and everything starts to
shut down.
So we easily pivoted, thankgoodness, because that's why we
have such a great administrativeassistant.
We actually call her a creativedirector because she does
everything behind the scenes forus.
So blessed to have her with us,she was able to get everything
(07:43):
kind of easy to go.
We used to use a system, atfirst called Doxyme, that was
HIPAA approved.
That seemed to go really well.
We started to hire moretherapists because we saw an
uptick, very much so, and peopleneeding services within our
community actually hired sometherapists, some of which you
know were completely remote andI didn't meet them for a year
(08:05):
because of the lockdown andeverything.
So we were able to pivot.
It was hard as a parent andbusiness owner to be able to
figure out how to work from homebecause we weren't having
clients in person.
So that was a big shift forpeople making sure you have a
safe environment that's alsoprivate and quiet, as much as
you can possibly do.
(08:26):
So we saw a lot during COVIDvery much an uptick in people
wanting services.
We also hired several peopleduring that time, so I think we
were very lucky to weather itfairly well.
Dr Andrew Greenland (08:40):
And several years down the line you still
have a sort of a hybrid approach.
You know now that we can stillsee people in person.
We can see people in personthese days, but I just wonder
whether the demand for onlineservices has kind of stayed and
people want to have caredelivered in that way, even
after lockdown finished.
Brooke Buck (09:02):
Yes, most of our therapists do some sort of
hybrid approach.
We do have several that arecompletely telehealth, given
where they are located.
So we are seeing very much atrend of people people, more and
more people wanting to be inperson, and I've owned a lot of
facebook different groups forlpcs, therapists in general,
virginia-based, around the us,world-based and they have also
(09:27):
the comments I read a lotrecently they have also seen an
uptick of people wantingin-person services again.
So it's very much both butsomeone that started services
with us living in possibly arural area.
They're going to probably mostlikely stay telehealth just
because they don't want to haveto then commute, and we wouldn't
require that of any of ourclients if they don't want to.
Some it depends on the day.
(09:48):
With so many people going backinto the office, we are seeing
it becoming a little moredifficult for scheduling
purposes.
So I'm really working with ateam to be flexible with those
individuals while they areemployed.
Dr Andrew Greenland (10:06):
And what's the dynamic like?
I mean obviously the nature ofthe work that you do and it's
really intense and traumafocused stuff.
How does that dynamic change,you know know, in the remote
setting versus in person, andhow do your team show up for
both?
I mean, how do they show up forsomebody who's online, where
you kind of lose a little bit ofthat connection, versus in
(10:27):
person?
Brooke Buck (10:29):
we try our best to make sure we're building rapport
with our clients.
We're open with our clients.
Is this working for you?
Is clients Is this working foryou?
Is this not working for you?
Do you need, instead of atelehealth provider, do you need
an in-person provider?
And sometimes, depending onwhat they're going through and
their level of care, their levelof need, they do need to see
someone in person.
For example, the younger agedindividuals, children, teenagers
(10:50):
, even we really prefer to seethem in person because that's so
much more impactful.
Like you were talking about,some people actually prefer
telehealth as adults.
So it really just varies thepersonal preference.
So we try to be flexible witheveryone.
We do with medicationmanagement, especially if
someone needs to be higher levelof care, needs to be seen a lot
(11:11):
more regularly, we do encouragein-person services and the
younger they are, we doencourage in-person services.
Just, to make sure it's the bestfit for everyone.
Dr Andrew Greenland (11:23):
So what's going really well for you and
your team at the moment in thepractices?
What's something you're kind ofreally proud of that you've
managed to do?
Brooke Buck (11:30):
We're really proud of we were just awarded the best
counseling therapy practice forNorthern Virginia by Virginia
Living Magazine.
So we're very, very proud ofthat.
So we kind of feel like we'redoing something right.
So we were voted that and thenit just came out this month.
Dr Andrew Greenland (11:45):
And what is it you think that you do, over
and above, perhaps, what otherpeople in the space are doing?
What do you think was the thingthat made you win the award?
What was the thing?
Brooke Buck (12:00):
Well, I think, hopefully we're providing good
services and people want tocontinue working with us and we
are able to retain our clientsthat are still needing services,
that they feel that they have arapport with us.
We have built that connectionand that's really important
because when someone comes totherapy, they're probably not in
the best headspace,unfortunately, because they
don't come to see us becauseyou're doing really great.
So we kind of have to take astep back and be like they're
coming for services, they'recoming for support and what can
(12:22):
we do to make sure we are doingwhat we need to build that
rapport to help them, to breakthings down with them and
involve them in their treatmentprocess.
We do treatment plans with ourclients so they know their goals
, just like we know their goals,so they're not coming in every
session and saying, okay, well,I did this this week and this
happened over the weekend.
We're trying to make sure wetie it to those goals every
(12:45):
session, at least one of them,and this goes for all ages.
Dr Andrew Greenland (12:49):
Brilliant.
What part of running amulti-state practice has
surprised you the most?
Brooke Buck (12:53):
Obviously, you've been doing this for a while, but
what's the things that surpriseyou about this whole operation?
It's a lot of juggling.
The bigger it gets, it can be alot to manage and a lot to
support.
So we're not.
We only have one physicallocation, but we are seeing
clients in a variety ofdifferent areas and different
states.
So it's just continuing to makesure I check in with myself
(13:18):
when are we at?
What does the practice need?
Do we need to shift?
For example, our creativedirector is now finishing up
graduate school to be atherapist, so we're definitely
going to have to be shifting.
Do we outsource things now?
Do I take more onadministratively?
And where do we balance?
Because we are aninsurance-based practice?
Unfortunately, we're a dyingbreed being an insurance-based
(13:39):
practice.
Dr Andrew Greenland (13:40):
Got it and how do you maintain that sort of
consistence, culture acrosslocations?
Like you said, you've got onephysical location, lots of means
of patients accessing yourcolleagues, but how do you kind
of maintain the culture acrossyour business?
Brooke Buck (13:57):
Culture with the team.
Dr Andrew Greenland (13:59):
Yeah, yeah.
Brooke Buck (14:01):
Actually we try to do virtual team building
exercises and events.
We actually have one coming up,not this Friday, but next
Friday we're doing a murdermystery virtual experience.
So we try to do those tocontinue to build team morale,
check in with each other.
We have monthly meetings, wehave lunch and learns, to make
sure that we're continuinglearning and engaging and that
(14:22):
we have that connection witheach other.
Also, with the groupsupervision and individual
supervisions or so with thegroup we were able to come
together, collaborate.
I'm struggling here.
I had a win here.
This person had a breakthrough.
I'm so proud of them.
So we're trying really hard tomake sure no one's feeling like
they're isolated on a littleisland.
Dr Andrew Greenland (14:41):
Got it.
You talked about your award,which is amazing, well done.
But on the flip side, what'ssort of being hard or
challenging in the business?
What things are operationallycause you sleepless nights or
things that you worry about?
Brooke Buck (14:56):
Insurance Insurance being an insurance-based
practice that we do acceptseveral different insurances and
we've added throughout theyears.
There are some insurancecompanies that are really
wonderful to work with who arereasonable with their rate
increases for us annually.
Or if we do a value proposalonce a year and send it
(15:17):
requesting a raise, they reallytake that into consideration and
they work with us.
And then we have the insurancecompanies who refuse.
They won't change their rate,they haven't increased their
rate in eight years, so actuallywe're taking about a 30% pay
cut from that insurance company.
Dr Andrew Greenland (15:33):
Wow.
Brooke Buck (15:33):
And they are a dominating factor on the East
Coast.
So we are constantly trying tosee what we can do to make
things work.
We will take insurance, we willalways accept insurance, but
that can be a big barrier.
The insurance company's denyingclaims, the insurance company's
not increasing any of our rates, because it's kind of like how
(15:54):
I describe it to people Imaginethe insurance company is your
boss.
So we are, as practitioners,going to our boss, the insurance
company, saying, hey look,we've done all these great
things and served the community.
We would like this, we wouldlike a raise, and they just
either ignore us or say, no,we're not making enough money.
Dr Andrew Greenland (16:14):
It's funny because I'm UK-based.
We don't really have this kindof thing going on quite so much.
In the uk.
We have a health service whereeverything is free at the point
of delivery for patients in theservice, um, but everyone I talk
to in the us the insurancething is always crops up on
these calls.
It's really, really interesting.
I mean, how do you navigatethis?
I mean, do you have you foundsolutions to kind of work around
(16:36):
all these different things,because you've mentioned some
nightmare things in terms ofthings that affect your income
as a practice?
How do you kind of get aroundall of this?
Brooke Buck (16:44):
We try our best to increase our referrals with the
other insurance companies asmuch as we can.
We file complaints to get theinsurance company that I was
mentioning speaking about thatunfortunately I will not name.
We try our best to see what wecan and can't do.
We try to cut our costs inother areas.
We try our best to make surewe're aware of it and we're not
(17:07):
going to just go away.
We're going to keep doing thevalue proposals.
We're going to keep filing thecomplaints.
We're going to keep doing whatwe need to do to make sure that
we're trying to change whathappens with a lot of practices
and several that I know ofpersonally that I have
colleagues, friends, that ownpractices.
They've just said no, I'm notdealing with it.
So then they go self-pay and alot of people can't afford
(17:30):
self-pay and I know, being inthe Washington DC area.
There are a lot of high-payingjobs, highly educated
individuals, but that doesn'trepresent the whole population.
There are a lot of people whocan't and unfortunately, with
the political climate that we'rein, more and more people need
to be able to use theirinsurance or be able to have a
(17:50):
lower sliding scale rate becausethey've unfortunately have lost
their jobs or gotten laid offor ripped.
Dr Andrew Greenland (17:56):
Got it?
Have you noticed anything interms of client expectations
that you see coming through, andhow has your practice sort of
managed to adapt for what you'reseeing, what people are asking
for?
Brooke Buck (18:10):
Client expectations you know, making sure that you
have in-person availability.
They want to be scheduledfairly soon, especially because
they have something probablygoing on right then and there.
So we try to get people in asquickly as we can, not having
them wait months.
At some points We've had to,unfortunately, do that, trying
to make sure we offer differentservices for the client's
(18:30):
expectations, everything fromlike the medication management
side to maybe a provider thatsees young children, as young as
three.
So we try to make sure we'reoffering those services that
we're seeing people want andrequest.
In the area.
We've also started to offergroups.
We've done a parenting group.
We've also done a women'sempowerment group that people
have really taken hold of andreally seem to like that we also
(18:57):
have.
Every once in a while we'llsurvey our clients, our
population that we have rightnow that we're serving, and like
what are you looking for?
What would you like to see?
What is the most importantthing to you right now as far as
if we're mental health andtherapy, so we do that as well.
That way we can get somefeedback from them.
So we kind of know do we needto pivot and turn somewhere else
(19:17):
?
Dr Andrew Greenland (19:19):
interesting on that point.
Are there any sort of servicesthat families are asking for now
that they weren't sort of twoto three years ago?
Brooke Buck (19:25):
adhd and autism are definitely coming up more and
more.
It wasn't that it didn't existprior.
People are questioning, they'reasking and we're seeing links
and we're like okay we mightneed to consider getting tested.
We also see that in adults, sowe are seeing a big push from
(19:45):
families.
It's like what is going on withmy child.
Is it anxiety or is itsomething such as ADHD that you
know is creating that anxietyfor that person?
We are seeing a lot morediagnosis in autism and autism
spectrum, adhd, theneurodivergent population.
Dr Andrew Greenland (20:04):
Is there a?
I mean certainly in the UK thewait time to get an assessment
in the health service is aroundtwo to three years.
I mean, do you have anythinglike that level of burden in the
US or because of the?
I don't know, because there aremore practices doing what you
do?
Is that something that you canservice?
Brooke Buck (20:22):
We don't necessarily do as much in
testing in-house.
We are constantly networking.
I have a networking eventFriday with other therapists and
oftentimes when I go to thesenetworking events I will meet
individuals who just started apractice with medication
management.
So we can refer people thereand they can do testing.
Or we don't necessarily.
(20:43):
There might be something thatwe don't necessarily do.
So I'm constantly linking upwith people in the community
other therapists, otherpractices.
What do we need to do tocollaborate?
Because we want someone to feel, like they come to us, even if
we can't necessarily supportthem at the moment, that we can
try to link them up with someonewho can.
So these networking events areso important to go to in our
(21:03):
community to make sure that ifwe can't support someone, we can
figure out who can.
And I have my nice little bookof business cards with everyone
in there, so I can look throughgreat.
Dr Andrew Greenland (21:14):
Are there any um in terms of you managing
this as a business?
Are there any particularmetrics or things that you look
out for to kind of gauge howwell you're doing the kind of
things that you focus on as abusiness owner?
Brooke Buck (21:27):
I just want to make sure my staff is happy.
So if they're happy and I cangive them the rate increases
annually that I would like to, Iconsider the business doing
good.
Dr Andrew Greenland (21:37):
So at the end of the day.
Brooke Buck (21:38):
I just want to make sure we have a little bit of
reserve in the bank accounts.
I just want to make sure thestaff is happy, make sure that
they are feeling seen and heardchecking on them with their
mental health.
Feeling seen and heard,checking on them with their
mental health, Do they feel?
we do live in a very pricey area, making sure that they feel
that they can afford the thingsthat they need to be able to
(22:02):
have a place to live, eat allthose things.
So at the beginning of the yearI did ask everybody.
I was like how are you feelingabout what you earned last year?
What would you like to see thisyear?
Dr Andrew Greenland (22:15):
Let's talk about if it's doable what would
put you in a good position,financially Brilliant, and then
thinking about the future, sothinking about the next sort of
six to 12 months.
What are you hoping to build orevolve within the practice?
Brooke Buck (22:25):
Well, actually, Cloudbreak Therapy is partnering
with TheraGrace and that is a501c3 mental health nonprofit
that I've started.
That's going to start with thefunding we're fundraising right
now to be able to fund peoplewho can't afford therapy
services, balance the two ofthose so that we can start to
(22:50):
for the people who have losttheir jobs, having other
financial hardships, that theywill still be able to get
services, because we'll find abalance between practices in the
area for their providers to seeindividuals.
We'll offer a kind of ascholarship program that will
help with the payment of therapyfor individuals for X amount of
time.
(23:11):
So we're in the process offundraising, working with the
board, getting everything kindof up and established.
Dr Andrew Greenland (23:17):
Brilliant.
I was going to ask you.
I was going to ask you if youcould wave a magic wand and
solve one issue.
What would it be?
I think the answer is going tobe the insurance Is there.
Is there anything else, though?
That is like a sort of a blockin what you try to do for your
patients.
Brooke Buck (23:32):
I would love yeah, I would hit the nail on the head
Insurance.
I wish the insurance wouldaccept mental health as much as
they do physical health in theUnited States and work with us
to make sure we're paid areasonable rate for our areas.
I would love that to be moreaccessible for people and
basically making sure that ifsomeone wants services, they
(23:54):
don't have barriers to getservices.
We want to make sure that theyfeel that I live in this area,
there's no therapist, I can'tget services.
We want to work with thoseindividuals.
Yes, you can.
What's your barrier?
Is it finances?
Is it your location?
What is going on that youaren't able to get services?
And also reducing that mentalhealth stigma.
That therapy is not helpful.
(24:15):
It's not helpful to kind ofwork on yourself.
It can be very generational attimes.
Dr Andrew Greenland (24:24):
Brilliant Brooke, thank you so much for
spending the time talking to ustoday about you, your business,
what you achieve, what you've,what you've built really, really
interesting to hear.
Really interesting to hearabout the whole burnout thing
and how you look after yourstaff, um, and also to hear
about the, the common stumblingblock of the insurance, which
seems to be a universal us themethat I'm hearing on these calls
.
But it's interesting becausewe're all trying to learn from
(24:46):
each other as practitioners andit's useful to know what
challenges that other peoplehave in different parts of the
world in different space.
But thank you so much for yourtime today.
Really appreciate your opennessand giving us a sort of candid
insight into your clinic great.
Brooke Buck (24:59):
Thank you so much thank you.
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