Ep 43 | Follow Up Strategies

Leah: Hello there, Annie.

Annie: Hey there, Leah. How's it going?

Leah: It's going pretty good. How about you?

Annie: I'm good. I'm excited for our topic today. Follow up strategies, which is something that is an endless source of stress for my poor brain because I never feel like I'm doing it right. How about you? Well,

Leah: Yeah, I'm gonna join your club. I think there's like so many different approaches and I think that's what kind of makes it challenging is that there's, you know, and we'll put it out there right here in the beginning. Like there's no one right way to do your follow up strategies. But there are some things that we really want to consider because no matter what the families you work with need to have the information about how your follow up strategies or your follow up is going to happen right from the get go. And I think that's, you know, such an important aspect of, you know, there's no way right way to do it, but there's a right way to keep your clients informed about what you do offer as follow up, which helps both the client and you in the long run. So I don't know. How do you feel about. Follow up. Like, what do you see as, okay, this is my visit and this is my follow up.What do you think about that when you think follow up?

Annie: I think about the visit is the time that I'm spending with you. And then the follow up is how much time am I able to give and in what form to answering your questions about the time that we spent together. And it's really interesting to think about because Like I have zero expectation that my doctor is going to give me any follow up. Like I go to my doctor, I see him, he asks me questions, he writes me a prescription for whatever is ailing me that day. And then like, if I have questions in between, I don't, I'm not going to ask him, but I do have questions. I often have like many questions and I'm like, Oh, I should remember to ask Dr. Escobar what's wrong with me this time.

Leah: So I have the opportunity next time. I don't really interesting how the lactation field and I think it's, you know, the necessity of the clientele that we're working with and the awareness that we have that like this is how postpartum care should be done. Like, you know, we toss families out of the hospital and like, Hey, good luck. We'll see you. And you know, your OB will see you in six weeks, you know, and, and I think we all as lactation professionals recognize that. You know, that model doesn't work. So, us running in, doing one lactation visit and being like, Okay, we'll see you at two months for your return to work visit. Like, that doesn't work. Like, we know that. They need more. But finding a healthy balance for both the client and for us as providers, it can be, I think, where the biggest challenge comes in. Because, you know, it really, I know we've probably Every single person who's listening to this right now, if you've even worked with one client, can say that it was hard to find the right balance there because, you know, we want to help. We're in a helping profession. The clients want help, so they're motivated to reach out. And I don't know, I think that's why the clear expectations ahead of time are like the thing that I wanted to kind of throw out there from the very first second. But so Annie, tell me about Why clients, you feel like there is such a big need in the postpartum journey to have this follow up. I mean, I know we kind of touched on it just now, but what are your perspective on that?

Annie: I think it's really what you said is that there is a need for it. And I think Any of us who you don't have to have had your own babies to see and understand and believe how hard it is for new families. So Leah and I are both in the United States where it's terrible here. It's just terrible to have a baby because many of us, you know, many of our families are, they don't have Other family members around, they're not living in community with other people. And it's something that I, I say all the time to my clients is that we are not supposed to have babies in isolation. And so even pre COVID when we could be with other people. I wasn't, at least in New York City, seeing a lot of situations where people were being surrounded by other people that are there to help you. Like Javeena Coleman says, everyone wants to hold the baby who will hold the mother. Or even, you know, something I say to my clients, which is when they ask about like, my baby sleeps best when my baby sleeps on me. And I'm like, well, that's because your baby thinks there's an endless supply of adults. able to hold them while they sleep. They don't know that they were born in a pandemic where there's only two or sometimes even one person available. And that person has physical needs too. And so part of it is why we include follow up in the care that we give to families is because we see how bad it can get. For these postpartum families, even under the best of circumstances.

Leah: Definitely. And I think also the other thing, you know, some, there's, there's like magical fairy dust to consults that we might have like one a year where you, you know, they just needed a little tweak in positioning and, you know, the random baby who has like zero oral restrictions, which I'm like, I don't know if they exist anymore, but there might be a few out there, and that has like no dysregulation. Transcription is like this, you know, just lovely little one that just needed a little tweak on position and they go off and, and they do just fine. The rest of them, it's like, we're trying to teach, you know, I don't know, something really challenging, like a unicycle, you know, and we're just trying to teach it like in one two hour period, I'm going to teach you how to ride a unicycle and be able to jump down a balance beam on a unicycle. You know, it's like, nobody can do that in one two hour period, balancing so many different needs from each party. I think. That's why follow up is so important, like, there's so many things we're trying to get them to understand and, and there's just so much the information that might need to be transpired, but it can't all happen in that window of the consult. So this follow up gives us opportunities also to like test the waters, like, okay, you go ride. Write your unicycle for a minute, and if you fall down, let me know, and I'm going to give you another strategy for writing a unicycle, you know, it's like, I think that sometimes is where I'm utilizing my follow up time, I'm like, okay, for the next 24 hours, I want you to try then like give me a report back and let me see what happens and how you guys are feeling about it. And then we can change strategy if needed or decide we need another visit sooner than we thought. You know, those kinds of things.

Annie: Yeah. And I think too, it's a great way to. find out if what we're recommending works because we, they don't have an automatic. I'm going to see you for your six week visit or like once a year for your annual physical, like there isn't anything calendared of like, okay, this is the next time I'll see my lactation consultant. If they're not planning to see us again, we're not able to collect data on whether our interventions are, are effective. So especially. You know, when I was beginning to, I was like, I'll do all the follow up. Yes. You on the phone. I'm going to email you because I need to know if I'm any good.

Leah: Yeah. And I think it hones your skills tremendously. I find even still so much value in, you know, each, each new family that you meet is this like, new little puzzle that you're working out and you think you got the pieces just right, but then you find out like, oh no, one of the pieces fell off the table, you know, and you're like, oh, I got to pick it back up. I find it like so helpful for me, especially when I'm trying out new strategies or, you know, I've come up with a new idea for something they could try, like. getting that feedback is like, it's as much as going to a conference or, or getting a, you know, a webinar on a technique. It's like, yeah, you might have the information, but like putting into practice, it's like as valuable as that to me. And I think we need to be making sure that follow up is a big part of what we do because I do hear a lot of maybe discouragement from families that might be got like an outpatient visit or like right before they left the NICU. They, you know, got some information and they kind of sent them on their way, but then they're, it fell apart once they got home and then they're like, but I had, you know, nowhere to go and nobody to follow up with me on that. So, coming back to like, How we implement follow up or how we kind of communicate that with my families. What strategies have you used any to set the stage for follow up in your practice right now? And I know it's constantly changing because covid likes to make it crazy. But what's going on for you?

Annie: So I really Try to minimize how much follow up I'm actually giving between visits, and that's just come from experience and feeling more confident in what I am telling families also feeling more comfortable saying, And when would you like to see me again? And so that's easy with insurance clients because they are it. Getting coverage and I'm in network, but even for myself, pay clients really being very clear up front that I that this work is not a one one and done. So I have experimented a lot with pricing and as a way to deal with follow up. If that makes sense to say, well, how am I going to make it more? How am I going to make it possible for you to see me more than once? How are we going to make this happen? But I also need to make sure that what I'm giving you doesn't make me feel resentful of you. And that's something that happens to me is that I give too much. And then I'm like, well, why are you doing this to me? Well, you're doing it to me because I told you, you could, and that's how I've run follow up for a long time. So I really am very very clear. And my policy is if you are an insurance client, you do not get follow up between visits. You get visits. If you want to be able to email me between visits that cost 25 a week. And then I'm happy to answer your questions between visits. But often what I tell them is like insurance isn't gonna pay for that, but they will pay for you to see me again. Let's just book another visit virtual visits. So you know, not expecting people to have Unlimited or, you know, multiple in person visits. But with virtuals, I'm like, well, wouldn't you rather have a virtual visit that your insurance is paying for? Then email me and have to like explain it in words and then try to understand the words I'm sending back to you. I don't offer any phone follow up because I don't want to I really cannot talk on the phone. It is too hard for me. My brain can't handle it. I need to be able to see your face and it's very hard to find time for the phone for some reason. I don't know. So my self pay clients, they do get a week included in their fee where I'm saying I will answer your questions by email, text, secure message, whatever your preferred method is. And then after that, it's 25 a week or you book another visit. And I really am clear people ask me, my follow up policies are only as good as my implementation of them. So I have to remind myself when my clients are asking me things that go outside of what I've offered them to just say, here's how you can get the information that You need from me and I would say it's it works for me like in my life And clinically and in terms of my work life balance, I would say I have a lot of Fear that things are slipping through the cracks Because i'm not chasing my clients down to make sure I get you know, that I'm not the hand holding IBCLC. So there's a trade off. It's like it works. The things that work really work, but I'm like terrified that the things that I'm not doing are gonna not, they're not good. How do you handle? follow up. I think you're a little different from me.

Leah: Yeah, I think I probably like more on the side of the handholding. I B. C. L. C. I would say we do have some boundaries around it. Like we have a secure messaging app and they get, you know, a message that says, you know, you get two weeks of follow up after visits. So each time they have a visit You know, they get another two weeks and I also do, I reach out. So in my, I use intake queue, which I love because I've set up all these, the automations that you can do. And I have like my little to do list. And so I open my to do list and I follow up. Send a message to every family, usually a week after their visit and just say through our secure messaging platform, just like, Hey, just checking in, hope everything's going well. If you need any assistance, I'm here for you. Let me know. And they get an email also that's like, Hey, you're coming to the end of your two week follow up period. If you need to schedule another visit, or if you need additional follow up, you know, please reach out to us. kind of thing. So we do try to set the stage to let them know. And surprisingly, I feel like I get a ton more follow up visits because I reach out again. Like, so many times they were like, Oh yeah, we're still kind of like feeling a little unsure about The latch. Could we, could we go ahead and set schedule something else where I feel like if I didn't reach out, they probably would have been like, ah, it's never going to get better. I should just give up now. You know, or maybe just like Kind of hobble through and keep going where I'm saying when they write back, like they're still having some issues, I can say, Oh, you know, it really sounds like maybe you could try this other thing that I'm just going to text you back or, ah, that sounds like kind of a lot. Let's, let's do another check in, let's follow up with this. And for me and the way I work and you know, that, that just seems to work well for me. I will say it probably doesn't. play in as well with the boundaries and like work life balance, although, you know, I don't know how many billions of years have I done this now, but for, you know, now I feel like I'm, I'm much better at saying like, you know, at 6 p.m. unless I'm just like totally. Got nothing going on, you know, which is rare in a house with four boys, you know, I may answer something, but really, I'm not going to answer till the next day and and rarely is that ever an issue. But I do know that that type of follow up requires a lot of additional time for me. And so I have to work that into my schedule, which is probably my biggest challenge because I have a lot of new people coming on, like as far as like new clients. And, but then to still have time to answer the other questions and, and keep following up with people and stuff. There is a huge balance there, but I don't know, that's just the way that I've figured out like works for me, works ish for me, um, definitely works for my clients. They love it, but I feel, I feel like it's. That's a good balance so far for me. And I love now that I've figured out some more automations. I used to be like you were like a little nervous, like I'd worry, did I follow with that person? I don't know. I didn't have a good way to remind myself like who has gotten a follow up, who hasn't. So with Spruce and IntakeQ, which are two platforms that we use, like with Spruce, if like I told somebody to try something different and I said, try this for a couple of days, I put my I tag myself in it and say right back on Tuesday, find out how things are going. And then I just go into my little tags and I just work through them. It might take me, you know, 15, 20 minutes to do them on my computer because then I can type really fast and I'll just work through my tags and the same with intake queue. Like I'll just go through and do my little. To do list. I love my to do list on intake you and it's so fun when it gets to zero. I'm like, yes, I feel like a winner.

Annie: That's a great, that's a great tip about using the tagging yourself and spruce. I use spruce too. And I use it to tag my admin. I've never thought about tagging myself because yeah, that little like ping. Yeah. Is it something?

Leah: Well, because you have your little pages, like how many times you've been paged. And so at the end of the day, I don't usually like run through everything and like try to find what was, cause I have an admin too, that's like scheduling visits and everything. So I, I don't look through every scroll through cause I get like all freaked out, like, well, it's too much happening. What's going on? You know, I just go to my pages and she's paged me on anything new that's come up. And then all my things that I've told myself like you need to go back through and answer this call or answer this text message or check back in are in there. So yeah, so that's how I'm doing it. I, I don't know. It's probably not like the most work life balance, but you have to make time. Like if you're doing that kind of strategy, you have to set time aside. I think that's the biggest. lesson and I don't do it perfectly. I'm like epic fail at it. But like in my mind, my goal, I do have some small goals like from 8 to 8 30 is supposed to be my time to like sit and do it in the morning. But it's not perfect.

Annie: Yeah, that's a good example of a boundary, like making your system be your boundary. Like, okay, like they're gonna I'm gonna do this follow up, but I'm not going to do it just any random time and I'm going to tell myself I'm not doing it right now. And I think that's really important to have that in place to say, just because I told my clients that they get this follow up doesn't mean I have to give it to them the instant that they ask for it. And that's something that I, when I, you know, talk with the You know, subcontractor who works under me or when I'm talking with people that I'm giving just advice to about is that you get a text, you get an email, you get a message and you have a dopamine hit and you're like, Woo, something new. And you're like, it feels good. And then you're like, I got to do something now. I'm energized. I'm ready to act. And that, I mean, that's definitely like my brain is very receptive to that dopamine hit. But The when you respond really fast, you create an expectation that this is how it's gonna go. And so setting a system in place where you're like, I don't do that. My policy is that I respond to text, you know, I at every day at 9 30, I sit down and I go through my list. And then at 9 45, whatever is not done. I look at that at three o'clock or whatever it is, because it's a balance between the being responsive, being available, but not feeding into a sense of urgency or immediacy that can actually make the client's problems worse or, you know, Prevent them from, you know, the ultimate goal of follow up is to create this client self efficacy. And if we're there for them at the drop of a hat, then they're going to need us and we want them to outgrow their need for us. Yeah.

Leah: And I like one thing that I've worked on with my intake Q forms, which is so nice because you can like tweak it all on my care plan. I have, you know, like our follow up plan. And so I say I want it. You know, a report back from you on this timeline. So I tell them I want to hear back from you on, you know, three to five days or one week or whatever. I have like a bunch of different parameters that I have set there. And then like, this is my followup timeline. I put it right there. You need another appointment. I recommend another appointment on this timeline. And that's really helped me to like promoting their self efficacy. Like I want you to work on this on your own, like implement these things, work through them, try them out, use your intuition. you know, use feedback from your baby and work on this for five days and then respond back to me. Not, okay, we did the first latch after you left. You know, like you get those some parents that are like, I want to give you a play by play of my entire journey. And so I feel like that's really helped because we do. I do kind of have this like open door policy like come talk to me all you want. I'm here for you. But I do try to set the stage like this is the expectation. So when I do that, I think it's really helpful because like there are some people that I'm like in 24 hours, I want to know how many diapers this baby's had, how much volume have you been able to get. the baby to take in. Like, there are some people that I'm like, I actually kind of want your play by play, so to speak. And then there's other ones where I'm like, I think this would be helpful for them to know I need to collect data. I need to use my, you know, mom skills. Parent skills for the next three to five days, and then I'm going to tell her how it all went, you know, and that's been very helpful, and I find families are really liking that because I'll get this note like here's our three day follow up, like what's happened for the last three days, and it's really, you know, doesn't seem as overwhelming as just like these random messages here and there, and they don't even know what they're supposed to be messaging me back or what questions would be helpful or not helpful like that I could help them with, you know, like, you know, my, my baby burped one time, you know, like that might not be like as helpful as like, okay, these are the things I want you to report back to me. And so that's what I've been trying to send to them and their care plan. Like, these are the things I want you to look at and then report back to me on this timeline. Unless there's, you know, something changes drastically. So. That's another kind of strategy for that self efficacy part of it. I want them to take ownership and like work through it some.

Annie: Because you know that there are some of those, some of the texts that you get, the desperate ones. You're like, you wouldn't say this to them clinically because you can't really be like Just give it three days and like you can't, I mean, there are ways that you can say that, but you wouldn't just be like, just give it three days. Like, like, please, like, really, I, I believe this and the longer that, you know, I've done this work, the more I really have seen the value in, in time and also, you know, recognizing that. That's when you can say, I do need to just give a little, just give a little reassurance right now or just say, I got your texts. Oh my gosh, that sounds really stressful. I will respond to this in greater detail tomorrow. You know, just so they feel heard. They know that they didn't just send their problems out into the void, that somebody is there who cares about them. And even just that act of giving care without a solution feeds into that self efficacy. It's like, I believe you that it was hard. I validate that. Okay, just and I can't, you know, but also setting that boundary and saying, I'm not Okay. Yeah. I'm not going to go into this right now. Yeah. I'm not going to do what I did in the beginning. What I did in the beginning, which was just the, Oh my gosh, I got to solve this by text right now. You know, while my kids are like, mommy. And I'm like, well, I'm hungry. I'm like, you're not hungry. Just hang on. And then 45 minutes later, I emerged to be like, what just happened? And I didn't make it better for them. Yeah. And you know, worse for yourself, made it worse for myself and that's not being an effective care provider.

Leah: Yeah. I think there's a lot of balance that has to be found in follow up strategies, but I do think having some strategy to it versus like a free for all, like we were, we did when we were first out there, I think has been the most valuable thing that I have learned through my years is like, in the beginning, I didn't really. Have a plan for follow up other than like we're gonna need to see each other again, right, you know, maybe that would be the extent of it, but now setting the stage and expectations for myself with boundaries and like having a plan, but also for the clients like I think they take real ownership of their care plan when they know you know, They need to report back on it in a couple of days and so that we can tweak things or they can say things are getting better or not, you know, that kind of thing. And that has been so helpful for me to not go down that rabbit hole of like, and I still do. I mean, there's still those, those texts that just grab at your heartstrings and you're like, okay, the whole world has to stop for a second because I just have to help, you know, I still do it from time to time. But I think that would be. The one like most valuable thing is like a follow up strategy I think is so important and I love all the tips that you have about having some different strategies for different. pay, you know, like insurance versus self pay, because that's a huge barrier. You know, when people have to pay for the follow up care themselves, it's, it's so hard.

Annie: Yeah, it is hard. And it's, it's balancing it with the compassion, you know, because you're like, I know your insurance probably isn't going to reimburse you. But I also, you know, That's not my problem to solve as an individual person, that's like a systemic problem. And so just, you know, do your best to have good boundaries because good boundaries are good for your clients. You're going to overextend your own boundaries from time to time. Be good to yourself about that and really have a system and a policy. And remember that Time really does help and that are and have a, you know, communicating to your clients that you have a belief in them and in their babies, that they do have what it takes to meet this challenge, that you're here for it. And you're there to be there, their guide and their encourager. And you've got all these skills to help them. But at the end of the day, It's their life, it's their baby, and you believe that they can get where they want to go.

Leah: Yeah, yeah. I think that's such a valuable way to view the follow up strategies that we do put in place, because we don't want to be a crutch for them. You know, we really want to see them be able to take off on their own and, and not let that crutch hold them back. So there's a, there's a big balance with it, but I think recognizing, you know, the needs of that postpartum family, especially in the United States here, just because they are so isolated and left to their own figuring out, which is such a huge undertaking when you're exhausted and tired and stressed. And now with COVID even more isolated. So it's a hard, it's a hard workout, but you're not Not a hard, it's a hard thing to work out for your business and for what you're able to do. But I do think there's not one answer. You know, you see you and I, Annie, we do it so differently, but both of us have, you know, thriving. businesses with happy clients. So there's no right way to do it. It's just finding the way that suits you and your clients the best. So, well, it's fun talking about this today, Annie. I know it's a, it's one of those things we've probably morphed so much over the years. So we can kind of see so many different sides of it. I know you have, and we've talked about that

Annie: before. It was great. I love talking about this topic. I have a feeling this won't be the last episode we do on follow up strategies. Yeah. So thanks for listening. It was always so good to talk to you, Leah.

Leah: Yes, definitely. All right. Take care. Bye. See you next time.