2019 a Year in Review
Full disclaimer – I do own copies of many of the games that I will be talking about, but I do not own any stock in their companies, did not create, or help create any of these games for profit. I will mention whenever I mod a game or change it from its original intent to fit my client’s needs. It is important to note that yes, I am a therapist, but this blog is not intended to be therapy. I will offer advice, tips, and other guidance on my blog with the intent to illustrate important life skills, provide entertainment, inform, and at times empower the reader. If you or a loved one is struggling with mental illness or are facing any kind of crisis seek local professional help, and/or contact authorities or emergency professionals for assistance.
A thank you by way of transparency. In this post we open about what the last year has been like, where we have been, and where we think we might be going. We also talk about why we are not a non-for-profit, what does that mean for our company and any work arounds we see in the future. Explain a little more what it means to do what we do in New Jersey, and how we feel we can do more. Additionally, address ways that we can begin to hold ourselves to a higher standard. What trainings we are currently keeping an eye out for us to attend, and which we are looking to create ourselves. Also take the time out to not just thank the parents, children, and adolescents that we have worked with, but our staff as well. Lastly, we will talk about the outcomes we are looking to achieve in the next twelve months.
Year in Review 2019
2019 was not the easiest year in our lives and very nearly became the hardest on several fronts. In this post, Gaming Approaches Towards Education, LLC would like to lay out some of the buds and thorns of running the rose bush that is our business. We are very aware that we are not a non-for-profit, and in this report we will explain some of the legal aspects that keep us from doing so. Additionally, we will describe why we hold the educational values that we do. Furthermore, we will talk about some of the trainings that we have taken, the ones we feel our company needs to explore more, and the types we want to either create or see out there performed by our peers. At the end there will be a summary and explain where we are going as a company in 2020.
Our New Jersey Contracts
We like to say that G.A.T.E., LLC was created January 2018, but in truth the seeds for this company was planted many years ago. Either through the mentor and mentee relationship that myself and Dr. Moses James had when I first started in the field. Or through the long talks about gaming and therapy between myself and Timothy Grant over the years, the seeds were there. These one on one conversations took place over the course of no less then 15 years. If not over a chess board between myself and Moses, it was over a game of Settlers of Catan with Tim and our friends. I had listened to Napoleon Hill’s Think and Grow Rich and his other book Outwitting the Devil and the idea of creating master mind groups around the topic of gaming and therapy really took shape. There were several road blocks in the way, not the least of which was brand recognition.
If myself or Dr. James began this with one of our own companies it would convolute things. It was confusing enough to our referral sources for the companies we did have. Both myself and Dr. James had 2 contracts one for Intensive In-Home (IIH) and the other for Intensive In-Community (IIC). In fact, we did try this approach to start and get the ball rolling and it was a nightmare, the case managers did not know who and how to make the referrals for IIC-Groups. We were using billing codes that is rarely in use anymore and well, you cannot really blame them. So, the easiest way to simplify things was that only individual cases to our individual companies, and group cases to our co-owned group company. For the most part that worked and streamlined things. Until it did not.
Absorptions and Rejections
We started to notice even after streamlining as much as we could that we were still having problems. We had referrals coming in to one company for In-Home and another company for In-Community, and then another company for groups. The situation was rare but when case managers would get confused by Cyber (NJ’s often unhelpful online client database) it could cause issues where we were not getting paid right for months. At this point we were all making sacrifices to get this thing to work. Dr. James made the decision to close down his IIH and I was going to experiment with my own companies. The idea was to have my IIC absorb my IIH. That way we could see what happens when one company has both routes available to them. The idea was, since both contracts was under my Sole Proprietorship there should not really be any issues. I was wrong. Not only would the state not allow the two contracts to seamlessly merge, I could not even sell one to the other. This put everything in a bad way for us, because we had hoped G.A.T.E., LLC could just absorb my companies as well, since I am co-owner. It was my hope to go all in to make Gaming Approaches Towards Education as strong as possible and then switch to non-for-profit. It was apparent that this will not be the case.
The Desire for Non-For-Profit
Some might ask why even bother with non-for-profit, you have your company, why take that risk. And for the most part they would be right. I mean we have wrestled with these thoughts for over two years now. The only non-for-profit Intensive In-Community company that this writer knew of personally suffered the same weaknesses and dissolved just as easily as any other IIC company that we have seen come and go. Your profit margin would be the same if not lowered, since cannot own the company, or keep any unspent income for yourself. Not that we are operating in the black yet as is, but the idea of not having ownership of this project that we are pouring so much of into, well it has a sense of the profane to us. Ultimately making a non-for-profit version of what we do would not be for us, it would be to help our clients.
Since we have been open many unforeseen issues began to come up for our clients. After the long fight to get our clients into IIC group, the notion of step down into social skills groups through insurance or private pay started coming up. By the time this happened we were on a bunch of insurance panels and figured ourselves and our clients should be fine. Apparently, that is not how Medicaid in the state of New Jersey works, or copays for that matter. Three major issues came up: a.) Horizon NJ never added us in network, despite fighting with them for over a year about this. We are out-of-network and as such we cannot afford to pay our therapists to take those types of cases in the office. As part of step-down services, only myself can work those cases because the payout is $14 an hour. It would be like asking someone with a master’s degree and post license, to work for less than what someone with a bachelor’s degree makes starting in the field. b.) Under insured and/or high co-pays became an evident issue almost immediately. We started noticing that some of our clients would step down from our state contracted services and could not afford to out of pocket. So, we decided to put together a sliding scale. For those of you who do not know the area we live in, it is easy to see how some families would have trouble affording even that. Yet that is not what caught us off guard. What threw us for a loop, was that some families could not afford their co-pays, and the insurance companies would not allow us to put that on a sliding scale. Our contracts prevented that. In those cases, we had to turn to other non-for-profit support like from the local Elk’s Clubs for example. c.) Some of us grew up in Perth Amboy, Carteret, and neighboring towns, we know the community, and the need to help those who are new immigrates into our country. I distinctly remember having Section 8 housing and receiving government aid just to make sure our family can eat at night. The thought that receiving any kind of aid could lead to a denial of citizenship is insane to me. In the last few months families have refused to accept our services from the state out of fear denial of citizenship and deportation. They were doing everything the right way to enter our country, join our society, but could not give their autistic son the services he needed out of fear.
Many of us work in this field out of a desire to help others. We at Gaming Approaches Towards Education, LLC cannot help but wonder how many more people could we help if we could afford to pay more professionals to help, and if through charitable donations families could receive the services that they need without worrying about it breaking their budget, or endangering their ability to stay in this country.
The Rose Bush Critic
Over the years we have picked up a couple of tricks from different areas of both game design, counseling, and supervision. One notion is that if your going to provide a criticism to a supervisee you should have at least three to five positive things to say prior. The idea is that people are more likely to take it as constructive criticism if it is part of the larger overall positive narrative. Additionally, in the last year or two, we have noticed people use the idea of a rose bush to describe feed back on game design. Yes, it is a rose bush, it looks and smells beautiful, and you should also be mindful of these thorns. With that in mind I wanted to write three good things about the year and one negative regarding the game design that is our company.
Limiting ourselves to three areas of potential growth and beauty is surprisingly hard. We had a lot go on this year as individuals and as a company. The top three areas would probably all be associated with pushing us out of our comfort zones. All the therapists who work within G.A.T.E., LLC were used to working as Intensive In-Community clinicians who focused on individual and family counseling within the home. To shift gears to groups and go from as little as 4 group clients a week to as many as 32 in little over a year is jaw dropping. Those numbers have not stood stable, it is a lot of work, but given the opportunity we continue to try to help. Similarly, we have grown in terms of staff, from behavioral assistants, to therapists, to a secretary and a web presence, we are pushing ourselves to grow. Some in-home companies and their owners prefer to stay small, avoid growing and just focus on getting a couple of clients and coasting financially, no where near as stressful as trying to grow a company. For us to continue growing we still need more staff that can work in the field and help our clients in the communities they live in. Lastly, thanks to those helping us in both the gaming and therapy community we were able to get the trainings we needed, offer panels, and provide speaking engagements. For the first time, we spoke at suicide prevention and mental health awareness to groups of children, teenagers, and parents. We took specific trainings from those who do what we do, either Dr. B from “Take This,” or Jack Burkenstock from the Bodhanna group. And thanks to Double Exposure who host Metatopia, and Heather O’Neill from 9th Level Games, we took steps towards speaking at panels both at Metatopia and Pax Unplugged. It inspired us, forced us to grow equal to the challenge, and now we are looking at ways to challenge ourselves further. This year has provided multiple opportunities to prove that it’s a good day to be a rose bud.
Several pages into writing this post I received a phone call that would change my perception of what a thorn is. I could have focused on issues with building a reputation, with having to tell people we just could not provide the service they needed, or even moving from one office to another, then to another, before our current location. We cannot go into full on detail as to why we have moved so many times, especially since we are not in contract negotiations regarding our office space. That fire that God blessed us to avoid, well it is now the reason to terminate our lease which means we are moving again. We now have 90 days to vacate the premises, due to repairs to our neighboring building being so intrusive that it would essentially shut our company down for three to six months. Being that some of our clients have debilitating sensory issues, the noise alone we would have had to leave, not to mention multiple safety concerns. We now must move, manage to pull money together to find a new place, moving expenses, deposits, new brochures, flyers business cards, signs, windows, and all the time and effort that goes into looking for and moving into a new place. Our single greatest thorn, the lack of stability afforded us as we have grown out of our initial office space. If all of our clients were local to one city or town, perhaps we could have used a library for space as we were going through these growing pains.
Thank You Through Transparency
With 2019 behind us, we decided that the best way to thank everyone for this exciting year was to be transparent. To be as open as possible, to hold ourselves to the same standards as a Non-For-Profit even as we decide the best ways to help others. We wanted to provide a newsletter or an update like that of a Kickstarter or Patreon. By letting you know where our time and efforts have come from or gone to, it is our way of maintaining accountability. Moneywise, well it is safe to say that we are still operating in the red and will be doing so for at least another two years. All the moving has made it hard to stabilize and client inconsistencies make long term planning tough. Also, we have done our best to answer every question we can on our website, and if anyone has any other questions we may have forgotten, feel free to ask. We really do want our company to be an educational source one can easily navigate when looking for help for themselves or a loved one. Lastly, if anyone can think of a way, we can help the families we wanted to through Patreon’s, Kickstarters, or GoFundMe please let us know.
Knowing that we must vacate our current office within 90 days derailed our thought processes, and has forced us to hustle in different ways. Even during this chaos, we thought it imperative to provide a thank you by being transparent. We know what 2019 has offered us and we are moving full steam ahead into 2020. We want to go to BFG Con in Maryland, we are looking to do more trainings and be on more panels. It is our aim to provide as much free information to families as possible. The game database will begin in earnest in the coming weeks, and will look for input from other professionals to determine our best options for presenting it. We wanted to have an open house in January, but we might be having a grand opening in a couple of months instead. 2019 for better or worse is over, we are excited for 2020 but also needed to take the time out to not just thank the parents, children, and adolescents that we have worked with, but our staff, care management organizations, other therapy providers, and those in the board gaming industry as well. If we learned anything this year, it is that between now and next December, we need to remember to stop to smell the roses while planning for a couple of thorns along the way.
By Dr. Brian Quinones, LPC, ACS, RPT, Autplay Certified