Get to Know Danielle Besuden, LCSW and UpLift Quality Assurance Manager

UpLift’s “Get to Know” series features our providers—so other providers can get to know them, learn from each other, and connect. 

This month’s featured provider is part of UpLift’s clinical team, Danielle Besuden, LCSW, whose perspective requires both breadth and depth to understand the care we deliver.

What are you passionate about when it comes to therapy? 

I am passionate about seeing people make progress and being a support for them along their journey. 

Being a clinician is a special place to be, you get to bear witness to someone's choice to make change in their life. You can see how their life improves because of the changes that they choose to make.

I’m still a licensed clinical social worker in DC and North Carolina. I have practiced in community mental health and child welfare settings before I went into clinical quality work. There are a lot of structural inequities that impact people’s mental health and their ability to create change and movement in their lives, and it is really beautiful to see so much growth despite the barriers. 

What drives you in your work doing clinical quality assurance?

I enjoy the data. There is so much clinical information that is much easier to see when we look at trends across large swaths of information. I get to think about what could be helpful for a clinician in terms of what information we're collecting and how to provide information to them, so they can think differently about something that comes up, especially in their documentation.. 

I also just like hearing from clinicians and what they enjoy doing in their clinical practice. It’s great to hear about other ways that we can be supportive and when we have missed the mark. If we can, I take a moment to reach out to a clinician and say to them, “Hey, how are you? We got this message from someone, and it was positive.” We get to celebrate that. Or, we might have to say, “We got a message with something that could improve. Can we talk through how to problem solve that?”

My role often is to be support for clinicians in identifying ways to improve quality and provide the best care possible to clients.

How do you support providers and their clients?

People can expect to receive case reviews from me where we try to focus on what is going well. It’s also my role to let a clinician know if we receive a negative report, so we can help them improve.

If you reach out to me or have a clinical question or need additional support, we can talk it through. If I don’t know the answer, I can find the right person at UpLift who might have it. 

My goal is for us to be able to highlight clinicians who are doing well and to give that positive feedback. 

Although you are working in your own individual practice, we want you to feel like UpLift is also providing something in the way of support that you might not get in another online group practice situation: that we're actually thinking about you and we’re paying attention to our clinicians. You're not just out there on an island. UpLift is thinking about you and your clinical practice and ways to better help you. 

What does your role entail?

A big part of my role is protecting both UpLift and clinicians. I make sure we have the clinical data documented, so we can ensure that clients have an accurate report of the care they received.

Our data team created a warehouse of all of this information. Now we have to make meaning from all those pieces of data. For example, if there is a clinician who isn’t updating mental status exams for their clients, an outreach might look like, “Hey, it could be a good idea to consider changing your MSE over the course of a client’s time in therapy.” 

I would address something like that because it could come up in an audit. If someone isn’t putting in clinical documentation, I would reach out and suggest they document clinical notes so that everything is together in case of an audit. Another way that might look is, for example, if we have a clinician who has a pattern of seeing high-risk clients. I might reach out to them to make sure that the clinician is doing okay. 

I’ve been in a clinician role, so I’m also always asking, “What’s the space between what the numbers show and what reality is?” 

Numbers can show one thing, but the clinical reality of what those numbers mean may be different than what you think at first glance. 

Like, maybe a provider doesn’t give a client a lot of homework, or the clinician has a low percentage for homework. The reason—the reality behind those numbers—is that this could be a provider who doesn’t do Cognitive Behavioral Therapy. Homework isn’t part of their care because they use a different modality. 

Instead of setting a standard that says homework should be completed in 70% of sessions, let’s do a qualitative review. It also might be that the client stated that homework hasn’t been effective for them in the past—because there’s going to be someone who says they don’t do worksheets. You can ask them to reflect and think about something, but they won’t do a journal entry. Everyone is different. 

What inspired you to get into therapy?

It was sort of by accident. I worked at a lead hazard mitigation nonprofit in undergrad, and my executive director was a social worker. I thought the direction I was moving in was macro level social work. 

But then I went to grad school and I took some classes and I realized that there's something that's really joyful in therapy that I connected to. What I like about this role is that although I'm not in a therapeutic role, I can still use some of those skills I developed there, and I get to look at clinical care from a macro lens. 

What is the best therapy-related article or resource that you've read recently?

I read an old article about emotional contagion recently because I was thinking about one of my clients’ struggles with isolation post-pandemic. 

It was about how if everyone around you feels negative or positive, those feelings and emotions can transfer to you as well.  So you might want to think more deeply about who is around you, who you are connected to, and how that affects your mental health. 

What’s the last book you read or what book did you read recently that you would recommend to anyone?

I read a book called The Highly Sensitive Parent by Elaine N. Aron. It was helpful for my understanding and for my clients to think about their own level of sensitivity to their external environment and how that can impact their parenting. The book offered things that can help my client better think about their needs as requirements as opposed to options.

How do you believe change happens for a client?

Change can happen that is driven externally and internally. Frequently, people are responding to things happening in their environment. So if you lost a job or somebody in your family died, that can create change that's due to external factors. In therapy, change happens when people begin to think internally about themselves and their abilities differently. 

Sometimes that small shift in how they see themselves can lead to bigger shifts in how they then have interactions with other people, their expectations for people in their lives, their ability to communicate their own needs—these understandings can create overall change in their lives.

Are there any modalities or approaches you feel attached to?

Psychodynamic therapy is a modality that I really connect to. I think having a picture and a fullness of the client's story and past dynamics is helpful, even if you're trying to create short-term change, but can also be a path to long-term growth and increased understanding.

CBT is great for getting someone activated. Let's get them moving and changing negative cognitions—but sometimes those negative cognitions are really deeply based in that person's family history.

From a QA perspective, we know most clinicians use more than one modality and will use several within the course of therapy—different modalities for different clients. When I’m reviewing a chart, the modality is less important than consistency.

Is the client coming back week after week? Are we seeing reductions in their PHQ-9 and their GAD-7 scores? If they have a high PHQ-9 or GAD-7, have we connected them to medication management services to see if that would be helpful? Are they providing the client with homework to do between sessions? Are they really thinking about how the client is going to grow outside of the therapy room?

Those things are more important when I think about measuring quality.

What is your favorite way to practice self-care that you’d recommend to other therapists? 

I recently started working out consistently with some help. I started using an app where your trainer sends you your workout and texts you to bother you if you haven't worked out. You can say you’re going to work out twice or four times a week, and they’ll send you workouts for that week, based on whatever schedule you want. It’s created follow-through that I needed to be more consistent.

I think having accountability partners helps you accomplish your goals. My brother is my accountability partner. I tell him, this is what’s happening and what I’ll be doing. I don’t get to say I’m not working out just because I didn’t want to do it.  It’s helpful to have somebody else who knows what you’re trying to get to. 

What’s your favorite local resource you like to share?

It's important for people to go outside, especially when working from home. It can be so easy to just go from the medium screen to the small screen to the big screen. Going outside creates a moment for yourself, to disconnect from what’s happening on the screens inside. 

Why did you choose UpLift?

I chose UpLift because it was a place that was growing, and where I could design a lot of how the clinical quality process works. I could have a voice as opposed to just being top-down with someone dictating, “This is what we're doing.”

At UpLift, I have ideas for things I’d prefer to see as a clinician—our EHR is an exciting example—and there’s actually space to talk about those changes. People will engage in a discussion about making it and listen to me so we can add it to a list or work on another solution that is best for our clinicians and clients.