One case study and two samples that show how I build hiring and training systems for clinical teams.
Harbor Lane Behavioral Health is a fictional three-site outpatient agency. The denial reasons, baselines, and goals below are illustrative assumptions, not client data.
A fictional client says she is “doing okay.” She has missed two work shifts this month and sleeps about four hours a night.
Client reports doing okay. Discussed coping skills. Client engaged and participated. Continue weekly sessions.
Client reports low mood most days and anxiety, sleeping about 4 hours a night. Has missed two work shifts this month and skipped a planned lunch with a friend.
Used behavioral activation: client and I scheduled two activities this week and planned the first step. Client agreed and named fatigue as a barrier.
Client denied thoughts of self-harm today. No change in risk since last visit.
Plan: weekly sessions. Review activities next session. Recheck sleep.
Payers deny claims for insufficient clinical evidence, and auditors flag notes. Each denial costs billable revenue and supervisor time. New providers feel it most, and many fall behind on productivity in their first weeks.
Illustrative denial reasons, based on common payer rejections:
I was the instructional designer and the clinical subject matter expert. I owned the needs analysis, objectives, sample notes, scenario, and measurement plan.
Harbor Lane's Clinical Director confirmed clinical accuracy. Billing and compliance supplied denial reasons and audit findings.
I started with baselines and a gap analysis, not a course.
One decision. Based on the assumed causes, I did not build a time-management module for late notes. They came from caseload and no protected time, so training would not fix them. I recommended protected documentation time instead, and built training only for the skill gap: new providers did not know what a reviewer needs to see.
| Problem | Likely cause | Training fixes it? |
|---|---|---|
| Notes that do not support medical necessity | Skill gap | Yes |
| Late or missing notes | Workload, no protected time | Partly |
| Burnout and caseload | Staffing, scheduling | No |
My recommendations, not findings: an EHR note template with payer prompts, supervisor note review in weeks 2 to 4, protected documentation time, and a phased caseload ramp-up.
Objective. After the scenario, a new provider writes a progress note with six elements: symptoms, effect on daily functioning, a clear intervention, client response, current risk factors, and a plan. The note is scored against a checklist.
I built a 12-minute branching scenario for laptop or phone with three decisions:
Each choice gets immediate feedback. I paired it with a draft note-quality checklist built from common denial language. New providers and supervisors use the same checklist.
This is a design sample, so there are no results yet. Here is how I would measure it:
| Level | Measure | When |
|---|---|---|
| 1. Reaction | Two-question survey after the scenario | At completion |
| 2. Learning | Share who pick the strongest choice on the first try | At completion |
| 3. Behavior | Note-quality checklist score on real notes | Days 30, 60, 90 |
| 4. Results | Denials, audit findings, on-time notes, week-four goal attainment, early turnover | 90 days, then 6 months |
I would compare the new cohort with the last one. A pilot at one site against a comparison site would be stronger.
I would change four things:
The documentation skill carries over to primary care and specialty clinics. For those clients, I would swap in a scenario built on a medical visit note.
AI process note. I directed the problem, audience, and scope. I edited all copy. Clinical content would be confirmed with a Clinical Director before real use.
A 12-minute branching scenario for new providers. Three decisions about clinical notes, with feedback after each one. It shows how I build practice, not just content. The project is fictional: Harbor Lane Behavioral Health is an invented agency, and no client data is used.
A seven-stage map from job posting to the 90-day check-in. It shows where providers are commonly lost at each stage, what a strong version looks like, and who owns it. It also lists the skills that matter for seven common roles in behavioral health and clinics.
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