LSSND's Abound therapists come 'Together' to form new practice

FARGO — Tina Jacobs was sitting in a chair and cradling her 5 ½-week-old baby, Anders, when her boss, Sara Stallman, walked into Jacobs’ living room.

It was Tuesday, Jan. 12. Stallman, clinical director at Lutheran Social Services of North Dakota, had texted earlier to tell Jacobs, a provider-relations coordinator with Abound, that she was dropping by. At the time, Jacobs had turned to her husband, Andy, and remarked, half-jokingly, that Stallman was probably going to tell her she didn’t have a job.

But when she saw the look on Stallman's face, her worst fears were confirmed.

She learned that LSSND, a 102-year-old statewide agency, would be forced to close its doors and file for bankruptcy — due to debilitating debt caused by the nonprofit’s affordable housing division . Jacobs would lose her job, along with 282 other LSS employees.

Although the official announcement happened on Friday, Jan. 15, service areas like Abound Counseling were informed a few days earlier so they could give their clients some warning. Abound also was one of a handful of programs that stayed open for several more weeks so its team had a chance to transition their clients to new providers.

“We had 300 families get two weeks’ notice that they were going to lose all their support during a pandemic,” Stallman says. “And the waiting lists at all the agencies and options were so, so deep.”

Jacobs, too, immediately thought of Abound's clients. They served a large Medicare population and many were foster children who had already experienced much trauma and loss in their short lives. How could they tell these children, adolescents and their caregivers that they were going away, and they would have to start all over with someone new?

That evening, the Abound team held a three-hour, tear-filled videoconference. Jacobs and Stallman were impressed with how quickly the team shifted from shock to action. Before it was over, the group had rallied to form a new counseling practice.

“What should we call it?” someone asked.

A male voice piped up. “Together,” said Abound Counselor Jeff Stine, without missing a beat. He said it almost casually, as if he were telling someone the correct time.

“Together,” as in a family of providers working together to help families stay together. It just fit.

Everyone immediately agreed.

With that, Together Counseling was born. Abound closed its doors at LSSND on Friday, Feb. 5; Together opened its doors at 2632 47th St. S., Fargo, on Monday, Feb. 8.

“Rather than just walking away and giving up, we spent hours and hours at night, and just figured out how to do this in as good a way as possible,” Jacobs says. “So I’m proud to say that not one client went with a gap in service.”

Stallman had joined LSS as one of its first mental-health providers under Abound and been promoted to clinical director in 2019.

Once she was in a leadership role, the agency's grim financial picture grew increasingly more obvious. Stallman worried constantly about the future of Abound’s providers and the clients they served. She and the agency's leadership team took a $20,000 pay cut toward the end to help alleviate the agency's expenses. She also volunteered to take on leadership of the organization's interpretive services, which were in danger of being cut.

"Pretty soon I was juggling so many plates of just trying to keep everyone OK," she says.

The situation had become so stressful that it took a toll on her mental health, Stallman says. She felt personally responsible after recruiting all those providers to join Abound's team.

Once the news broke that LSS was closing, Stallman says several large organizations called her with offers to acquire the entire Abound practice. Stallman informed them that Abound's counselors were independent contractors, who could go wherever they wanted to go.

“Everybody had job offers lined up,” Stallman says, “but everyone was spoiled being their own boss. No one wanted to give that up.”

Once Stallman and the other counselors decided to form Together, all energy went into informing clients, finding a new home and taking care of credentialing and insurance paperwork.

“It was nuts,” Jacobs remembers. “It felt like we were all up 24/7. I was up at night, breastfeeding and taking notes, trying to plan the new business, closing down the old one and making sure clients felt OK on the phone.”

The timeline was so tight that the team signed the lease on their new space the weekend before they opened for business.

Why did they push themselves so hard?

In short, they knew North Dakotans were grappling with job loss, financial uncertainty, violence, isolation and addiction in the throes of a pandemic. They were needed.

“It wasn’t just our story,” Jacobs says. “It was the community’s story.”

One element that got them through the difficult transition was the support they received from the community. “People have been courteous and so patient and so understanding and compassionate toward us,” Jacobs adds.

After Together’s website was created, Jacobs started monitoring the site’s traffic report. “It was amazing to see how many people were looking for us,” she says. “And when we got the cell phone, I would get so many calls. People were asking, ‘Do you have a website yet?’ They wanted to know that we were settled.”

While at LSS, the Abound team had won a large grant to offer free counseling and assistance to victims through the Victims of Crime Act. The funds couldn't be transferred to the Together group because it wasn't a nonprofit.

A Grand Forks nonprofit, the Community Violence Intervention Center, stepped in to accept transfer of the funds, which they could then funnel to Together therapists so their clients who were crime victims could continue receiving free therapy.

"They didn't have to do that but they did, and that was a huge impact for the clients," Jacobs said. "Those are some of our most vulnerable."

The two women praised two major insurance carriers — Blue Cross Blue Shield of North Dakota and Sanford Health Plan — who streamlined their typical processes to ensure their clients didn’t lose coverage.

Nearly all of the Together counselors were former Abound therapists, so were already credentialed as “in-network” providers with those insurances. However, their transition to a newly formed agency could have required going through the long and complex credentialing process all over again, Jacobs says.

But when Jacobs explained the situation, BCBS and Sanford officials reacted with flexibility and compassion. “They actually looked at it with logic and … immediately credentialed our providers … so that none of our clients lost care because of insurance policy,” Jacobs says. “The fact that this happened was paramount to us even being able to operate.

Despite its new name, new location and independent status, Together Counseling looks a lot like Abound 2.0. In fact, 14 of the 17 team members are Abound alumni and the other counselors previously interned or partnered with LSS.

Just as Abound had satellite sites throughout the state, several counselors will continue offering services under the Together banner out of Jamestown and Bismarck.

The Together team has also kept counseling contracts with many of the local schools they worked with as Abound.

As they did under LSS, therapists will rely on a creative, individualized approach vs. the traditional medical model, in which therapists see patients for one one-hour session each week from their offices, Stallman says.

“Some people prefer that medical model,” she says. “I think there’s definitely a place for that. It’s a very important and a very good place in the world. But I think the vibe we give off is much more down-to-earth and casual. It’s: ‘We’re here to support you. We’re not the medical experts on your life and what needs to happen.’”

Together’s team are all licensed social workers or counselors with the traditional credentials, but may use innovative approaches such as art projects, cooking sessions, games and field trips to the mall or zoo to help their younger clients relax, open up communication and work on their social skills.

“We meet people where they’re at,” Jacobs says. “Everyone says that. They talk the talk but they don’t always walk the walk. Sara is literally all over town (working with families)."

The Together team will continue offering most of the services that Abound did, with emphasis on treating trauma in foster or adoptive children; support for caregivers, parents and foster parents, and reunification work — in a neutral, safe, therapeutic setting — between children and birth parents.

“We’re really helping caregivers feel capable, competent, cared about and heard,” Stallman says.

At Abound, Stephanie Mestery was the division's main provider of Parent-Child Interaction Therapy. PCIT includes "coaching" sessions in which a parent and their child interact in a playroom while a therapist in an observation room watches through a one-way mirror or live video feed. The parent wears a transmitter in their ear through which the therapist provides in-the-moment coaching on skills that the parent learns positive ways to manage a child's behavior.

Mestery will continue that work, but will be joined by several more providers who are completing PCIT certification. This evidence-based approach is one way in which families can learn healthier parenting skills so children don’t wind up being removed from the home and placed in the child welfare system, Stallman says.

As she did at Abound, Becky Kopp-Dunham will continue offering therapy for farm families through video meetings from her family's farm in Minnesota.

“We’re not just looking at short-term goals, but the long-term prognosis for the family, and how does that mean being resilient and independent, and yet feeling like they have a safety net if they fall back,” Stallman says.

As for her own career path, Stallman says the move from management in a large agency to member of a small, close-knit team has brought her back to what she likes most: helping others. “I’m not managing budgets and people, but doing things that fill me up and doing what I love,” she says.

Reach Together Counseling at 701-404-0997.