Starting a child and adolescent therapy practice gives you greater control over your clinical work and the families you serve. But along with treating clients, you will need to manage intake, billing, clinical records, and referrals.<\/p>\n\n\n\n
Working with minors adds legal and clinical responsibilities. State laws determine who can consent to treatment, who may access records, and when information can be shared. Establishing clear policies before your first session can help you avoid confusion later.<\/p>\n\n\n\n
This guide explains how to start a child and adolescent therapy practice<\/a> in the United States, from confirming your license to preparing your first client appointment.<\/p>\n\n\n\n\n\n\n\n A child and adolescent therapy practice provides mental health care<\/a> to children and teenagers.<\/p>\n\n\n\n Depending on your training, you might treat anxiety, depression, behavioral concerns, trauma, grief, or difficulties at school and home. Some clinicians work mostly with young children, while others focus on teenagers.<\/p>\n\n\n\n Treatment approaches vary by age, presenting concern, and clinical needs. Depending on their qualifications, therapists may use cognitive behavioral therapy (CBT), play-based interventions, family therapy, or other evidence-based approaches. <\/p>\n\n\n\n Parent participation may be part of treatment, but the level of involvement should reflect the child’s needs, applicable consent requirements, and confidentiality rules.<\/p>\n\n\n\n Common practice models include:<\/strong><\/p>\n\n\n\n Solo and group describe who works there. Telehealth and hybrid describe how care is delivered. A solo practice can run fully online.<\/p>\n\n\n\n These 10 steps give you a practical launch order. Some, like credentialing and website work, can overlap.<\/p>\n\n\n\n Start by checking your state licensing board’s requirements. Confirm that your license permits independent practice and covers the services you plan to offer.<\/p>\n\n\n\n Clinical social workers, licensed professional counselors, psychologists, and marriage and family therapists<\/a> may provide therapy to minors within their respective scopes of practice. Supervision requirements, professional titles, and independent practice rules vary by state.<\/p>\n\n\n\n Telehealth requires another check. You must meet the licensing requirements where you practice and be licensed or otherwise legally authorized to treat clients in the state where they are physically located. Review the HHS telehealth licensure guidance before accepting out-of-state clients.<\/p>\n\n\n\n Decide which age groups and concerns you want to treat. You might work with younger children experiencing behavioral difficulties, teenagers managing anxiety, or children adjusting to divorce or other family changes.<\/p>\n\n\n\n Choose a focus that matches your training and experience. Some approaches, including specialized play therapy methods, may require additional education.<\/p>\n\n\n\n Next, decide how you want to operate. Consider your budget, preferred work environment, and the needs of the families you plan to serve. A solo practice may be easier to manage at first, while a group practice may suit you if you intend to work with other clinicians.<\/p>\n\n\n\n You can also start with in-person appointments and introduce telehealth when appropriate.<\/p>\n\n\n\n Pick a business structure your state allows for your profession. Choose a business structure permitted for licensed healthcare professionals in your state. Depending on state law and professional licensing requirements, options may include a sole proprietorship, professional limited liability company (PLLC), or professional corporation (PC). <\/p>\n\n\n\n Some states restrict ownership or require professional board approval. Consult an attorney or accountant familiar with healthcare practices before registering.<\/p>\n\n\n\n Next, register the business, get an Employer Identification Number if you need one, and open a separate business bank account. Keeping money separate makes taxes easier. It also shows whether the practice is working.<\/p>\n\n\n\n Check whether your city or county requires a local business license, zoning approval, or home-office permission. If you plan to hire employees, arrange payroll, applicable employment registrations, and workers’ compensation coverage where required.<\/p>\n\n\n\n Choose professional liability insurance that covers your intended services. Ask whether it covers work with minors, parent consultations, and telehealth. Hiring employees may require additional coverage.<\/p>\n\n\n\n You may need an individual Type 1 National Provider Identifier (NPI), while eligible organizations may need a Type 2 NPI. An NPI identifies a healthcare provider but does not establish licensure or insurance credentialing. Check the CMS NPI guidance<\/a> and the enrollment requirements of your intended payers.<\/p>\n\n\n\n If you plan to accept insurance, prepare your professional credentials, practice details, and other required enrollment documents early.<\/p>\n\n\n\n You can accept private pay, insurance, or both. Private pay gives you control over your fees, but families need to be able to afford the cost. Insurance may make treatment more accessible, though it also adds credentialing, claims, and payment follow-up.<\/p>\n\n\n\n Set your fees based on your expenses, your income goal, and how many sessions you can really complete. <\/p>\n\n\n\n For example, if you want to collect $6,000 per month and expect to complete 60 paid sessions, you need to collect an average of $100 per session. This is a planning example, not a recommended fee. <\/p>\n\n\n\n Use the calculation as a starting point, then account for cancellations, unpaid claims, processing fees, taxes, business expenses, and time off. Distinguish between revenue collected and the income you take home.<\/p>\n\n\n\n Under the No Surprises Act, healthcare providers generally must give uninsured or self-pay patients a Good Faith Estimate of expected charges when requested or when services are scheduled at least three business days in advance. This includes patients who have insurance but choose not to use it for their care.<\/p>\n\n\n\n Establish a process for preparing written estimates, explaining expected charges, and updating estimates when circumstances require it. CMS provides official guidance on required information and delivery timeframes.<\/p>\n\n\n\n If you plan to accept insurance, start credentialing early because the process can take time. Compare each payer’s rates, covered services, and documentation requirements. Our guide to why insurance credentialing is so hard for LCSWs<\/a> explains common challenges.<\/p>\n\n\n\n Do not advertise yourself as in-network until the payer confirms your participation, the applicable agreement is effective, and your practice is authorized to bill under the correct provider and organizational identifiers.<\/p>\n\n\n\n Common codes in child and adolescent practice include:<\/strong><\/p>\n\n\n\n Select codes according to the service provided, documented time where applicable, and current coding rules. Parent consultations do not automatically qualify as family psychotherapy. Check payer coverage, authorization requirements, and documentation rules before billing.<\/p>\n\n\n\n Verify eligibility, copayments, deductibles, and authorization requirements before the first appointment.<\/p>\n\n\n\n Also consider adolescent privacy. An explanation of benefits (EOB) may reveal treatment information to the insurance policyholder. Explain this possibility to families, check available confidentiality options, and follow applicable state laws and payer procedures.<\/p>\n\n\n\n Before beginning treatment, verify who has legal authority to consent. Depending on state law and the circumstances, consent may come from a parent, legal guardian, or the minor. Custody arrangements and court orders may affect who can authorize care or access records. <\/p>\n\n\n\n Request relevant legal documentation when needed, and do not assume that physical custody alone determines healthcare decision-making authority.<\/p>\n\n\n\n Tell families what you will and won\u2019t share. Explain in plain words when safety or the law requires you to disclose something. Use age-appropriate language with the child, too.<\/p>\n\n\n\n Under HIPAA, parents are generally treated as the personal representative of a minor child, with exceptions. State law may let minors consent to some mental health care on their own, and that can limit parent access to records. HHS explains these rules in its guidance on personal representatives and minors<\/a>. Also learn the difference between separately kept psychotherapy notes and your regular progress notes.<\/p>\n\n\n\n Finally, learn your state\u2019s mandated reporting rules for suspected abuse or neglect before you open.<\/p>\n\n\n\nWhat Is a Child & Adolescent Therapy Practice?<\/h2>\n\n\n\n
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What Are the Steps to Start a Child & Adolescent Therapy Practice?<\/h2>\n\n\n\n
1. Check Your License and Practice Rules<\/h3>\n\n\n\n
2. Choose Your Focus and Practice Model<\/h3>\n\n\n\n
3. Set Up Your Business and Finances<\/h3>\n\n\n\n
4. Arrange Liability Insurance and Billing Credentials<\/h3>\n\n\n\n
5. Decide How You\u2019ll Get Paid<\/h3>\n\n\n\n
6. Complete Payer Credentialing and Learn the Codes<\/h3>\n\n\n\n
Code<\/strong><\/td> Common use<\/strong><\/td><\/tr> 90791<\/td> Psychiatric diagnostic evaluation without medical services<\/td><\/tr> 90834<\/td> Individual psychotherapy, typically 38\u201352 minutes<\/td><\/tr> 90837<\/td> Individual psychotherapy, 53 minutes or longer<\/td><\/tr> 90846<\/td> Family psychotherapy without the patient present<\/td><\/tr> 90847<\/td> Family psychotherapy with the patient present<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n 7. Write Your Consent and Confidentiality Policies<\/h3>\n\n\n\n
Set Up Your Practice Workflow Before Your First Session<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/h2>\n\n\n\n
Vozo EHR brings scheduling, clinical documentation, telehealth, and billing into one platform. Explore how these tools fit your practice and your plans for working with minors.<\/h5>\n\n\n\n