Introduction

ADHD presents perhaps the clearest example of the insight → action gap in psychiatric practice. Patients grasp what they need to do—organize materials, initiate tasks promptly, follow through on commitments—yet consistently struggle with implementation due to executive function deficits. Even with optimal medication management, the gap between knowing and doing persists.

Coachiatry™—defined as between-session, psychiatrist-supervised interpersonal accountability coaching—represents an exciting advancement in ADHD care. Our foundational philosophy is simple: "Stick to the Plan!" Our coaches never create treatment plans, recommend therapeutic actions, or engage in psychiatric assessments. They focus exclusively on ensuring patients complete the specific tasks and exercises you prescribe between sessions.

While this article discusses ADHD specifically, diagnostic information stays between you and your patient, and is never shared with coaches as it's completely irrelevant to the accountability support they provide.

The Implementation Challenge

ADHD creates implementation barriers that medication and traditional interventions struggle to fully overcome:

First, executive function deficits persist even with optimal medication. Studies show that medication improves attention by 70-80% but organization and time management skills typically improve by only 15-30%, creating a critical treatment gap.

Second, inconsistent environmental structure makes maintaining systems particularly difficult. Patients create organization systems during sessions but struggle to maintain them without regular reinforcement and adaptation to real-world complications.

Finally, the task initiation barrier—perhaps ADHD's most debilitating feature—leads to chronic procrastination and avoidance behaviors that intensify as tasks accumulate, creating cycles of overwhelm and demoralization that medication alone cannot break.

These challenges aren't about understanding techniques but about consistently following through on agreed-upon activities between appointments—precisely where accountability coaching can make a difference without ever crossing into clinical territory.

The Coachiatry™ Solution

Our 'Stick to the Plan!' approach means coaches never 'play doctor' by discussing diagnosis or treatment rationales. Instead, they simply verify that patients follow through on the plan established with their doctor. Coaches support clients between sessions by helping them stay accountable to their agreed-upon goals. They never diagnose, interpret medical data, recommend treatment modifications, or provide therapy. Their sole focus is ensuring clients complete their assigned tasks and documenting any non-adherence with the specificity doctors need to adjust treatment plans. Just like a parent asking their high-schooler 'have you done your calculus homework?' without understanding calculus or attempting to teach it, our coaches help clients stick to their medical goals without practicing medicine.

For patients with executive function challenges, Coachiatry™ coaches provide accountability for following your prescribed plan:

• Workspace organization verification: Coaches check that patients maintain the organizational systems you've prescribed, confirming whether daily filing, desk clearing, or digital organization tasks are completed as scheduled.

• Task initiation accountability: Coaches conduct scheduled check-ins at times you've identified as problematic, verifying patients have begun their assigned tasks and identifying specific obstacles to starting when they haven't.

• Planning system adherence: Coaches verify patients are consistently using the planning tools you've recommended, checking that appointments, tasks, and deadlines are properly recorded and reviewed according to your prescription.

• Weekly Behavioral X-Ray reports documenting only adherence metrics: completion rates of organizational tasks, on-time initiation percentages, and planning system usage—providing you with actionable data about implementation, not clinical outcomes.

As the psychiatrist, you create and adjust the treatment plan while coaches simply verify completion. Coaches focus exclusively on questions like: "Did you set up your planner for the week as Dr. Johnson prescribed?" and "What prevented you from starting your work project at the scheduled time?"

When patients raise clinical questions, coaches redirect: "You need to discuss those symptoms with your doctor. My role is simply to help you stick to the plan your doctor created."

Hypothetical Clinical Scenario

Consider a hypothetical case: Jason, a 34-year-old software developer in your practice who has responded well to stimulant medication but continues struggling with project completion and organizational systems. Despite understanding planning concepts, his work and home environments remain chaotic.

"The medication definitely helps me focus," Jason says during a session, gesturing with visible frustration. "But I still can't seem to start tasks until they're urgent. Last week, I almost missed another deadline, and my manager is losing patience. I know I should use a planner, but I buy one every January and abandon it by February."

You develop a comprehensive treatment plan including specific organizational systems, scheduled task initiation times, and a digital planning system. You suggest Coachiatry™ as an implementation-focused addition to this plan: "Jason, you understand what systems would help, but it sounds like the gap is in consistently applying them. Let me suggest adding Coachiatry to your treatment—you'd work with a coach between our sessions who would check that you're completing these specific organizational tasks and using your planner as we've discussed."

When referring Jason, you only communicate the specific tasks he needs accountability for: "Client needs daily verification of workspace organization (both physical and digital), check-ins at 9am to ensure task initiation, and weekly confirmation that his digital planning system is properly maintained." You deliberately omit any mention of ADHD or medication details, as this information is irrelevant to the coach's accountability role.

After your referral, Jason's Coachiatry™ coach schedules regular check-ins to verify completion of these assignments.

"Have you organized your desk according to the system Dr. Smith prescribed?" his coach asks during a check-in.

"I started but got distracted by emails. I only finished half of what I was supposed to do," Jason admits.

"I understand getting distracted happens," the coach responds, carefully avoiding any clinical assessment. "What might help you complete the full organizational system tomorrow as scheduled? Would a morning reminder or having me check in during the process be helpful?"

During their third session, Jason asks his coach, "Do you work with a lot of people with ADHD? I'm wondering if my medication dose is right." The coach promptly redirects: "Those are important clinical questions that Dr. Smith is best positioned to answer. My role is simply to help you stick to the organizational system and planning routine your doctor has prescribed. Speaking of which, I noticed you didn't complete your planner setup yesterday—what specific obstacles prevented you from doing that?"

Each Monday, you receive a Behavioral X-Ray report documenting only Jason's adherence metrics. Week 4's report highlights:

• Workspace Organization: Physical desk organization completed 4/7 days (57%); digital filing system maintained 3/7 days (43%)

• Morning Task Initiation: Started work at scheduled time 3/5 weekdays (60%)

• Planning System Usage: Weekly planning session completed; daily review sessions completed 4/7 days (57%)

Reviewing this adherence data before your session, you can make informed clinical decisions:

"I see from your Behavioral X-Ray that you're consistently completing your weekly planning session, which is excellent," you observe during your appointment. "However, I notice you're having more difficulty with the daily maintenance tasks, particularly in the afternoons. Let's discuss what's happening during that time and whether we need to adjust our approach."

You update Jason's treatment plan and communicate the changes to his coach: "Please continue morning check-ins for task initiation. We're modifying the organizational system to include shorter, more frequent maintenance periods instead of one longer session. Please verify Jason follows this revised schedule, with 10-minute organization periods at 11am and 3pm daily."

"Having someone check that I'm actually doing these tasks has made all the difference," Jason reports at your next session. "At first I thought I didn't need someone to remind me, but knowing my coach will be asking about completion really helps me follow through, especially with the repetitive organizational tasks I tend to skip."

By week 14, Jason reports substantial improvements: "My productivity has completely transformed. But I've noticed something—when my coach and I miss our scheduled morning check-ins, I still struggle with starting complex projects. I'm concerned about what happens when the program ends."

This prompts an important discussion about ongoing support needs. "Many of my patients continue with accountability coaching long-term," you explain. "Just as professional athletes always work with coaches despite being at the top of their field, ongoing support for implementation is often necessary. The goal isn't to graduate from needing support—it's to maintain optimal functioning."

Jason decides to continue with Coachiatry™ beyond the initial program, transitioning to a maintenance schedule with focused check-ins at his most vulnerable times for task initiation and organizational maintenance.

Practice Integration & Business Model

Coachiatry™'s 16-week structured program represents the starting point in treatment, integrating seamlessly with your clinical approach. For patients with executive function challenges, approximately 70% choose to continue with accountability coaching beyond the initial program.

This continuation reflects the reality that certain implementation challenges often require ongoing external structure. Just as professional athletes maintain coaches throughout their careers despite being experts in their sport, many patients benefit from continued accountability for implementation. This represents a normal human need for structure rather than a treatment failure.

As the psychiatrist, you establish a weekly rhythm of receiving Behavioral X-Ray reports each Monday, reviewing the adherence data, and adjusting treatment plans as needed. This supervisory workflow allows you to maintain complete clinical direction while coaches simply verify patients are following your prescribed activities.

The referral process is straightforward—simply introduce Coachiatry™ to appropriate patients and complete a brief referral form specifying only the tasks they need accountability for, not their diagnosis. Within 48 hours, a coach begins working with your patient, checking that they stick to your plan.

Our billing arrangement is refreshingly simple: you pay directly for our coaching services with no CPT codes required, which eliminates any need to share diagnostic information. Since billing happens directly between you and Coachiatry™, no diagnosis codes are ever needed. All our services are HIPAA compliant with BAAs available upon request, ensuring medical-grade privacy standards.

Weekly Behavioral X-Ray reports and all correspondence between coaches and you strictly adhere to our "stay in our lane" principle. Reports focus exclusively on task completion and adherence metrics, never venturing into clinical territory. Coaches never reference psychiatric conditions, treatment approaches, or medication effects in their reporting.

This iterative cycle of prescription, verification, and adjustment creates unprecedented precision in treatment implementation, allowing you to make evidence-based decisions about your clinical approach based on real-world adherence data.

This service generates additional revenue for your practice while delivering a comprehensive treatment approach that bridges the gap between neurobiological treatment and behavioral implementation in daily functioning.

For detailed pricing information and implementation steps, visit our website's pricing page or schedule a consultation with our practice integration team.

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