The expansion of access to telemedicine in the state under Gov. Charlie Baker’s emergency regulations to slow the spread of coronavirus disease 2019 has highlighted its role in delivering timely and safe health care to patients when a face-to-face appointment is not needed and possible.
River Valley Counseling Center, part of Valley Health Systems that includes Holyoke Medical Center, is among the many behavioral health providers that has been able to add telehealth appointments with its therapists at this time as a result.
Alexa Mignano, director of the counseling center’s school-based clinical services and a licensed mental health counselor at the master’s degree level, was asked about the impact.
What kind of response have you had to initiating therapy/counseling remotely with established clients?
About 50% of clients responded immediately to continuing their services through telehealth, and with each passing week, we are getting more and more clients on board. There are a number of factors that might contribute to clients accessing telehealth, so we are steadily working through those issues and removing barriers.
Have you had many calls for new intakes wanting remote counseling?
The clinics are still getting many referrals and we remain able to accept new clients in all of our locations - Holyoke, Chicopee, Easthampton, and Springfield.
Bilingual and bicultural staff are available to address the needs of our Spanish-speaking population.
We are also continuing to accept referrals for our Children’s Behavioral Health Initiative programs for children/adolescents, as well as our substance abuse programs.
Additionally, we are now able to start services for kids that were on the school-based therapy wait list. We have reached out to numerous families in the last week and most have welcomed scheduling intakes.
What do clients need do counseling remotely? In other words?
Clients can access telehealth with a phone, tablet or computer. We attempt our most secure platform with clients initially, which is Google Hangouts through our encrypted server.
This requires the client to have WiFi and a device with video/audio, as well as an app for tablets/phones.
However, the guidelines for telehealth have shifted during the State of Emergency to minimize barriers people may face in accessing healthcare. If clinicians are unable to set up video or a secure platform with certain clients, they can utilize other means with the client’s permission, such as the telephone.
What do clients say they like about it and has it helped ease barriers to counseling for some clients, particularly in terms of being able to offer telephonic therapy?
Initially, there was some apprehension about telehealth from both clients and clinicians. People were worried about the technology or that telehealth may feel too impersonal.
However after trying this for a couple of weeks, I think we are all pleasantly surprised how well it is working.
Clients with social anxiety are especially benefiting, as are clients that traditionally experience barriers to keeping appointments, such as disabilities, transportation issues, etc.
All clients seem to appreciate the convenience and safety of telehealth at this time.
What new issues are you hearing from clients with the onset of COVID-19 in terms of mental health counseling?
Everyone is struggling to some degree with being homebound and disconnected from friends and family.
Anxiety is running high for many adults regarding the state of the world, their health, job security, and meeting basic needs for themselves and their family.
Parents were initially very overwhelmed with homeschooling and parenting, but recently many seem to be hitting a stride with balancing their own working from home tasks with keeping their kids busy.
During this epidemic when home is supposed to be a safe haven, some homes are not safe at all.
As stress increases, so are incidents of domestic violence and child abuse nationwide.
As a preventative, we attempt to work with children and parents on reducing stress, increasing resiliency, and connecting to resources for meeting basic needs.
We are certainly most concerned about those families who have been unreachable. When this is all over, we anticipate immense need for trauma-focused therapy.
What are some of the therapies being suggested to people in terms of coping with these new stressors?
One mode of therapy does not fit all, but there are some suggestions for maintaining mental health during a crisis.
Sleep, nutrition, routine, exercise, relaxation are all areas that we are working with clients to stabilize in an effort to improve their resiliency.
Some clients have been through acutely stressful situations before and they have internal resources to draw from; as clinicians we can support them in implementing what has historically worked for them.
Others are learning/implementing new coping skills with the support of their clinician.
How has the introduction of telehealth for counseling enabled you to continue therapy with students and how important has this been?
Our child and adolescent clinicians, who were primarily school-based, are working really hard to create engaging and effective telesessions for kids.
Many parents are grateful to have the continued support, and the kids seem to enjoy connecting with their therapist virtually.
In their excitement, they are taking us on home tours, showing us their favorite stuffed animals, photos, artwork and introducing us to pets and family members.
Maintaining these relationships with our young clients is an intervention in and of itself when so much has changed for them.
We work with kids on coping skills and strategies for being bored at home, having family conflicts, and missing school, their friends and teachers.
Clinicians are finding unique ways to work on skills for the youngest clients.
Activities such as freeze dance, joint storytelling with stuffed animals, and scavenger hunts for meaningful objects that lead to great discussion, are keeping kids engaged and looking forward to their teletherapy sessions.
Some students were in therapy primarily for school-based concerns and are currently less motivated to engage in therapy. For those who decide not to continue sessions during this time, our school clinicians will be able to resume sessions when school is back in session.
How do you like it as a clinician?
It has surprisingly been very effective and something that I hope we can offer some clients even after COVID-19.
We are seeing another side of clients as they chat with us from home, which has been informative and beneficial in many cases.
This is certainly a new way of operating for us though. There is a lot more preparation and effort to engage clients, and staring at a screen all day is a major adjustment for clinicians.
Additionally, clinicians are conducting many sessions that can be very intense and they are doing so from home, losing the important physical separation between work and their private life.
But, we are all adjusting, figuring out what works and doesn’t work, and I am seeing such an outpouring of collegial advice and support around keeping ourselves emotionally healthy and providing high quality therapy.
What kind of need do you feel the expansion of access to telehealth, particularly for mental health counseling covered by insurers in all forms, is meeting during this public health emergency?
The option for telehealth has been absolutely essential during this time.
We are screening for risk and helping people remain hopeful and resilient during a time of great uncertainty.
People are losing their jobs, struggling financially, coping with illness, overwhelmed with parenting, experiencing loss, and scared about getting sick.
Everyone needs a support system during this time, and for our clients, that includes their therapist.
Additionally, before too long, there will be many sessions focused on grief as people lose friends and family to COVID-19.
The fact that we can maintain relationships with clients throughout this crisis and provide that specific grief support when needed will be critical for our society during the recovery phase.
We are very grateful telehealth has been made so accessible by the state and we imagine the benefits will help broaden options for mental healthcare in the future.