In March of 2020, COVID-19 broke the mental healthcare system.
From large health systems to small private practices, nobody was immune to the immeasurable toll that this pandemic has taken on the livelihood of our beloved profession. For some, the stay-at-home orders resulted in an immediate loss of clientele and no choice but to close up shop for the foreseeable future. For others, it meant rapidly trying to adapt by sifting through the ever-changing landscape of billing and telehealth requirements while frantically trying to maintain ethical and legal competence throughout the continuity of care.
A select few clinics, however, embraced the COVID-19 pandemic as an opportunity to become forerunners in adopting a new form of technology-enabled mental healthcare that is predicted to quickly become the new normal across the mental healthcare ecosystem. Through the use of digital technologies to enable asynchronous touch points with clients, mental healthcare professionals are now able to stay connected to their caseload like never before - resulting in some striking implications to the way in which clinicians can understand and support the individuals that they serve.
One such clinic that successfully adapted to the recent challenges presented by the COVID-19 pandemic is Total Family Solutions. Based out of four locations across the state of New Jersey, Total Family Solutions has been providing quality behavioral health services to children, adolescents, adults, couples and families since 2003. After navigating the transition to telehealth services for the entirety of their client population, a number of noteworthy shortcomings began to surface in response to this new provision of care.
“What we were seeing were a lot of issues related to clients not being as engaged in their treatment as they were during face-to-face visits and at times not being forthcoming with their therapist” says Raelyn Sprenkle, LCSW, MEd., a lead therapist at Total Family Solutions. “Because of this, we decided to use Blueprint to better stay connected with our clients.”
At the top of the priority list during their transition to telehealth was ensuring that all clients received routine mental health screening for any safety-related issues, particularly among vulnerable or high-risk populations. Through the ability to remotely administer weekly screeners and daily check-ins, Raelyn was able to keep an eye on her clients’ mental health and proactively intervene during times of need.
“One of my clients had a job that was deemed ‘essential’ and was required to show up to work and be around individuals who were exposed to the COVID-19 virus” Raelyn explains. “During this time, that client struggled a lot with increased anxiety going to work, panic attacks on the way to work, and we saw an increase in suicidal ideation which the client had never previously experienced.”
As leaders in the field begin to understand the national impact of COVID-19 on mental health, anecdotal evidence points to the fact that generalized and health anxiety are among the many mental health concerns that have drastically spiked in the past months. In this way, it is critically important to make sure that the practices and procedures related to maintaining patient safety remain intact and are able to be translated to the digital landscape.
For the client above, Raelyn explains that by “using [Blueprint], I’ve been able to keep tabs on how the client’s check-ins are going and have been able to reach out to the client when needed to schedule emergency sessions during times of need. I’ll let them know that I’m here for them and that they can reach out if they need to have a brief call to go over their safety plan before their next session. This process allows [Total Family Solutions] to make sure we can do everything we can to support our client population and be there for them as much as possible during this difficult and stressful time.”
Engagement in treatment
Another clinical difficulty resulting from the lack of in-person visits at Total Family Solutions was the challenge of how to keep clients engaged in the process of therapy when they now had the opportunity to participate with relatively low commitment from the comfort of their own home.
“What we started to notice during the transition to telehealth were a lot of clients showing up for their appointments but not really following through on anything during the week” says Raelyn. “We usually assigned paper/pencil homework assignments for clients to fill out throughout their week, but when that wasn’t available anymore we really couldn’t keep track of whether or not clients were keeping up with our recommendations.”
In fact, client engagement in mental health services, both inside and outside of the therapy session, is one of the leading predictors of prognosis. In this way, making sure that clients feel connected to the process of care and know how to practice and track their skills and behaviors throughout the week is critically important to promote positive treatment outcomes.
“Now that everything is digital, I personally like using the CBT thought record with my clients because I can bring it up with them during session to ask more specific questions about their experiences throughout the week. If they don’t complete their assignment, they won’t have the typical excuse of leaving their paper at home, giving the client more accountability as well. It really just takes what myself and others on the team were already doing and makes it better.”
While maintaining patient safety and engagement in treatment services were more or less expected challenges for Total Family Solutions when transitioning to telahealth, one experience that came as more of a surprise was the changing dynamics of client communication as it relates to the therapeutic relationship. Although the research literature has found generally favorable results related to the ability of clinicians to maintain a positive therapeutic alliance through online and phone therapy sessions, there are undoubtedly common challenges to open and honest communication that result from participating in therapy sessions while at home.
One such example is a young adult client who came home from college to live with their family during the pandemic. “[This client] has a very difficult relationship with their parents, and now that they are stuck at home they have nowhere to retreat to. They can’t leave, they can’t go for a drive, and it’s hard for them to find privacy during our sessions…so when we are in session they can be very cautious about what they say to me. They are aware that their family may hear things from around the house.”
Cases such as this remind us that a strong therapeutic alliance may not be enough to overcome the unique challenges that telehealth presents when it comes to client communication. And although this is just one specific example, it is not difficult to imagine the multitude of situations that may arise and present barriers to obtaining a full and accurate understanding of clients and their lived experiences in this new context.
Raelyn explains that since Total Family Solutions has implemented Blueprint, “[this client] can now fill out assessments online and tends to be much more candid and honest about their experiences when communicating in this format. We are able to talk about it and anytime I see [a discrepancy] between what the client is saying to me on the phone and what the assessments show I try and have a conversation with the client about it. It really helps to provide better care all-around, especially when trying to understand exactly what my clients are going through.”
Through embracing innovation in the face of adversity, behavioral health organizations such as Total Family Solutions have been able to respond to the national pandemic in a manner that has accelerated their quality of care and overall reach in the clinical community. In light of new research suggesting that psychotherapy outcomes have not improved significantly over the past five decades, it’s no wonder that leaders in the behavioral healthcare field are beginning to look to technology as the next evolution of the practice. Digital innovators such as Blueprint help elucidate the new and unique benefits that arise when clinicians are able to use technology as a supplement to their clinical practice. In this way, alongside the struggles, sadness, and devastation that resulted from the COVID-19 pandemic is a silver lining that has accelerated our field into a new and exciting future.