How one Oregon behavioral health practice helped its youngest clients and their caregivers stayed engaged and healthy during the pandemic.
There’s no easy day in the life of a behavioral health practice, which provides mental and emotional support to vulnerable patients who need it most.
Some require medication assisted therapy, coupled with counseling, to stay sober. Others need relief from toxic home environments. The ongoing care provided to patients throughout Oregon is as essential as food and water, but it doesn’t always yield immediate results—that’s the hardest part.
Earlier this year when COVID hit, and the state of Oregon shuttered businesses, Options was faced with a level of difficulty never encountered in nearly 30 years in business. The agency was especially concerned about its youngest patients (those ages 18 and under) who represent a sizeable portion of those served.
In the thick of state-mandated quarantines, these patients felt especially powerless, having lost their usual coping mechanisms like regular in-person contact with mental health counselors. They struggled to process their emotions, understand new physical manifestations of their behavioral disorders, and grasp new safety measures like wearing masks.
The work was challenging. Fortunately, Options has a dedicated staff ready to activate.
Facing Challenging Times
While the physical ramifications of COVID on adolescents is usually minor, the emotional toll on youth is significant.
An April study published in JAMA Pediatrics, which measured emotional distress in more than 2,330 schoolchildren in the Hubei province of China, revealed that after 33 days in quarantine, more than one-quarter (22.6%) reported having symptoms of depression, about five percentage points higher than those in parts of the country that did not quarantine.
Options’ youth patients already suffered from depression, anxiety and related diagnoses, and they often lived in difficult home situations before COVID. Having a guardian who struggled with mental health problems or substance use disorders was not uncommon; many patients also struggled with learning disabilities like ADHD, or physical health conditions such as diabetes and/or asthma.
Many of the most effective strategies service providers employed, such as finding temporary housing for children who needed one or two days of respite, were suddenly off the table. Much of the CDC guidance for staying home and isolating was antithetical to best practices in mental healthcare for vulnerable families.
Many tools had been taken out of the toolkit, but it wasn’t an option to simply ask patients to wait out the quarantine, as this approach could provoke a higher level of care, such as a hospital stay.
Leveling Up
With all of these challenges creating new complexities, Options was forced to get creative, balancing patients’ needs with new safety protocols.
Within ten days of stay-at-home orders, Options moved most of its workforce to telehealth. To help transition individuals and families to teletherapy, IT staff created video tutorials for staff and clients. This included details on logging into and using the telehealth platform (in both English and Spanish) and assigned case managers to answer questions and schedule appointments.
Options took this one step further and sent out dozens of tablets to clients who needed a device for engaging in telehealth, and also offered to pay for a couple of months of additional Internet bandwidth. If clients required headphones and ethernet cords, Options staff shipped those items.
But as anyone whose kids have undergone remote learning knows, telehealth alone is not always an effective intervention for children.
To supplement the telehealth program, Options relied on its information-sharing network, provided by Collective Medical, to push out real-time notifications of events like emergency room visits into patients’ medical records. The network enabled all providers within a patient’s care team—from primary care to behavioral health—to share and exchange information.
Having critical information in one place saved hours of guesswork and combing through files. Staff can simply scan a list of patients in high-risk cohorts, and when there is a “flag” at the top of the patient’s record, it’s time to dig deeper.
For example, Options works with youth struggling with anxiety and depression whose parents are also struggling with their own issues. Through the alerts, and releases of information to effectively coordinate care, practitioners are able to see which members of the family are utilizing emergency care, supporting a better understanding of why that family isn’t responding, and why Options needs to reach out to them.
In addition to leveraging these technology solutions to identify needs for support, Options works with parents and children to develop new routines and structure inspired by their activities of daily living (school, work, social interaction), but adapted to a COVID environment. Options staff shared resources during one-on-one teleconferences, while following social distancing guidelines, skills-training and therapist teams also travel directly to families’ homes to meet with children, talk to them, and help them articulate what they’re feeling.
Over the past few months, Options has seen improved patient engagement, and fewer missed telehealth appointments, among both children and adults. In addition, there is a 90% follow-up rate for behavioral health clients after an ED visit, which means they’re willing to engage, likely avoiding further escalation of their issues.
While the struggle to keep patients on track is constant, having the right tools in place helps to direct efforts most effectively, and preserve limited resources. And while no one can turn back the clock to pre-COVID times, Options is learning invaluable lessons on how to engage patients in new ways, so they can manage their behavioral health conditions more easily.
Related Reading: It Takes a Village: Overcoming Information Asymmetry in Healthcare
Lara Barnes, M.Ed., is a licensed marriage and family therapist with Options Counseling and Family Services.
This article is published through a partnership with Collective Medical.