BEHAVIORAL HEALTH

Perspective: Behavioral Health

Providing Essential Services in a Pandemic

The COVID-19 pandemic has affected the delivery of essential mental health services in every way imaginable. Throughout Rutland Mental Health Services, staff are learning new ways of doing their jobs, demonstrating tremendous creativity, resilience, and sheer determination – all while dealing with the same fears and uncertainty as their clients. Leaders from across the agency share their thoughts and insights on a year like no other.

Usually, in agency life, change tends to take a long time; and yet, here we were completely changing everything we did overnight. It was an immediate pivot. Staff really rose to the occasion – literally everything had to be reinvented, without any reduction in service. In fact, the demand was even greater.

We found pretty early on that telehealth with young kids and families could work – kids love devices. The fact they could see their case manager was really helpful. People had to work hard to be engaging over technology. We tried all kinds of crazy stuff – singing, dancing – anything to be more interesting. We had a lot of families in the middle of PCIT treatment (Parent-Child Interaction Therapy), and we had to find new ways of doing that over ZOOM, so kids couldn’t hear the coaching. It was messy, but somehow it worked out. I think staff discovered they are much more capable than they knew. We’ve started a new program for parents called Circle of Security™ which teaches how to be a secure base for your child. We are starting to run these groups on ZOOM, and it’s working. People are getting used to doing things remotely.

My team is very close-knit, and it’s been hard to be separated – to not be able to bump ideas off each other. Also, young kids rely on hugs, lap-sitting, and being close to grownups. It’s been hard clinically, to collaborate with the families and be as helpful as we want to be.

One of the benefits of being school-based is that we have access to kids – we can pop into classrooms, and we know exactly how they are doing. When the shutdown happened, we lost that access. I think I was most impressed with how quickly everyone mobilized. We very quickly figured out what we needed to do, with a lot of creativity and as few disruptions as possible. Fortunately, most families were able to engage with us remotely – either by video, phone or Google Voice. We very quickly adapted to using Doxy & ZOOM, and found that remote works well for some kids. We did have some families we had to troubleshoot, and in some cases, the school was able to drop off computers for families to use.

Our staff does a range of things -- from parent support and individual therapy to case management and skill building. We don’t always have access to families, and the push to telehealth provided a new way to connect with them remotely.

It’s interesting – this month we have started to feel and see the impact of everything. There is such a need right now -- no one realized this pandemic was going to go on for so long. The stressors just keep piling up, and the numbers are increasing. I think the hardest part has been seeing how overwhelmed our systems are, and not having enough resources to meet the need. In Rutland, we’re experiencing huge truancy issues – kids are supposed to be learning remotely and aren’t showing up. This is hard to address remotely.

This pandemic has forced us all to be intentional with our own self-care; our own mental health, so we can help our clients more. Our team is trying to get outside more, exercise more, and be more mindful. I can’t underscore enough the creativity of my team, and how much they support each other.

LAUREN NORFORD, LICSW Program Manager, Early Childhood Services “

Scan to hear staff perspectives on resilience.

HEATHER HILDEBRANT, LICSW Supervisor, School-Based Services “

We were able to switch to telehealth pretty quickly, but it has really been a mixed bag. Our census has fallen off the cliff, for any number of reasons. For some it’s the absence of face-to-face services; others don’t have connectivity or equipment. We also have a lot of court-mandated clients who don’t want to be here. The pandemic gave them an excuse to get out of treatment.

Alcohol sales have gone through the roof. People are drinking at home and they are drinking more heavily at home. This behavior would cause problems under even the best of circumstances. Now, people are dealing complex situations at home and compounded levels of stress and anxiety. We’ve noticed that 2-1-1 (Information & Referral) has been getting a lot of calls from a new population – one we’ve not heard from before. These folks aren’t accustomed to seeking help, and don’t really know where to go.

When the stimulus checks went out, we immediately saw an increase in substance use, and some overdoses. A lot of people we work with are not good at handling large amounts of money – it goes right to their addiction. One of my female clients actually expressed anger at the government for putting more drug money in her hands. Telehealth certainly has its place, and looking ahead it will be really advantageous in winter when the weather gets bad. Some of our clients have a lot of anxiety around getting to an appointment –no transportation or child care – for them, telehealth has been a big plus. For group therapy, it’s not always as effective – screens freeze, people struggle with audio – it can be intimidating for some.

We have been able to resume our Impaired Driver Rehabilitation Program, and ZOOM works really well for that program. The response has been good – we have a fair amount of folks dealing with their DUI’s now.

I think the hardest part is not knowing where we’re going, or how long this is going to last. I do think we are going to see aftershocks of this pandemic, and the need for our services is going to continue to increase.

CLAY GILBERT, LADC Director, Evergreen Recovery Services “

Initially we were very concerned with the idea of some of our families isolating themselves. For families with challenging kids, the parents need that break that school provides, and school can be a safe and stable environment for the kids. We expected the phones to blow up. We did see an increase of crisis calls, but not what we expected. We saw families really rise to the occasion.

Our biggest challenge with remote work has been to see that people who are seeking our services are getting what they need. In mental health, the most important aspect is your relationship with the therapist, and so much of our work centers around making a strong connection right from the beginning. Distance makes it much harder to establish those relationships, and make assessments.

Generally, it’s very awkward for kids to come to therapy. We’ve found that in some cases kids are much more comfortable with telehealth – video is their preferred way of communicating. They tend to open up more when they are in their own environment. As providers, how do we identify the kids that might do better through telehealth? Nothing would prevent us from offering this in the future as an alternative strategy. My outdoor adventure program had to stop in their tracks. Counselors spent time individually connecting with kids, and got super creative. They took facetime hikes, and kept the interest going that way. Staff did a phenomenal job rising to the challenge. This is much more taxing on all of them than anything I’ve experienced in 28 years here.

This is really intense work, and it can creep up on you. We have to be able to put our own stressors behind us so we can focus on the families and kids we’re working with. With 90 staff working out of their homes, it’s been a lot harder to support each other.

Seeing clients is only part of our job. Because we’re a designated agency, most of our funding comes with a lot of regulatory requirements, and managing all of that becomes much harder when you are not in the office. How do you get the answers you need? It has been tremendously challenging.

DOUG NORFORD, LICSW Director, Child & Family Services “