DEVELOPMENTAL DISABILITIES SERVICES

Normally our clients meet once a week with their individual therapist for 90 minutes. Moving those sessions online was a struggle in itself for our clients – determining whether they had the right technology and the cognitive ability to utilize telehealth. Fortunately, the introductory calls that took place prior to each session took a lot of pressure off the clinical staff – we didn’t have to teach.

I thought we adapted really well. There was virtually no delay in services, we just had to pivot and adapt. I was one of the first to roll out telehealth using DOXY – I used it almost immediately. It was clunky at first and a bit frustrating, but I was adamant about getting back to work. After about a month I switched to ZOOM.

We’ve noticed that the group member dynamics are not the same. Sharing becomes more difficult. Attendance is good, people are participating via ZOOM, but as far as the interaction goes, it is diminished.

Doing psychotherapy on ZOOM presents a whole list of challenges. It is more difficult to get a read on someone’s emotional state of mind. Sometimes there’s a little delay, sometimes you can’t hear people, and some don’t like to be on camera. It can be clunky, and it can be trying. When you can’t read facial expressions, it makes it tough for both client and therapist. That is also true of in-person sessions when we are wearing masks.

Working from presents its own set of challenges. As psychotherapists we deal with a lot of heavy stuff all day. To do so in your home feels a lot different than in the workplace. I’ve had to create some boundaries, and reorganize things in my mind. Not being able to see co-workers also contributes to daily stress.

This is not the time to rally against change. With no end in sight, I’m now working on putting my DBT (Dialectical Behavior Therapy) online. Everything will be uploaded into an app. Clients will be able to access the manual, submit homework and manage their diary cards, all through the app. Everyone has had to be creative, and some real innovation has happened. You just do what you have to to make things work.

CATHY MCMULLIN Clinician, Adult Services, Community Rehabilitation and Treatment Program “

Perspective: Developmental Disabilities Services

Overnight, we went from being very person-centered to having to do everything from a distance. We – along with the people we support – were definitely not used to that. Because we are a long-term service provider we like to spend time with folks and get to know them. The pandemic has made that really difficult.

The directive to stop all non-essential supports brought a level of panic – how do you determine what is essential, and more importantly, how do you keep people safe? It ultimately came down to this -- If losing services put someone’s health and safety at risk those services were deemed essential.

There has definitely been innovation around telecommuting and finding new ways to interact with people remotely. We’ve had specific brainstorming groups to identify best practices and look for sustainability, as this is likely to be our future.

This is a field that is rooted in personal connection. We’re used to being around people -- walking down the hall and saying hi to co-workers. Right now, our whole world is pretty disconnected. As we navigate through this and adjust to doing everything from a distance, increasing our communication and compassion with each other is going to be essential.

DUSTIN REDLEIN Director, Developmental Disabilities, Services Systems “

The pandemic made us stop and ask ourselves, what is essential about providing remote services? It immediately became clear that it was up to us to remain essential in a remote world – that we would need to perform constant re-evaluation to ensure the work we do continues to be relevant, even from a distance. If families aren’t accessing our services, how are we troubleshooting? There is no single answer, and everyone is finding their own way. We’ve been surprised at how well some have engaged with our telehealth, and have had quite a bit of success.

Some services were interrupted at the beginning, guided by state-mandated safety precautions. Service coordinators who continued to provide in-person supports had to stay outside, and had to keep a safe social distance from their clients. In our search for best practices, we encouraged our staff to explore different platforms, and make their own decisions about going remote. We looked for ways to incentivize direct-support work. And we empowered our teams to be creative, to embrace change, and to share their ideas with one another.

Kids with Autism tend to be rigid in their thinking, and they do not enjoy change. Some kids just closed their laptops, which was their way of walking away. A couple of practitioners found a way to stay engaged by using a dollhouse-building app and a shared screen. They put furniture in the wrong rooms to prompt a response. It tackled the same treatment goal, and it was really creative. Another staff member found a way to engage a very young child in an imitation exercise through the living room window. It continues to be an exciting challenge, and people are really rising to the occasion.

I think the hardest part of this pandemic is the loss of structure across the board. I’m continually struck by how passionate this staff feels about the people they serve, wanting desperately to do the best they can. I applaud all of the efforts to embrace telehealth. The most exciting piece is that everyone is onboard to explore remote. I think new services will come out of this, and I’m very excited to see where it takes us. Why would anybody not embrace change right now?

MARY-GRAHAM MCDOWEL, BCBA, LBA Director, Developmental Disabilities, Autism Services “

CAP currently provides shared living supports to 145 individuals in 130 homes, and normally we are an in-person, in-home service. In mid-March, a lot of those services shut down. We were not able to physically be in homes, or even at homes initially. Like the rest of the world, we scrambled to figure out how to monitor homes remotely.

People have been pretty resilient in figuring out how to coordinate weekly meetings through telehealth. The whole virtual connection is very new. I think some people have really liked that connection, and for some it’s just a little too abstract or confusing. Fortunately, the majority of our staff already had iPads, so it was a matter of IT activating camera capabilities and getting us hooked up with ZOOM and Doxy. There was definitely a learning curve.

In the first few months, I think all our contacts were via phone and virtual visits. Around the end of June, the guidelines allowed us to do in person, socially-distanced, masked outside visits. To be able to connect personally with folks again -- that eased a lot of tensions. I think people are concerned about losing that again.

Masks have been a struggle -- many of our folks are sensory challenged to begin with. The whole idea of wearing this thing on your face took a lot of work and required some creative solutions. Getting our hands on PPE was tough at the beginning. Fortunately some of us are sewers.

We’ve all had to get creative about how best to connect and support our teams. The reality is we spend more time at work than we do at home, and it’s been very hard for people to lose those social connections. We have some staff who have never met in person. It’s just a strange dynamic.

We have three nurses that work with us, and the shutdown of medical offices shifted them to remote work as well. This has made our advocacy role that much more challenging. Since we can’t be there in person, there’s a lot of time spent playing phone tag with medical professionals.

Our home providers have really risen to the occasion. They’ve provided crucial support through a really confusing time, and it’s miraculous that none of our individuals or providers have contracted the virus. This is a true testament to their commitment and dedication.

MICHEL KERSTEN Manager, Community Access Program, Shared Living Services “

I came into the program as a service coordinator just three weeks before the pandemic arrived. In-person visits stopped, and I still hadn’t even met the individuals I would be working with. It was a very stressful experience. Remote introductions were difficult. It’s very hard for individuals with developmental disabilities to grasp the whole concept of a pandemic. They don’t understand what’s happening.

When we started working from home, I actually really enjoyed that. Somehow, I felt I had more flexibility to have more down-to-earth, relaxed conversations with the people I was handling. There’s more time to get to know people, without the distractions that exist in a workplace. On the other hand, being home alone for that long is exhausting.

We continued with virtual visits until mid-April, until we were given guidance that we could resume in-person, and only if people were comfortable on both sides. We did daily phone check-ins for a while, and that at least offered a sense of routine. I was pen pals with a couple of individuals, and that was really fun. Community supports were completely suspended, and employment supports for most individuals. The loss of LifeSteps was heartbreaking. This was a place where individuals in the CAP program could hang out with their peers. In some cases it was the only peer-socialization they received. For a lot of people, this was their life. This loss has been really devastating to their overall routine and sense of purpose, and it’s going to have a long-lasting impact. It makes me want to cry.

It’s hard not to get emotional when you see that certain individuals aren’t able to understand why this is all happening. Their whole world is upside down. Just watching them struggle -- it’s really hard. We think this is hard for us to endure – to be a person with a developmental disability, I just can’t imagine.

AMELIA ASHLEY-SELLECK CAP Service Coordinator “

Before Covid hit, I was doing community work with two individuals – one had Autism and was non-verbal, the other had communication issues and had violent tendencies at home. We would go out into the community and enjoy all sorts of activities like bowling, swimming, playing basketball – but the pandemic shut all of those activities down and I lost most of my community hours. I did continue to work with one individual for a couple of months. We found things to do outside, and when the weather was bad, we just took long drives in the country. Sometimes we would drive up to Pond Hill Ranch in Castleton and look at the horses. It was going ok, until his behavior made it unsafe for us to continue.

Now I’m working with an individual in the Employment Services program who works for Meals on Wheels. Meals on Wheels had to ramp up production during the height of the pandemic because so many more people needed meals – they went from 1200 meals per day to 5000. D.J. came in every day, right through the pandemic. You could say he contributed in large part to keeping Rutland fed. It’s a real feather in his cap.

The environment at Meals on Wheels has gotten a lot busier and a lot more hectic. D.J. gets nervous in crowded areas, so I’ve had to provide much more emotional support. The pressure to produce meals can be very intense at times, so we take breaks and do deep breathing. Wearing masks in a hot kitchen is no fun.

I think the hardest part has been dealing with the fear that my individuals have. D.J. lives in a home with vulnerable family members, and he is constantly worried about bringing the virus home to the people he lives with and loves. We take great precautions with mask-wearing and hand-sanitizing, and over time he has gotten more comfortable.

There has also been so much misinformation floating around, he has a hard time processing what is true and what isn’t. I just have to keep filtering information in a way he can process.

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Scan to hear more staff perspectives on Community Care Network’s crucial work. MIKE HUNDT Direct Support Professional “