As we enter the third month of social distancing and in an evolving healthcare landscape with COVID-19, community-based care management teams are adapting and testing innovative operational approaches to ensure the needs of the people they serve are being met. This adaptation is taking place in real time, meaning years of cultivated technique and experience are yielding entirely different approaches to care management. Care management staff have needed to navigate all this while often dealing with their own challenging and anxiety provoking personal situations.
Barry Granek, LMHC
Accessing care management and healthcare services in this pandemic, while maintaining a safe physical distance is vital, and in many instances lifesaving. Yet, it is not just in-person care management services that require adjustments. Many coping resources used successfully before the pandemic are no longer available, due to closures of gyms, places of worship, entertainment establishments, schools, and workplaces. Consideration is needed to ensure continuity of care in providing mutual support, linkages to services and activities, and troubleshooting barriers.
CBC’s Pathway HomeTM (PH) is an award-winning care transition intervention for individuals returning to their community after an institutional stay. PH recognizes that uncertain times like these require novel practices to meet the needs of individuals receiving community-based behavioral healthcare. Care transitions from psychiatric inpatient units back to the community continue to occur, currently at a faster rate, as hospitals are expanding capacity for COVID-19 patients. Under these conditions, PH teams continue to accept referrals, operate with quality care, and attend to the individual’s served daily needs.
These are some of strategies that PH Teams have implemented to keep individuals in their care safe and ensure they are following the recommendations enacted by government and healthcare organizations:
Telehealth Services: With the inability to conduct in-person visits, open and frequent communication between members and providers is more important now than ever. Therefore, PH services have shifted to primarily telephonic and video-based services. Although many providers and members believe in-person visits are more effective than telephonic interventions, many are now realizing that telehealth services are necessary and useful. PH was fortunately well prepared to move to telehealth services, as PH has been practicing and utilizing these technologies, such as texting and smart phones treatment applications to connect with members for several years (Petit and Granek, Behavioral Health Care, 5(4), pp. 22, 2018).
For the numerous PH members without phones, PH is supplying smartphones and shipping them directly to members to ensure ongoing contact with the PH team and their support network. Members are being taught how to attend their appointments and recovery groups virtually. PH has also outreached former members to extend emotional support and offer enhanced linkages to community resources.
Mindful Recreation: During these times of self-isolation, PH teams have prepared individualized care packages and have had them delivered with personalized letters to help overcome feelings of loneliness. Items sent have included home audio players, art supplies, books, board and video games, TV and streaming services, and literature on coping strategies. PH peers have also led virtual yoga and cooking classes, workshops on making comics, and social-distancing bike rides.
Basic Needs: To address the factors influencing social determinants of health and enable members to remain home and avoid contracting and potentially spreading the virus, PH is helping those with limited access to resources. Food, toiletries, and clothing provisions are being shipped directly to members utilizing online resources such as PeaPod, Instacart, and Seamless. PH nurses are delivering safety kits containing gloves, masks, hand sanitizer, and other precautionary items. Transportation assistance is provided through ridesharing (e.g. Uber Health), so members can avoid public transportation and continue to attend appointments with their outpatient providers.
Supporting Staff: Even though PH is familiar with using technology to supplement in-person engagement, the effort to transition to distance-based services still posed challenges and entailed adjustment for frontline staff. Many staff had to train on often unfamiliar technology, requiring learning on new techniques for distance-based engagement. PH created a “Tips and Tricks for Distance-Based Care Management” manual with standards to assist PH staff in adjusting to telephone and video communication. A comprehensive resource guide was also created to centralize available resources and emailed weekly with updates. Categories in the resource guide include food, childcare, telehealth support, benefits assistance, phone and internet, crisis hotlines and online support groups, pharmacy delivery, and in-home wellness activities.
As we continue to responsibly physically distance, it is important to simultaneously attend to our own self-care and support our staff to help them perform their work and adjust to changes in their roles. Therefore, PH has been hosting virtual meetings for specific team roles (Peers, Supervisors, Clinicians, Nurses, and Care Managers) to share strategies, lend collegial support, and share experiences and resources. A Member At-Risk Committee meeting (following the principles of Project ECHO) is held twice monthly to brainstorm effective interventions and marshal resources for members having difficulty accessing services or display high risk behaviors. Pathway Home™ Training Institute transitioned trainings offered onto a virtual platform. The trainings are designed to address COVID-19 and provide guidance on ways to support members and PH staff during this time of heightened stress. For example, Coping Skills for Your Participants in the Age of the Coronavirus was tailored for interventions with members and Self-Care in the Age of the Coronavirus was geared toward care management staff. All these efforts help ease the stress or confusion of shifting roles and ensure staff feel confident and prepared.
Implications for the future: While there have been massive disruptions to the healthcare system and the behavioral health community, these shifts may help inform best practices after the pandemic. Agencies are learning that it is feasible for technology to be used to expand the availability and accessibility of behavioral healthcare services. Telehealth has become the dominant mode through which preventative and treatment services are currently being accessed. Many providers have begun reporting increased engagement and more regular appointment attendance since virtual options were provided. Overall feedback from members has been positive, many expressing a preference for telehealth. Post-pandemic, PH hopes to take these lessons learned during this time and incorporate some array of distance-based services into the program model.
As the behavioral healthcare community learns to navigate the new landscape brought forth by COVID-19, PH remains committed to service delivery innovations. PH teams will continue to provide distance-based services, monitor for needed in-person outpatient visits, and collaborate with local providers to assist those most in need throughout this pandemic. As one PH staff member said, “We know that this is a scary time in the world. However, we’re also here to say that this too shall pass, and we will all be stronger as we come out of it.”
For more information about Pathway Home, visit www.cbcare.org/innovative-programs/pathway-home/.
