With the urgency in care for vulnerable populations during this current pandemic, SAE & Associates (SAE) understands providers are looking for answers and solutions to continue and possibly grow services to meet the needs of overall population outcome during COVID-19.
It is clear that, as providers of care for vulnerable populations, this is not the time to step back. However, the implementation of services and collaboration with new partners must still be critically aligned to your agency’s mission and strengths. SAE’s prior experience in emergency management has enabled us to make available a knowledgeable COVID-19 behavioral health response team whose members have developed a series of podcasts (available at http://saeandassociates.com/ ) that inform an effective response to this virus.
As with all organizational planning and the reshaping of agency operations in times of crisis, there are key components that must be addressed. The following are elements that are forward-leaning to implement services and care during COVID-19. Each element addresses core organizational planning and requires critical clinical and risk management decisions. Communication, structuring, and performing constant reviews of moving parts due to increasing risks and policy changes are necessary.
Providers are urged to consider addressing the following critical issues, which SAE has discussed over the course of the COVID-19 Podcast Series: Going from Reactive to Proactive in Response to the Coronavirus Pandemic.
Leadership – management preparation for service changes to help identify organizational areas of challenges, identify service-specific continuation during the pandemic, identify new collaborations with external partners to increase or offer internal resources, and resolve decisions/protocol for organizational risk mitigation. Develop workflow for decision-making and roles/responsibilities. Identify an emergency management team with leads for: operational security, health and safety, communication, data integrity and breach security, and employee wellness. Develop action plans, goals, and benchmarks for each emergency management team lead. Assist the team to organize and synthesize internal and external responsiveness for change/accountability with a roadmap for team implementation.
Triaging New Services and Business Activities – identify new services and activities responsive to COVID-19 and appoint personnel for leadership with accountability for oversight and management reporting. For example, if new services include teleservices, develop a crosswalk of current to new activities, ensure staffing capability fits with state requirements for the new services, communicate with health plans / payor to ensure fiscal responsibility, and identify quality management indicators for risks to new service implementation. This may include guidance on management reports for quality oversight across operational, administrative, clinical, personal, and revenue elements.
Screening and Protocol Development – adapt current internal clinical services to COVID-19 guidance and state requirements. Identify the protocols for service activity changes (such as teleservices, care coordination of members who are discharged after COVID-19 treatment, and support services like training programs). Identify clinical concerns such as minimizing trauma for those recovering from COVID-19, physical/health requirements and guidance on caring for individuals with reported symptoms, and provide support/wraparound services (such as providing food, medicine, and transportation) for families of those identified with COVID-19. Address clinical vulnerability issues such as elevated suicide risk, increasing depression/anxiety symptoms, and substance abuse issues or access to buprenorphine. Clinical vulnerabilities would also identify the most impacted population with guided profiling of weighted risk, based on known chronic diseases, general population health indicators, and communities at risk geographically.
Communication — development of internal and external messaging on how the organization is addressing COVID-19. Messaging is important, as it speaks to awareness, leadership, knowledge, and support. Developing action plans on messaging and identifying internal key personnel are also essential. The messaging must be consistent and come from members in the leadership group, as well as possibly from the service community. A key internal statement must be developed for this messaging. A key external statement must be developed as well.
The internal messaging must prioritize:
- improving staff competency to give them the skills to meet health, security, and training challenges;
- providing structure and daily goals;
- organizing tele-huddles to give support, supervision and decrease sense of isolation while working; and
- giving continued updates on how leadership is addressing risk and security for staff and the organization, etc.
Internal messaging has to be determined in terms of pathways of communication and scheduling. It is important to offer emotional support and develop messaging on coping and self-care for staff, particularly with the organization’s Employee Assistance Program (EAP).
The external messaging includes continuation of services to clients, other providers, the state/county, and any potential collaborations. This must be developed in alignment with existing vision and presence in the community of service.
The client population must be messaged consistently about new service activities, risk characteristics, and coping skills. They should also be notified of wraparound services and/or offerings of new platform services (such as nutrition while in isolation, refresher on first aid at home, guided mediation/relaxation for biofeedback, narrative journaling, etc.). Coaching may include giving guidance on the use of current media, identifying goals for each activity, and using new media with assistance on procurement issues.
Education and Training — assist in identifying and/or developing responsive training for new services/activities (decontamination and safety hygiene, implementing teleservices in secured environment, care coordination of COVID-19 recovering patients, symptom assessment of COVID-19 risk, referral procedure for suspected COVID-19 infection, documentation of services, risks in data breach with hacking or ransomware, etc.). Identify and ensure training rollout of Evidence-Based Practices (stress reduction using CBT, reducing risk for self-harm with EMDR, sleep hygiene assessment, etc.) and federal guidance on services (state-specific implementation of the 1135 waiver) during the pandemic. Identify appropriate separate training rollouts for different levels of contact and duties to each organizational staff member (supervisors, clinical staff, peers, support clerical/administrative staff, IT, etc.). Tracking and management reports for training should be developed for quality oversight and risk mitigation.
Data Integration and Security with New Technology Launch — with new or responsive services identified for COVID-19, assist providers to develop a roadmap for new tech-supported functions (patient portals for direct messaging and journaling, teleservice products, cloud storage and secure VPN access, group chat capabilities for staff in-checks and supervisions and huddles, etc.) to track, implement, report, and safely store data with existing or new products. Align organizational IT capabilities with state-specific requirements (store and forward function for teleservices, data integration and CMS billing updated for COVID-19, user security and authentication for remote access to data/cloud server, etc.) and a roadmap for implementation to lessen user burden, in addition to ensuring management oversight and data security.
SAE recognizes that these outlined tasks can certainly appear daunting to providers facing the challenge of providing behavioral health services to individuals and families coping with this illness. The spectrum of issues to address include the impact of anxiety and depression, dread and uncertainty, and the need to ensure the integration of behavioral health and medical care. Given the horrendous and terrifying symptoms that many COVID-19 patients endure during their treatment and recovery from this illness, we can expect the emergence of PTSD symptoms, often occurring beyond the patient’s 30-day recovery period when still experiencing brief bouts of COVID-19 symptoms, such as shortness of breath and chest pains. Unfortunately, based on previous experience from Hurricanes Sandy and Katrina, we may see concurrent increases in domestic violence, child abuse, substance abuse, depression, and suicidality, to mention just a few potential outcomes from environmental trauma. Therefore, immediately identifying clients at greatest risk and developing safety plans is a natural first step.
SAE understands that many providers faced with the impact of this pandemic on their administrative, clinical, and financial operations need help now to get them through this crisis; to gain organizational stability; to access new resources; to identify and implement new technologies such as telemedicine; and to train staff to implement these new technologies effectively. SAE’s COVID-19 Behavioral Health Response Team has the capacity to help your organization access new funding from SAMHSA, primarily through the CCBHC Funding Opportunity Announcement where SAE’s grant writing team helped six behavioral health providers each receive 4 million dollars to expand their services in 2019-2020. We anticipate that the 2021 SAMHSA Funding Opportunity Announcements will focus on providing behavioral health agencies with the resources to expand the use of innovative technologies to engage and maintain in treatment the most disadvantaged populations of focus impacted by the coronavirus pandemic.
SAE’s COVID-19 Behavioral Health Response Team has the skillsets and experience to help agencies implement the six critical steps noted earlier that you need to take to effectively implement changes required to gain agency control over its destiny and to begin the process of its recovery and eventual growth. SAE provides training, guidance, research, updates, and solution tools to help address the needs of agencies during this pandemic. Visit http://saeandassociates.com/ to view our array of resources, such as our Issue Briefs and Podcasts. To explore how we can assist your agency during this pandemic, email firstname.lastname@example.org to connect with our team.