Technology Trends: Taught on the Fly
Moving services to telehealth amid COVID-19 lockdowns meant clinicians needed to be trained for online delivery.
Over the past several years, behavioral health providers have begun to consider the benefits and logistics of offering telehealth services. Although these considerations have led to an increase in availability, telebehavioral health has not been widespread. At the start of 2020, many agencies were in, at most, a preparatory phase in which they were considering which and to what degree services could be moved online.
The coronavirus changed that in an instant, significantly accelerating the adoption of telebehavioral health. Statewide lockdowns forced providers to find virtual means of meeting with clients. Appointments—both group and individual—were moved to the telephone and/or video chats.
This seemed like an ideal solution to a unique situation. However, the move online and the speed with which it occurred created challenges. Clinicians who had, for the most part, learned and gained experience delivering in-person services suddenly had to find a way to do that same job virtually. Similarly, the agencies that employed them had to devise a way to best prepare and support their staff.
“We had a plan to roll this out,” says Shauna Reitmeier, MSW, LGSW, CEO at Minnesota’s Northwestern Mental Health Center, which had, in fact, made the growth of telehealth services one of its 2020 initiatives. But rather than having the chance to roll out training and then delivery, “We literally flipped the switch in four days,” Reitmeier says.
To better facilitate the move online, organizations and individual clinicians sought training (also online). The education, guidance, and support providers relied on throughout the lockdowns took many forms and will help shape how clinicians are trained even after the pandemic.
Some of the most popular and needed trainings, particularly at the start of the lockdowns, had to do with logistics.
Prior to the lockdown, organizations may have hired a consultant to come in, either virtually or in-person, to discuss how best to utilize an online platform, such as Zoom. “But we didn’t have time,” Reitmeier says. “We were at the point of ‘How do we maximize the tool to engage people [now]?’”
And it wasn’t just engagement that had to be considered. How would privacy be maintained? What type of security was needed, and how would it be set up? While providers like Relias couldn’t offer a “101” on Zoom, they could and can help answer some of those more nuanced questions.
“They were looking for guidance and best practices,” Lewis-Stoner says, noting that legal and ethical considerations are key components to setting up and implementing telebehavioral health. Relias already had a series on telehealth available prior to the pandemic, which included information along those lines.
John Jay, strategic product marketing manager at Relias, adds that prior to lockdown, users might ask higher-level questions such as “Does telehealth make sense for my organization?” or “Does telehealth have efficacy in terms of the services we provide?” The questions were more technical about set-up and getting started.
In addition, agencies had to consider procedures. The protocols clinicians adhered to when meeting with clients in person couldn’t be relied on in the same way when meeting virtually. Clinicians needed to be trained in the new (sometimes yet to be developed) protocols for their position and agency.
Take, for example, safety planning. “How do you do that when you’re not physically there? You’re not able to call the nurse in from down the hall in that situation. Somebody suicidal, if they’re in your office, you’re able to get rapid response or stay with them or call in the mobile crisis team in that moment,” Reitmeier says.
While a provider might be able to sit with a client on the online platform, they can’t, at minimum, guarantee that the online connection won’t be ended by the client. Clinicians needed to learn what steps to take to be most effective in that type of virtual situation.
For online offerings, that meant making sure the training was truly useful to clinicians. Hours of work from home could easily be filled with webinars, but the content that was needed had to have practical application for practiced providers.
“The feedback we get from clinicians around content in general is that it is super important to make it meaningful to them,” Lewis-Stoner says. “There needs to be an acknowledgement that they’re coming in with some knowledge. We want to make sure that the content we offer is relevant. Clinicians want to be able to take the knowledge that they’re gaining and apply those skills. It needs to make them think beyond recalling.”
At Northwestern Mental Health Center, this type of training took place not via online training but rather through online supervision. Reitmeier says weekly supervision with clinicians was prioritized, so that specifics could be discussed. “That’s the opportunity to do real-time problem solving, real-time strategizing” she notes. “We know who the person you’re working with is, who the client is. It’s not just a blanket training.”
That one-on-one time allowed the clinicians to think about how they were approaching the new environment and what new details were coming to light now that the client was at home for sessions. “It’s coaching to think differently. You’re asking the same questions, but you get to observe other information about the environment. Now you get to see, ‘Oh, it’s cluttered’ or ‘It’s really dark,’” Reitmeier says.
“It’s Zoom fatigue,” Reitmeier says. “You don’t get the time to leave the building and stretch your legs, [but] you need to take that break.” She adds that when clinicians were able to take a minute away from work or end their day, they found themselves diving immediately back into household and family concerns. “We are having providers that didn’t realize they missed that 15-minute drive home,” Reitmeier says.
While there were and are a number of self-care webinars available online, training providers recognized that there needed to be COVID-19-specific content. “What we’re looking at right now,” Lewis-Stoner says, “is developing some content around self-care and making sure that what we’re talking about is really addressing what they are experiencing in this environment—having the content come from the sustained public health crisis approach.
“Historically, we might have a course about vicarious trauma and self-care after a grueling day at work. Here we’re taking a different approach,” she continues. “There’s not a way to get away from it. You’re concerned about yourself. You’re in isolation. It’s more challenging for you as a clinician.”
“What I think you’re going to see is the need to train clinicians on best practices for both [in-person and telehealth delivery],” Jay says. “As organizations adapt to and become more accustomed to delivering telehealth, telehealth is going to be more prevalent in behavioral health moving forward. You’re going to see from organizations a mix of best practices when you’re engaging via technology and also best practices for face to face.”
Lewis-Stoner says that when creating content moving forward, “we will need to be mindful of even the practice scenarios. We will need to have scenarios with telehealth.”
Reitmeier agrees. Even after the pandemic, services will be a combination of telehealth and in-person, she says. There are swaths of individuals who have to be seen face to face, either because of internet/telephone service barriers or because of diagnoses and other extenuating circumstances. However, the move online is not a temporary one. It is a sign of what’s to come.
Of course, with the pandemic ongoing and the uncertainty of additional lockdowns and surges, it’s unclear exactly what lies ahead for behavioral health services. But what is known is that tomorrow’s new normal will be much more virtual than yesterday’s. Providers need to be ready and well trained.
— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.