The coronavirus causing expansion of tele-counseling services
This is the 2nd article in an ongoing series on the state of the coronavirus and tele-health services.
As the coronavirus (COVID-19) impacts the world with increasing severity with each passing day, its implications on the delivery of healthcare continue to be evident — and not just in emergency departments and intensive care units. From outdoor triage units being established in parking lots and cars to skilled nursing facilities and long-term care centers receiving waiver protections to accommodate more patients, there aren’t many healthcare settings immune from the dire effects of the pandemic. And yet, measures such as quarantining and social distancing of the general public are preventing providers from seeing patients for non-emergent reasons. Through it all, the presence of tele-health for a variety of services has become exceedingly critical. Among those services is the delivery of tele-counseling sessions, where the conversation has gone from “what if coronavirus impacts us” to “what now,” said Lisa Henderson, LPC, a licensed professional counselor and chair with the American Counseling Association. Entering Saturday morning, the number of global coronavirus deaths had surpassed 11,000, with more than 260,000 people reported to be infected with the disease, including more than 17,000 positives in the United States, where there are 200 deaths reported as of March 20. For Henderson and other clinicians who care for a mental health patient population that had been growing even before the pandemic (and, yes, the virus is producing its own uptick as spring commences), seeing patients virtually is raising its own set of questions and uncertainties, even if it’s proving to be beneficial.
Coronavirus Compliance Matters Regarding Tele-Health
According to Henderson, at the core of how people are responding to COVID-19 is an unhealthy level of anxiety. While any mental health clinician will be well trained in treating anxiety, the core of the uncertainties that are currently confounding providers is the relaxing of certain HIPAA and tele-health standards related to technology and compliance that have been issued specifically for the treatment of coronavirus and related conditions. Such waivers include the relaxing of penalties typically associated for such issues as ensuring of privacy protections and the confidentiality of communications, especially when the use of technology is a component of one’s care. But for those patients who experience a stir of echoes from past traumatic experiences that are brought to the surface when COVID-19 anxiety hits a high note, well, then, how far can the care go?
“Past traumas can flare up by what’s going on right now with COVID-19,” Henderson said. “But we don’t know who is going to be making the determination about whether something historical is considered part of current COVID-19 treatment. So when you start to ask about past traumas [during a tele-session], that presents a grey area. And that presents challenges for clinicians.”
Another example of where confusion may reside is the removal of restrictions that typically prevent clinicians from conducting care across state lines. In the face of COVID-19, licensed providers can explore opportunities to treat out-of-state patients without infraction or risk to licensure, but there is at least one catch: “This is typically limited to licensed providers who are acting as volunteers, for example, those who sign up for the Red Cross to go into disaster recovery,” Henderson said. “What would be really problematic is for a licensed clinician to think that he or she can go ahead and see any patients who reside in other states [because of the waivers]. But if those providers were to get paid for that service, that would need be included in that waiver. The truth is that there’s fine print in all of this.” Henderson suggests that all providers consult state regulations before proceeding with any services that they would not otherwise conduct despite the existence of said waivers. “Each state has the right to declare for themselves whether they are in an emergency situation or not,” she said. “When a state of emergency has been declared, there are existing response plans that are put into place. Many things are said ‘in the news,’ but that doesn’t mean everything is enacted. “The risk that all of this brings is, perhaps acting in haste and not doing enough research to ensure that the reasons you’re conducting tele-health are safe and ethical.”
Patient Profiles With Coronavirus
In Henderson’s experience, the coronavirus is producing three general presentations among patients:
- People are preemptively mourning things that they are worried about losing or that have been placed on an indefinite hold – such as financial stability or a job promotion that’s now in limbo.
- Those people who are triggered by the events of their past. Survivors of such things as childhood abuse or neglect may now feel isolated, or out of control, or that they’re not going to be able to take care of themselves.
- People who feel helpless overall. They have always coped with problems happening in their life by being able to do something to help, and now they’re prohibited from doing that. And so they’re having to learn new ways of dealing with that.
“We’re seeing these traits in people who we already are caring for and we’re seeing an increase in people reaching out for care,” Henderson continued. “These may be people who had previously reached out for care but never followed through with it. The may be contacting us months or years later to say, ‘Now’s the time.’ This pandemic is definitely impacting people in really important ways and in ways that they didn’t anticipate.
Within the general public, Henderson said she and her colleagues are seeing new patients who have never undergone therapy as well. “There are people who may have had mild, but manageable, circumstances that may have benefited from self-help strategies previously,” she said. “But now things have doubled because of the virus over and those strategies are no longer sufficient for them.”
Potential New Mindset For Tele-Health Providers
Traditionally, clinicians who engage in tele-counseling may do so only at the request of patients and/or when they believe that a clinical presentation is conducive to this type of counseling occurring safely. Some patients may be better served strictly though in-person care, given normal circumstances, based on opinions and clinical assessments. Due to the coronavirus these providers and their patients are not able to consider their options, something that Henderson also acknowledges as a challenge—though she’s confident that adaptation due to circumstances is bound to happen. “A lot of providers are going to struggle with this; from an ethical standpoint, and when you add multiculturalism to the equation, it’s important,” she said. “In our profession, we tend to be biased toward what’s good for the individual. But we may need to expand our thinking to ‘what’s good for the group.’ As the entire country is dealing with COVID-19 and exposure, and limiting exposure, being able to broaden your viewpoint of who you’re responsible to is going to help.”
Referring Patients For Tele-Counseling
Despite the complexities that mental healthcare providers will have to juggle, the referral of patients by allied professionals should remain consistent, Henderson advises. “Allied providers may not know [everything] about a patient’s history, and so that’s why mental healthcare providers are here — to be that referral source that you can know and trust who has the responsibility to determine if they are suitable to treat that person’s condition, especially when considering the potential for tele-health,” she said. “It all comes down to healthcare providers trusting one another and doing right by what that patient needs.”
Similarly, with the strain that COVID-19 is placing on the system overall, Henderson said that providers should ensure that they’re developing relationships with their peers that could protect them from the mental pressures that the virus may inflict.
“Providers need relationships with their co-workers where they can tell one another if someone seems to be “off,” she said. “You need to be able to trust one another, and you need to be able to be honest with one another. It’s ok to have a bad day; it’s ok to be frustrated. But when you stay there, you need someone who can tell you, “I think you may need to talk to somebody” – and you need to listen to them.”
