Traci McCarty, LISW-S, Clinical Director at The Village Network, a multi-discipline behavioral health organization in Ohio.
The COVID-19 crisis has demanded that we shift our practice in many ways, and staff have responded differently to those demands. I have found it helpful to remember that it is skill, not will, getting in the way for some staff, and to practice Plan B when problems arise.
Two weeks ago, upon order from Ohio’s Governor to shelter in place, our agency, like many, started the transition to telehealth; providing clinical services to youth and families remotely through use of technology. This process required our clinicians to learn how to use a new software application quickly and then immediately shift to the role of “teacher” to their clients.
Within a 5-day period, clinicians were trained in the new software application, state regulations, and best clinical practices to support the change to telehealth.
Simultaneously, these same clinicians were adjusting to working from home while also navigating through their own fears about community spread, home-schooling, and limited access to practical necessities like toilet paper. Many clinicians wondered whether they could be successful counseling clients by phone or laptop when they typically depend on using sensory regulating tools and relational-based interventions to capture and maintain children’s attention. It seemed that the conditions of telehealth appointments would make it likely that challenges and challenging behaviors would arise. The transition to telehealth meant that each clinician’s own emotional regulation and cognitive flexibility skills were being put to the test.
I noticed that one clinician in particular had not signed on to any of the required telehealth webinars or to the new software application. Zero clients were on the clinician’s schedule for telehealth.
Now, prior to our recent focus on implementing the Collaborative Problem Solving approach into our agency’s supervision philosophy, my response to this clinician would likely have been very “Plan A.” I might have assumed that this staff member was simply being uncooperative; avoiding the transition to telehealth to avoid having to put in extra work. My response might have included performance-based tracking forms and corrective actions.
However, since we have implemented Collaborative Problem Solving into both our clinical model and into our supervisory practices, we hold tightly to the philosophy that it is skill, not will getting in the way when our youth or our staff aren’t meeting expectations. I turned to Plan B to find out what was getting in the way of this clinician delivering services via telehealth to clients.
I started the Plan B conversation neutrally. “I noticed that you haven’t attended the telehealth webinars or started transitioning your clients to telehealth. What’s going on?”
In rapid fire, the clinician immediately expressed several concerns that were getting in the way of being able to transition to telehealth. First, they felt anxiety around using any new technology, and they were not able to find the necessary software application on the desktop. The clinician also cited doubts that elementary-school aged clients, most of whose families had limited financial resources, would be able to engage via telehealth, due to lack of access to WiFi, computers, and mobile phones; even the libraries where many clients and parents typically accessed internet are closed due to state orders. Finally, the clinician was very concerned that telehealth sessions would not be clinically useful, and that they would instead result in the clinician staring at carpet and ceiling fans via webcam. (Any aunt, uncle, or grandparent who has tried to face-time with a 6-year-old can probably relate to this!)
Wow, I thought. That’s a lot. And every one of those concerns was valid. In asking for this staff member’s perspective, I learned something new that would likely help me be a more effective leader in the confusing wake of COVID-19. I surmised that other clinicians were likely experiencing the same challenges. I made a mental note to follow up with others.
The calming effect of the first ingredient created the safety for the second ingredient: I expressed two concerns. First, our agency wanted to avoid contributing to a community spread of the virus. Second, continued contact with clients could be helpful to maintain the clinical relationship, to check for worries or other mental health needs related to the virus, and to keep an eye out for critical needs or the need for crisis intervention.
With both sets of concerns on the table, the clinician and I brainstormed several solutions. Some of the solutions were quick and easy. As it turned out, there was a technology glitch that impacted the software application from displaying on the clinician’s desktop. We solved it with just one email to the IT department. Once the clinician could actually see the software application, the novelty of the application became much less intimidating.
The clinician identified several other flexible strategies to provide consistent services during this time. One idea was using a hybrid model of phone calls and the web application, depending on the client’s level of access to the internet. In addition, the clinician requested permission to still provide face-to-face sessions when truly in the best interest of the client, utilizing all physical distance protocols and personal protective equipment. Finally, the clinician suggested that it would be helpful to have a plan for accessing technology support or a supervisor for quick troubleshooting if (and when) technology failed.
All of the solutions posed by the clinician were reasonable and do-able, and they met both of our concerns. In fact, the flexible options for using hybrid methods to connect, and the reminders of how to access supervisors and tech support were rolled out to every clinician to assure that no client was left behind in our shift to telehealth.