In the phone line, a lifeline: how behavioral health via telehealth has helped kids navigate COVID

Nikki Fangman · March 11, 2021 · Short URL:

This is the world kids are living in and telehealth allows us to meet them where they are

The small and great tragedies of COVID-19 are innumerable. That said, if you start to look closely at how life is changing as society continues to adapt, there are some things that may actually have gotten better in the wake of the pandemic than they were before we ever heard or spoke of the novel coronavirus.   

There’s an argument that can be made for putting behavioral health in the category of things that have improved.

Let me explain: The behavioral health services practice I oversee, MEBS Counseling in Covington, Kentucky, comprises a multi-disciplinary team of professionally licensed mental and behavioral health specialists. Before COVID-19, MEBS was providing counseling and other behavioral health services primarily to children and families across northern Kentucky. Many of our clients came from high conflict family situations; some experienced trauma; many were referred through the Kentucky public school system; few had access to other sources of behavioral healthcare. Most of MEBS’ revenue comes from Kentucky Medicaid. 

Given the population we serve, prior to the pandemic we were doing a lot of community work, meeting with clients where they are, particularly in schools. We were providing in-office services, as well, but serving a rural population distributed across eight counties and hundreds of miles, we spent a lot of time on the road.

When the pandemic hit, we, like everyone else, were forced into an at-home situation overnight. We were cut off from our clients and from each other. We knew the isolation we were feeling ourselves was amplified for our clients, so we hustled to get a workaround in place as soon as possible. We knew that our integrated EHR and billing vendor, Azalea Health Innovations, Inc, offered telehealth as well, so we arranged with them to add telehealth to our portfolio. The process was very quick: we had initial conversations with Azalea on a Wednesday morning and by Friday we were in training. On the following Monday, we were delivering behavioral health services via telehealth. 

One of the biggest factors that made our transition to telehealth so easy and so fast was CMS’ relaxation of the HIPAA guidelines, allowing providers like MEBS to offer and get reimbursement for telehealth appointments. It’s interesting and unfortunate that it took such a calamity for our health system to push through this expansion in how behavioral health services can be delivered, but this forced experiment proved the efficacy of conducting counseling remotely. 

The results we’ve seen utilizing telehealth to maintain continuity with our clients have been somewhat unexpected, especially with kids. We work with children from as young as three all the way up to 18. For many of these young people, we anticipated difficulty getting them to engage with us through a telehealth platform. What has surprised us is that so many of them have not only succeeded in making the transition along with us to remote sessions, but they’ve actually thrived in ways we weren’t seeing when we were meeting with them face-to-face. When they are in their own comfortable surroundings and are able to show us a favorite stuffed animal or something else meaningful to them, and when we include some of those cherished items in our work with these kids, they’ve really opened up to our therapy.

For the teens we work with, the chat functionality in telehealth has been very helpful. For many, texting can be an easier mode of expression than speaking the words. Having this alternate mode of communication available to us was an important aspect to building rapport with young people who are particularly reticent. Of course, for some of the providers, this took a little getting used to. But it’s important to remember that this is the world kids are living in; this interface is their element. Our telehealth platform allows us to meet them where they are.

We’ve also seen some very positive developments with the adults we work with. Many struggle to leave their homes due to anxiety or other issues. Just getting to an appointment and being on time can be a major obstacle. Telehealth has allowed them to remain comfortable in their own homes and reassure them that they will be able to maintain regular access to their care providers. This continuity is critical to building the trust that is essential to their care.

The benefits of delivering behavioral health services via telehealth extend to the families of our younger clients, as well. Time management for parents who are juggling their own work with care for their children (including making time for counseling sessions) is easier without the travel time to and from appointments. And this is doubly true for families also dealing with supporting online learning while schools are operating remotely or in a hybrid model. 

Of course, we can’t say that this year of behavioral health via telehealth has been an unequivocal success. Some of our clients that we thought would fare reasonably well with the isolation of the pandemic haven’t responded as well to the telehealth modality as we expected. For them, getting back to face-to-face sessions as soon as possible is critical. But, moving forward, if we look at telehealth as an additional means for providing care to our clients rather than a wholesale replacement for in-person delivery, the forced introduction of telehealth has been a positive for the health of our clients and the health of our practice, too.

There’s one additional challenge that we didn’t anticipate: The convenience of receiving services via telehealth has given some of the families we serve a false sense of informality around scheduled appointments. Some mistakenly assume that counseling via telehealth, with video and chat features, will be available on demand. For others, the convenience of receiving services without having to leave home may translate to the sense that skipping a scheduled session is no big deal. Either way, it’s important for all recipients of telehealth services to treat scheduled sessions just like in-office appointments so that a regular cadence is maintained and so that services aren’t underutilized due to last-minute cancelations. On the whole, though, we are very happy with the freedom CMS has given providers to deliver behavioral health remotely.

I know we’ve all had to adapt to life with COVID. Everyone deserves credit for finding a way to get by. I do have to note that I’m extremely impressed by our team and proud that they have been so flexible, learning new techniques and continuing to push forward. This goes the same for our clients. We’ve both endured a lot of teamwork and that is a huge area of positivity I have seen coming out of this.

Looking back, while the transition to offering telehealth wasn’t trivial -- there were a lot of moving parts and important training that we had to go through -- it was an easier augmentation for MEBS than I imagine it may have been (or may be in the future) for other providers. We were fortunate on two fronts: First, apart from the pandemic, we had identified telehealth as an operational objective for 2020. We had already done our homework so we didn’t need to find an internal champion whose job it would be to evangelize telehealth and sell it to the members of our practice. Second, we knew our EHR and billing provider offered a telehealth module on their platform, so adding Azalea’s telehealth to the platform we were already using was a no-brainer. In all, the head start we serendipitously gave ourselves made the technical integration easy and the staff ramp-up manageable.

Looking ahead, we anticipate that CMS will make permanent the flexibility to offer telehealth for behavioral and other clinical services. What’s likely to change, however, is CMS’ relaxation around utilizing non-HIPAA-compliant platforms for delivering and managing telehealth. For care organizations that have been relying on a conferencing solution like Zoom or some other service and are now in the process of identifying a HIPAA-compliant telehealth product, I have a bit of unsolicited advice: Find a vendor that can provide integrated services that will make your telehealth offering a native feature of your health IT platform rather than a bolted-on solution that can’t share data with the rest of your technology tools. Doing so will make both your frontline providers and your back office personnel happier, allowing all team members to focus on the most important work -- delivering a better patient experience.

(Vator will be holding the Future of Mental and Behavioral virtual event on May 19. We'll have top-level VCs and C-level executives from the leading mental and behavioral companies, such as Teladoc's BetterHelp, Amwell, Doctor on Demand, Kaiser Permanente, Bessemer Venture Partners, GSR Ventures and more)

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