HJNO Sep/Oct 2020

HEALTHCARE JOURNAL OF NEW ORLEANS  I  SEP / OCT 2020 49 Jan Kasofsky, PhD Vice President of Behavioral Health & Human Services Access Health Louisiana al facility-based care, what did the early months look like from the therapist’s and the patient’s point of view? Let’s start with the regulatory and re- imbursement side for providers. Almost immediately, the federal government changed the Medicare and Medicaid rules on telephonic and virtual sessions; rules regulating confidentiality were softened due to the emergency, as were rules reg- ulating out of state virtual appointments. Virtual and telephonic appointments not previously paid for by insurers became billable services, and prescribers could provide access to controlled medication prescriptions without an in-person ses- sion. Rapid adoption of new technology oc- curred using smart phones and the in- ternet. After an application was selected, there was initial fear and concern that the technology would be a barrier due to poor connectivity, sound, and picture, but thankfully, many appointments moved fairly easily into the virtual realm. There were, however, clients in areas without WIFI who had to move to hot spots to con- nect. Most clients were motivated to over- come their initial concerns about the tech- nology and privacy, and they found value in their virtual sessions. What happened for the therapists, and how are they doing? About half of the providers at Access Health Louisiana (AHL), a FQHC mostly serving the greater New Orleans area, had no prior experience with teletherapy/tele- medicine prior to March 2020, but by mid- May, all mental health services became virtual. By June, 80 percent of the provid- ers responded to an internal survey noting their initial concerns; they also described their relief due to not needing to have in-clinic appointments that could lead to illness, being able to keep clients engaged in treatment, not needing to arrange their own child care, their ability to offer flexible appointment hours, and having a higher number of kept appointments. Nearly all providers expressed a desire to provide some level of intermittent and initial ap- pointments in person when it becomes safer. Melissa Laneaux, LCSW, one of AHL’s school-based therapists noted the sat- isfaction of her teenaged clients with a virtual group therapy appointment; “I ex- pected no one to talk, and for them all to be nervous, but as the students became more comfortable, they all participated and were excited to talk. The students liked seeing each other on the screen because there were several of them. The group went as well as any face-to-face group would have gone, so I’m now a huge fan.” What happened for the clients, and how are they doing? In early April, AHL, surveyed its behav- ioral health clients regarding their ability to use smart phones, tablets, and comput- ers, their access to WIFI, and their satis- faction with the quality and convenience of moving to teletherapy appointments; 90 percent of the respondents affirmed a positive response to the technology, and a desire to continue virtual appoint- ments. There has been a steady increase in requests for behavioral health services through a survey tool posted on the AHL website; new and existing clients are re- questing appointments that focus on grief and loss, family management, anxiety, de- pression, substance abuse, and addressing stressful issues, such as isolation, related to the pandemic. Patient satisfaction with teletherapy in the literature cites a higher level of satis- faction related to convenience, not hav- ing to travel, being able to connect in the comfort of their own homes, shorter wait times, avoiding a waiting room, the ability to match therapists to client preferences, and the promotion of patient-centered communication. A client of Vanice Zenon, LCSW, behavioral health director at AHL, said the following about their virtual ses- sion; “This was great because I can more easily manage my family’s needs. I don’t need to arrange childcare, and I can share my world with you virtually where you can see my kids and home.” Another cli- ent noted, “I hope this can continue after COVID-19 is over because it’s easier when I don’t have to take more time from work to travel to my appointment.” What is the future? At the time of this writing, Louisiana is experiencing a sec- ond wave of infection, there is still no vaccine available, and many still congre- gate without social distancing or masks. Therefore, no date has been identified for AHL behavioral health services to reiniti- ate face-to face-appointments. Once saf- er, and if demand increases, clinic-based services will minimally return. In-clinic appointments will reflect best safety and therapeutic practices, and focus on newly admitted clients, and reengaging existing clients requesting them, with or without technological challenges. All pre-appoint- ment registration and in-clinic, primary care appointments, will expand screen- ing for anxiety, depression, and substance misuse and abuse to ensure the behavioral health needs of our community and cur- rent clients are identified early, and ad- dressed by professionals, largely through teletherapy. n