When the pandemic hit in March 2020, the biggest worry for OLV Human Services in Lackawanna, New York – as with most agencies – was that the most vulnerable population served would possibly have interruptions to their services due to face-to face services being canceled.
With stay-at-home orders from the governor in effect, the reality was there would be clients who did not receive services. OLV also was guarding against the possibility of staff layoffs and/or program closures due to not being able to financially sustain them if no services could be provided.
“When the temporary order from the government to allow telehealth was announced, that gave agency providers hope that they could still provide services to the families they serve, while not financially draining them,” said Sheila Hunt, the chief managed care officer at OLV Human Services.
“The quick shift from in-person visits to telehealth happened overnight for most providers,” she continued. “The telehealth platform doxy.me was announced during a webinar with agency providers, who were all dealing with the same issue of having to conduct appointments on an ad hoc basis through the use of technology and devices.”
OLV’s chief IT strategy officer quickly went to work to implement doxy.me for the agency and set up user accounts for all providers who would be providing telehealth services. There was a great deal of work that needed to be done before this could be accomplished. Technology for staff had to be identified and deployed. Users had to be set up to work remotely, and the staff needed to educate the families on the new technology.
“The number of COVID-19 cases was extremely high in Erie and Niagara counties, which are the main two counties we serve,” Hunt recalled. “Erie County actually had the highest number of COVID -19 cases in New York State. We knew the only way to provide services going forward would be through the use of telehealth.”
The implementation of telehealth services was done so OLV could continue providing services to families and individuals it served. Most clients typically are lower income, underserved and are high-risk for mental health crises.
“The flexibility and accessibility of telemedicine has allowed treatment to continue, and we have not seen an increase in inpatient hospitalizations for admitted clients.”
Sheila Hunt, OLV Human Services
“We were hopeful that through telehealth we would still be able to actively engage our clients so there would be no interruption in their services,” Hunt explained. “We also envisioned having fewer appointment cancellations and no-shows. There always was the thought of the families who would not be able to receive services due to having no access to appropriate technology to support telehealth.”
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MEETING THE CHALLENGE
Telemedicine has allowed OLV’s OPC Clinic and home- and community-based providers to deliver treatment, despite the various barriers that clients have been experiencing.
“Prior to telemedicine, various barriers would prevent an individual from accessing the treatment they needed,” Hunt said. “Among these barriers were medical issues, transportation needs, financial needs and individual needs. These barriers were very stressful for our clients and would lead to inconsistent – though much-needed – treatment.”
COVID-19 also became a major stressor for clients and clinicians. When schools and businesses were closed due to the pandemic, OLV was able to continue to serve clients using telemedicine. Clients were grateful to continue with treatment knowing their clinicians were available to provide support through this difficult time.
“The flexibility and accessibility of telemedicine has allowed treatment to continue and we have not seen an increase in inpatient hospitalizations for admitted clients,” Hunt noted. “Many individuals in need of treatment are concerned with face-to-face treatment due to COVID-19 and telemedicine has provided them with an opportunity to receive treatment.
“Since implementing telemedicine, OLV Human Services has seen an increase in engagement and compliance,” she continued. “Mental health counseling and psychiatric services have continued, and we also now are able to provide treatment to more individuals, despite numerous barriers. We monitor referrals, admissions, continued engagement and hospitalizations.”
OLV has continued to accept referrals and provide treatment throughout the pandemic. It also learned that telemedicine is a valuable and effective mode of providing treatment.
All OLV outpatient clinicians, psychiatrists, psychiatric nurse practitioners, and home- and community-based providers have been using the doxy.me telehealth setup.
“Doxy.me has been extremely useful in keeping clients connected to providers throughout this whole pandemic,” Hunt said. “Many of our kids had no outlets besides our staff; they have been able to continue to work on their goals by using video and telephone sessions with their providers. We’ve been able to utilize doxy.me to provide counseling sessions, as well as working on coping skills, anger, social skills, etc.”
Providers immediately were trained on engaging with their families remotely, and made it an expectation for service offerings. The supervisors and clinicians practiced using doxy.me with each other to ensure there would be little to no connectivity issues. OLV also educated the families on what telehealth services would involve and explained that it would allow them to continue receiving the much-needed services in the comfort of their own homes.
“For some families, the use of telehealth made their experience with receiving and interacting with their provider easier,” Hunt noted. “For some programs that quickly had to transition to telehealth, it provided a way for us to continue with completing initial intakes and bridging providers to their families post-intake.”
By providing services in place of, and in support of in-person services (with the needs of the participant in mind), the team/treatment meetings and screen-sharing capabilities worked well to involve other providers, Hunt added. The agency was still open for business in the event families needed to come to the brick-and-mortar site for emergency services, or if they just felt the need to see a provider in person.
With the use of telehealth, OLV’s main goal and focus was to ensure families had no interruption in receiving services. Staff then looked at no-show rates and patient cancellations in the outpatient clinic to see if any of those metrics changed or remained the same. The clinic had a very high no-show rate and a higher patient cancellation percentage.
“After using telehealth for the past year, we did run some reports on no-shows and patient cancellations, and realized that the use of telehealth for some programs improved a little. But for the outpatient clinic, our no-show percentage actually increased by 3%,” Hunt reported. “For some clients, the use of telehealth for almost a year became a little exhausting, and some families just wanted to wait until the pandemic was over, and felt safe coming to the main site for services.”
For those families, OLV does provide regular check-ins to ensure they are coping with being confined in their home for an extended period with children who also are doing remote instruction.
“We did find, however, that the number of patient cancellations drastically decreased,” she noted. “We ran the report for the previous year from March to February, and there were more than 1,100 patient cancellations for reasons related to transportation issues, childcare issues, and not being able to leave work on time or being home sick.
“The use of telehealth for the time frame from the beginning of the COVID-19 pandemic to today has allowed patients to still attend their sessions, regardless of any of the above issues,” she continued. “We used the same time frame, from March 2020 to February 2021, and noticed that we only had 794 patient cancellations. The difference in the number of cancellations saved the clinic approximately $30,000.”
Some of the home- and community-based providers were able to extend the length of sessions from 0-5 minutes to 15-60 minutes with the use of telehealth. Offering of initial intakes via telehealth has been very useful, Hunt said.
“Many families take advantage of this,” she said. “Because they were able to offer meeting options when in-person meetings were not realistic, this did help reduce cancelled appointments and no-shows, and helped to build the relationship between the provider and participant.”
USING FCC AWARD FUNDS
Last year, the FCC awarded OLV Human Services $174,840 to support the cost of connected devices and telemedicine solutions used to remotely treat COVID-19-vulnerable populations using video telehealth applications throughout Erie and Niagara counties.
“When we initially applied for the FCC telehealth funds, we met as a team to create an itemized budget for the items we would need to implement this successfully,” Hunt recalled. “We submitted an application asking for the following items: 125 laptops for providers who were providing telehealth services and licenses for the telehealth platform doxy.me for providers using telehealth.”
OLV thought about the families who would suffer from not receiving services due to lack of technology at home. So OLV asked for funding for technology for the families for items such as tablets or iPads.
“When we received the funding, we purchased the laptops for providers as we requested. We purchased the licenses for the doxy.me platform for providers, and we purchased tablets to be deployed to families who didn’t have the appropriate technology at home to allow them to continue receiving services,” she said.
“The use of telehealth has allowed us to continue providing services to our families, who otherwise during this crisis would not have been able to receive face-to-face visits,” she continued.
Some clients feel it’s not as personal as actually being able to sit across from their providers to express their thoughts, but feel fortunate that they had someone to talk to during the pandemic, said Hunt.
“With so many families dealing with depression, higher suicide rates, domestic violence, death of loved ones from COVID-19, unemployment, food shortages, higher opioid addiction and loneliness, we are hoping that we made an impact on their lives just by being there and available through the use of telehealth.”