In a time when physical distancing and isolation are necessary responses to COVID-19, healthcare clinicians are rightfully concerned about their personal mental health as well as that of their colleagues, family members, and patients. Join our discussion about how COVID-19 has affected mental health needs within your practice and how you are working to address both your own, and your patients’ needs within the current context.
Various forms of technology exist to support different aspects of mental health care in practices. There are also a number of consumer-mediated technologies (such as mobile health apps) that may serve as additional tools for clinicians and patients.
How useful have they been to practices/patients? Were they easy to implement/use? How were they integrated into the broader care planing and corresponding treatment?
Have folks felt more comfortable openly discussing these types of issues? How has it influenced their ability and willingness to seek and receive treatment? What effect has the the increased media attention had?
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Physician
In many ways, the pandemic has reduced barriers to discussing mental illness. Conversations have grown from the evolving community discussions and awareness of substance use disorders before SARS CoV-2. The open discussions and media coverage of fear, anxiety, depression, and despair that may result from the pandemic directly and the consequences of job loss, social isolation, and uncertainty of the future all have worked to reduce stigma-based barriers. Many of us are now working to build upon this awareness to target preexisting stigma and other barriers to care access.
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Physician
As a Pediatrician, I'm finding that parents are trying to protect their children from the media frenzy. My older patients (teens) willingly admit they prefer not to watch. But those who do seem to be more fearful. I ask patients who are old enough about their media viewing, and try to discuss their anxiety.
The pandemic and subsequent coverage has highlighted that nearly half of Americans report an impact on their mental health. I do believe this assists in reducing stigma for socially acceptable diagnoses that may be perceived as maladjustment, stress, anxiety or depression. However, for severe mental illness and substance abuse there continues to be marginalized experiences for several individuals. Reducing barriers like access through telehealth does open up opportunities to increase intervention and engagement with patients who may otherwise forgo care due to stigma.
I appreciate the comment shared that the work now is to build on the awareness and momentum created during this period.
Physician
We have not seen any changes in reduced stigma, but being able to leverage telehealth should reduce the issue of actually going to be seen going to a psych office; most concerning is we have seen patients defer care for all medical reasons including mental health, leading to some higher acuity needs when they final do reach out to their medical provider.
Mark, great point. I wonder if this will be one of the lessons learned from the pandemic: we may have overdone it on the messaging to patients to limit utilization of the health system, particularly primary care. My sense is that we could have messaged better by educating patients about what issues they could come in with and then telling them to feel free to ask us if a certain issue was suitable rather than trying to figure it out on their own (or feel bad about accessing their doctor). I've had patients apologize to me for requesting my help under their assumption that I was somehow slammed in primary care with COVID issues.
Physician
In our experience I agree with above. We over did telling patients to stay home. Our patients told us clearly they needed us and wanted or needed to be seen. Next spike of the infection we are planning on doing our best to create low risk environments to see people in person. i personally are going to touch people. Patients have communicated they need the physical touch. i will do my best to minimize risk, hand shake and wash immediately. We have also experimented with zoom groups.
The combination of the direct effects of the pandemic (eg. workflow changes, exposure risk etc) and indirect effects of the pandemic (eg. financial stress, strain at home) put health staff at significant risk for burnout and fatigue. I'd love to hear what creative strategies practices are using to support their staff.
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Physician
Our health system's response is not unlike many others I have spoken with across the country. We have expanded our EAP to incorporate a wellness line- and it is on every computer's screensaver. Our Chaplains are spending time talking with the care teams on our units- far more than they used to. We have expanded the use of Watson rooms (calm, meditative recovery rooms with massage chairs- cleaned before and after each use). We offer scheduled video peer support groups that are targeted by discipline (physicians, nurses, respiratory therapists, food service, etc) and by location (ED, ICU, etc). We have expanded our wellness activities in each clinical department- both inpatient and ambulatory- to engage and support staff. And- our communications staff has worked overtime to push out these messages over and over, to build a culture that affirms caring for each other.
Physician
Just like many other health systems , caring for our caregivers is one of our highest priorities .
A) Reactive strategy :
When a Caregiver feels overwhelmed and wants help, we have a seamless process to guide them to appropriate resources based on their preference . (including wellness resources, BH therapy , Spiritual care support but also information on Child care , Finances etc all easily accessible in one place ) .
We have built an interactive tool along with our Digital innovation Group to help guide our caregivers to appropriate resources based on their self reported levels of stress .
These tools include various self help resources including a partnership with CredibleMind who have curated all the highest quality resources based on ones prefered method of learning ( eg: I want help with stress and want to hear a podcast or use an app).
Our partnership with SilverCloud provides easy access to high quality Computerized Cognitive Behavioral therapy.
Tele Spiritual care has been one of the most utilized resources for people with mild stress levels. Work2BeWell helps with resources to address the MH and well being of our caregivers children. We have a BH Concierge service for all our caregivers and their dependents ,to provide same day access to a therapist trained in CBT,IPT and DBT.
We have created a stress meter that helps guide people to these resources , you can find it at Providence.org/stress
B) Proactive startegy:
Self care/Wellbeing needs to be proactively built into the workday , not an additional task for an already overwhelmed group. We have created a tool kit to help our core leaders that includes peer support , Schwartz rounds etc.
Physician
Wellness Wednesdays emails with counseling resources, mental health support apps, exercise and nutrition tips, and discounts. Meal delivery discounts. Virtual Townhalls. Meditation video: facebook.com/uclahealth/videos...
UCLA Health and DGSOM Deans Office leadership recognizes the mental, emotional, and physical challenges that this pandemic has brought staff and their family.
The UCLA COVID-19 Wellness and Mental Health Workgroup has developed resources and services to provide emotional support to UCLA Health staff and faculty who are working on the frontline and have been impacted by COVID-19.
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Physician
Let's not forget a very important factor to maintain behavioral health--keeping everyone employed. It hasn't been easy, but our corporate owners have been willing to sacrifice and wait for things to turn around.
We have been providing expanded EAP programs, peer support groups, and wellness days. We have also put together a childcare program and community resources for our teams related to wellness, educational resources, and community resources for social needs. In addition to the general mental health support programming, the resources we've provided around parenting and childcare have been particularly welcome with so many team members working from home with children out of school.
In addition to what has been shared here we have completed two surveys from staff to receive feedback of what teams would like and heard overwhelmingly the need for communication on pandemic and recognition. Our leadership has provided daily communication on our response plan to all employees and weekly sourced overview of publications and learnings related to COVID. Provider services initiated a gratitude program with meals to sites that are open and to team member homes. We have provided "flex days" in addition to established PTO where a team member may take paid time off to attend to personal needs (e.g. caregiving).
Physician
We have used many strategies as mentioned above. We were told to use EAP services as needed - provided free of charge, as they are at many places. I also agree with prioritizing self-care as a part of daily life, especially IN the work place. There is great importance in having time carved out to reflect on the uncertainty of the most recent stressful events (the pandemic, riots, job loss, etc).
Lastly, not job-related but there is a group of psychiatrists who have made a free call-in line for any doctor struggling during this COVID-19 Pandemic.
I really hope a part of our new normal is maintaining many of the things you all have listed. I am excited to see how physician wellness has been prioritized and even more excited to see that it is not just about individual's caring for themselves well, as important as that is, but institutions taking ownership of creating workplaces that foster wellness. Long-term those structural changes are key for maintain the wellbeing of the workforce. These include: responsive communication channels, empowering clinical teams to manage productivity demands flexibly and in concert with administration, and of course prioritizing a physical and psychologically safe workplace for all.
Physician
We are a small enough office to meet together every day and talk about our feelings. we are doing that now with the protests. we are doing our best to respect each persons ideals, and feelings and at the same time support each other. This dynamic is a large part of each day.
Certain patients are at high risk of negative outcomes in stressful situations. Those with pre-existing mental health conditions are at high risk. For patients who are currently in therapy, it can be addressed during scheduled visits. For those who have completed therapy, they may or may not reach out to us. Perhaps we should be reaching out to them?
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He/Him/His
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Physician
That's a real good suggestion. I'll mention that to my counselors, although I'm not sure where they will find the time. But even if they reach a few a day, it would be valuable.
Yes, many practices have in fact generated patient lists based on specific criteria and others have done this in an ad hoc manner (eg. providers reviewing their own panels). With EHRs it is easy to create a patient list, for example, for patients with PHQ9s over 15 seen in the last 6 months. In some practices care managers then make a first contact to assess for coping with COVID-related issues. Pediatric practices would select slightly different criteria, for example, creating a list of patients in foster care or with certain diagnoses. I think proactive outreach is essential given that the messaging for so long has been "stay away unless you really need medical attention."
Physician
Leveraging rosters sorted by risk, actively outreaching via phone and patient portal to patients who missed or cancelled appointments, or have been previously identified as rising risk
Active outreach has been a very large part of our COVID response in general. Very early on, we developed both an algorithm based on clinical data we collected as well as claims from our plan partners to determine which of our members are at high risk for complications/hospitalization if COVID positive. We then also developed a screening tool that covered physical (including exposure, symptoms, and testing), behavioral (anxiety and depression), and social health (social support, food access, housing. etc). We prioritized outreach based on the algorithm and used the data from the screening tool to develop interventions. These interventions included grocery delivery, a courier service for needed medications/medical supplies/cleaning supplies/PPE, and a housing program (brief hotel stays for members who could not safely isolate). Additionally, our behavioral health team quickly developed virtual support groups in all markets as well as community forums where our members had space to ask questions. Especially in Brooklyn, these were very well attended.
Similar to other responses here we used our risk tiering to assign outreach calls to different roles. Our social workers targeted calls to highest risk while outreach workers called moderate to low. All calls included social determinants of health screen and loneliness scale. Based on responses we escalated to interventions including food delivery program for food insecurity. We have continued these calls monthly proactively as part of COVID response.
She/Her/Hers
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Physician
The practice ACO provided toolkit resources which not only risk stratified the patient population but also a toolkit to create workflow allowing the staff to reach out to high risk patients. The check in call and subsequent telehealth visit allowed the assessment of mental health stability as part of these visits.
She/Her/Hers
Yes we have created a layered outreach strategy. Our goal has been multiple touchpoints by multiple people. High risk patients get a minimum of monthly check ins, unless they have either said they are not interested, or if they indicate they would like more often. Through population health tracking, we have generating patient lists for outreach, based on complexity, social determinants of health, and utilization patterns. However, we have made a point to try to outreach all of our patients at least once to educate them about COVID-19, preventive health behaviors, and assess adjustment to the pandemic. It has been remarkable how grateful patients have been overall for the check ins. With the shelter in place orders, people have been isolated and lonely. News of business and hospital closures also triggered fear in patients - they have said "we are so glad Cherokee is still here for me"
If so, how has it changed your practice’s ability to respond to patients’ mental health needs during COVID-19? Do you foresee yourself continuing to use the technology, or only continue to offer mental health care services as long as the emergency persists?
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She/Her/Hers
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Physician
I have been using telehealth for mental health services for a few years to improve access to care for my patients. The major barrier has been payment. Until the COVID 19 pandemic most insurance companies only paid for care if the patient was in the office and the physician at a remote location. Allowing payment for the patient to access care from their home has improved access. My concern is that may end before the need for it does. I am hoping that the insurance companies will realize that this is what patients need and continue paying for these services after the stae of emergency ends.
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Physician
Prior to Covid, we had done a survey to ask how many patients would be willing to do tele-visits rather than face-to-face. Approximately 45% said yes. The pandemic suddenly forced us to do 100%, and there has been very little push back. However, I think there will always be a need to do face-to-face, and I think these visits are more valuable. Our office is returning to these on a limited basis now.
Proper reimbursement will be an important issue. In many ways, it actually takes longer to do the telehealth visits, including the note, billing, and set up.
It is clear now that the main barrier has been payment for remote services. The predominant trend nationally, per our membership, has been that many (if not most) patients prefer telehealth (including phone consults) due to the convenience and relative efficacy. Behavioral health providers have adapted well to phone/ video in general and are as busy or busier than per-COVID. Medical providers have certainly had a bit more of an uphill challenge adapting their practice given that face-to-face is necessary in some instances - however they have also adapted many visit types quite well to telehealth. The technology has worked well in most instances, save recalcitrant institutions that have been too restrictive. So, that leaves payment as the only potential barrier. I foresee a hybrid of in-person and telehealth given that payers sustain payment. And they should if they know what is good for them and their patients.
Physician
We have used telehealth for several years: video consults to primary care; teletherapy services; video consults to our far-flung critical-access emergency rooms. In March, within two weeks, we went from 5% ambulatory telehealth to 99% telehealth visits. While we tried to offer video visits to all, many declined (typical reasons: difficulty with the technology; don't live in an area with adequate signal; can't afford the data cost of video; don't want people seeing were I live). About 70% of our total ambulatory psychiatry telehealth visits are by phone. Video and phone have both been well- received. The convenience is a key factor-- our no-show rate dropped dramatically. Also, for very ill patients or for families- the ease of video/ telephone is hard to ignore. We are ramping back up our in-person programs, but anticipate that video -and where appropriate, phone- will now be a standard of care that will account for over 50% of our future care delivery.
Physician
At this time we are 100% Telehealth visits for our Psychiatrists and Therapists, with high patient and provider satisfaction. The Behavioral Health teams have all been working from home since April. We have seen no decrease in productivity and slot utilization, except the elimination of group therapy. TelePsych is here to stay for the majority of psych care in the future. As for quality I would say it is non-inferior but not better than in-person. .
Physician
We had been using Telepsychiatry to serve 33 rural hospitals across 4 states BC (Before COVID). We had however struggled to get Telepsych adoption across our ambulatory care network but COVID served as a catalyst and what we could not accomplish in 6 years ,happened in 2 weeks.
Patients from our Perinatal and Cancer Psychiatry programs have particularly benefited from Telepsych services. We have also incorporated Computerized Cognitive Behavioral Therapy through our primary care clinics and are trying to measure our key performance indicators including patient enagement/satisfaction rates, provider satisfaction, clinical outcomes (PHQ 9 and GAD 7 sent by MyChart) , no show rates as we want to demonstrate to the payors that these services need to continue even post COVID
Prior to moving all behavioral health therapy to virtual visits we provided telepsychiatry in our practice. I agree with what has been shared about addressing reimbursement barriers and restrictions related to prescribing controlled substances.
Due to the older adult population we serve a lesson we have learned is that while a patient may be video capable with the technology they have access to, they may not be video competent. There are still several opportunities to partner with our patients to optimize this medium of service. I believe this is a role the care manager or behavioral health provider can play in a therapeutic context.
Additionally, while we intend to maintain a percentage of telehealth visits in a new normal there will remain patients where this is not a fit clinically such as those that experience memory loss or the need for lab work.
She/Her/Hers
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Physician
The tool of telehealth with a well rehearsed workflow provides the clinical resource to engage with patients during the pandemic. The access created has diminished non medical home services such as use of the emergency and urgent care settings. In addition, relationships established with the care team is enriched due to ability to continue management plan. Televideo and telephonic visits are well received across all age groups and communities.
The Peer Support group in a local community requested references for African American specific resources to share with clients in the support network.
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Physician
We live in a rural area and resources are less available. We end up being a primary resource.
We have started Zoom groups. We had so so success.
We are finding the loss of human touch and live interaction is very serious.
Yesterday I had a gentlemen in recovery that came in the office and said a number of times that he missed our hug.
I have stopped introduction physical touch with patients.
Since he left yesterday I am starting to rethink this concept.
I will discuss with our office opening up more in person groups with space between people.
I will probably start physical touch, hugs, handshakes with certain patients that touch is as important as me examining their hearts and lungs.
Physician
This is from our lead Peer Recovery Specialist, Erin Casey: This is a list of organizations and individuals that are all led by people of color that do mental health/SUD/Wellness/Recovery and advocacy work for people of color. Some of them are clinicians, and some are people with lived experience, some are organizations. The more clinical ones also have treatment directories - and opportunities to work with clinicians if desired.
1. Full Circle Therapy (Instagram: @fullcircletherapyservices) - fullcircletherapyservices.com/ Clinical Treatment with a focus on racial trauma website includes a blog and Instagram is very inspiring and supportive.
2. Yard of Greatness (Instagram: @yardofgreatness) - juneallen.net/ "African Centered Self-Love, Sisterhood & Sobriety." - Free Resources, Training Available, Community, Blog, Inspiring & Supportive Instagram.
3. Therapy for Black Men ( Instagram: @therapyforblkmen) therapyforblackmen.org/ -directory to help men of color in their search for a therapist. It also has a blog, resources, and statistics about racial disparities in mental health care.
4. Black Female Therapist (Instagram:@blackfemaletherapists) blackfemaletherapists.com/ - Black Female Therapists (BFT) was created to promote, inspire, and elevate other black female therapists and create a safe space for black mental health. Includes a blog, podcast, and their Instagram is really great!
5. Black Women's Health Imperative - bwhi.org/ (instagram:@blkwomenshealth) a national non profit organization dedicated to improving the health and wellness of our nations black women and girls.
a. They also launched recently: coronavirus.bwhi.org/
Physician
6. Black Mental Wellness (Instagram: @blackmentalwellness) blackmentalwellness.com/ - Black Mental Wellness is a virtual community dedicated to the mental health and wellness of all Black people to include adults, children, adolescents, and members of Black families. They have a great instagram and on their website they have a section on coping strategies and resources that includes digital resources!
7. Alishia McCullough (Instagram: @blackandembodied) - Her instagram is REALLY good. She has also written a number of articles that have been published on different platforms she has most of them linked here: linktr.ee/AlishiaMcCullough
8. Jocellyn Harvey (Instagram: @sharingmysobriety) - She also has an really powerful instagram, and has written a lot about being sober as a person of color. She has some of her articles and resources here: linktr.ee/sharingmysobriety
9. Black Girl in Sobriety (Instagram: @blackgirlsober_) www.hopegoesglobal.com
10. SoberBrownGirls (Instagram: @soberbrowngirls) soberbrowngirls.com/about-me/ - Blog, safe space for women of color in recovery.
11. Yoga Body Image Coalition (Instagram: @ybicoalition) ybicoalition.com/ - Social Justice Movement on what "wellness culture" looks like via race, body image, ability, health status etc. - very empowering.
Physician
Excellent resources shared above! I have minority patients who have continued their Alcoholics Anonymous through zoom and have done well. Will refer them to some of the aforementioned resources as well.
The family and child advocates reviewed restricted use of zoom platform due to security risk thus temporarily halting services until further notice. It is recognized only certain military installations are affected.
A 34 year old African American long distance truck driver scheduled a televideo visit for review of his employer's request for return to work. The patient described his job as essential but at high risk for exposure to Covid-19 despite use of mask and hand washing. The patient was visibly anxious with profuse forehead sweating. His GAD 7 revealed moderate to severe anxiety. His conflict is noted as fear to return to work and possible loss of employment. He is willing to start formal therapy and intervention for his anxiety disorder.
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Karen, this is a tough one. I have not had to deal with this one yet, but can offer a hypothetical of how I would work with the physician to process it. At its core I think the issue is not COVID-19 but rather the patient's symptoms, diagnosis and level of impairment. If, between the physician and myself, we felt that the symptoms were of sufficient intensity and duration to qualify for a diagnosis and if we felt that it was reasonable that a leave from work would improve the patient's chance of improving/ recovering from the underlying issue (eg. anxiety), then I would encourage completing an FMLA form. I think without the underlying diagnosis as justification, then filling out a form would be difficult.
With school not in session, there is less bullying and social pressures. But children are becoming very bored at home, miss their friends, and want to return to school (even those who thought they disliked school).
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She/Her/Hers
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Physician
I have been seeing an interesting dichotomy. Some children who have challenges with social skills and separation from their parents or doing much better. I worry what will happen to them when they need to return to class. Then there is the opposite extreme, those who have conflicts at home with their family and get their support at school. Some of them are having significant mental health problems and are seeking help. The ones I really worry about are the ones who are having really problems at home and are not reaching out for help and are not being seen for incidental illness, or routine check-ups.They are just off the radar. I am working on a plan to do some screening of those I am NOT seeing.
Great question Jay. In our national network of members in (cfha.net) integrated care clinics I'm not hearing a lot of uptick specific to children and mental health concerns, but I am hearing about their parents. I think the strain of the pandemic has been most felt by parents and the increased demands on them between homeschooling and working. In some cases some children are doing better (kids who struggle with classroom settings, for example). Of course this is all anecdotal and research would need to confirm this observation. The other variable is whether mental health issues are likely to pop up later in the pandemic as parental stress gets transferred to their kids? All this said, many clinics I know have done an admirable job of proactively contacting patients in their panels who are at risk.
As a potential counterpoint to my comment above, here is an insightful article by the United Hospital Fund in NY that details how families where opioid use exists are under increased strain with the pandemic: unitedhospitalfund.thankyou4ca...
Physician
In the region of western Virginia, we are seeing an increase in reported child abuse and neglect. We are seeing as many children as before the pandemic in our ambulatory services- but the vast majority are by telehealth. ER visits for kids are down, and that coincides with the absence of in-person school: no teachers seeing kids face to face leads to fewer recognized problems.
She/Her/Hers
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Physician
We are seeing some problems with irrational fears in the younger school age children secondary to the exposure of the child to either the media or the parents. I recently saw an inconsolable 8 yo boy who was convinced that his mother wanted to kill him because he had heard and overheard discussions of people "ignoring" the lockdown and then ongoing concerns about increasing death rates. He deduced that leaving his house equaled dying and when his mother made him go with her to the store, she wanted him gone because she was stressed out about homeschooling (as she had vocalized frequently.) By the time she got him to my office, he refused to get out of the car because "everyone that goes to the doctors ends up dead."
I am definitely seeing an increase in sleep disturbance and anxious behaviors in children whose parents are overly worried.
I have taken to limiting parental screen time in regards to the media coverage. My LMHC has also had to caution parents about how literal these children are and that the lack of exposure to any other people right now is making it difficult for them to dilute the rhetoric and insert rational explanations for the fear that they may be hearing in their parents.
Physician
unexpectedly no uptick in urgent mental health needs for children for our child psychiatrists/therapists, parents/caregivers have a bit more anxiety related issues, access is still good but only through Telehealth. Routine Referrals were a bit down as well as our Pediatricians were seeing less patients.
For example, changes/ the types of issues you’re seeing? Changes in PHQ-2 or PHQ-9 screening results as compared to pre-pandemic? More requests for a referral to a mental health clinician? More requests for medication?
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He/Him/His
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Physician
We're seeing fewer patients for bullying or poor school performance, but more for social isolation issues, sadness in general, and anxiety about the present situation. It turns out, the overall appointment requests are about the same as in past years. Spring, by the way, has always been the busiest time for our mental health providers. We have not had an increase in medication requests, however, I think that will be increasing as time goes on.
We have done a lot of patient (parent) emails to allay their fears, especially from what they are seeing from the media. Families have greatly appreciated these.
Our staff response during this is interesting. Our medical providers seem comfortable seeing patients and confident in our infection control measures. Our mental health providers, not so much! But they are getting more comfortable.
On the patient side I have not seen huge changes in the types of referrals, although COVID-related stress is an obvious difference. That said the biggest changes have been the consistency of work that behavioral health clinicians have had. The virtual environment, including a lot of telephone use, has actually made for increased productivity.
Physician
Our health system's response is not unlike many others I have spoken with across the country. We have expanded our EAP to incorporate a wellness line- and it is on every computer's screensaver. Our Chaplains are spending time talking with the care teams on our units- far more than they used to. We have expanded the use of Watson rooms (calm, meditative recovery rooms with massage chairs- cleaned before and after each use). We offer scheduled video peer support groups that are targeted by discipline (physicians, nurses, respiratory therapists, food service, etc) and by location (ED, ICU, etc). We have expanded our wellness activities in each clinical department- both inpatient and ambulatory- to engage and support staff. And- our communications staff has worked overtime to push out these messages over and over, to build a culture that affirms caring for each other.
We initiated wellness check calls to all high risk patients and implemented the 3 item UCLA loneliness scale in combination with our standard screenings. We've received great feedback from patients that we are proactively connecting with them and assessing feelings of loneliness during physical distancing. Base on responses we then connected patients to behavioral health consultants for ongoing support.
She/Her/Hers
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Physician
The practice data revealed increased complaints of anxiety, insomnia, inappropriate eating, changes in bowel habits, increased agitation with poor interpersonal interactions, depressed mood, and many other somatic complaints. These reports were noted early in the Pandemic with shelter in place. One patient jokingly symptoms of this nature were due to being locked up with his family! In actuality these symptoms aggravate both physical and mental chronic disorders such as hypertension, diabetes mellitus, coronary artery disease, and substance use disorders with increased overdose incidents and complications due to alcohol use.
She/Her/Hers
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Physician
The uncertainty of the clinical manifestations of the virus with daily reports of morbidity and mortality created initial acknowledgement fear of the unknown. The need for leadership through crisis, working in environments without personal protective equipment, reading reports of physician loss of life while serving to care for the sick, placing people before personal family and ourselves, maneuvering financial losses, participating in hours of webinars, and reading mounds of articles left many physicians with pure exhaustion. It is the resilience gained from experience with utilization of association based physician well-being strategies which allowed daily presence in the clinics, medical offices, and hospitals for the sake of others.
Physician
Just like many other health systems , caring for our caregivers is one of our highest priorities .
A) Reactive strategy :
When a Caregiver feels overwhelmed and wants help, we have a seamless process to guide them to appropriate resources based on their preference . (including wellness resources, BH therapy , Spiritual care support but also information on Child care , Finances etc all easily accessible in one place ) .
We have built an interactive tool along with our Digital innovation Group to help guide our caregivers to appropriate resources based on their self reported levels of stress .
These tools include various self help resources including a partnership with CredibleMind who have curated all the highest quality resources based on ones prefered method of learning ( eg: I want help with stress and want to hear a podcast or use an app).
Our partnership with SilverCloud provides easy access to high quality Computerized Cognitive Behavioral therapy.
Tele Spiritual care has been one of the most utilized resources for people with mild stress levels. Work2BeWell helps with resources to address the MH and well being of our caregivers children. We have a BH Concierge service for all our caregivers and their dependents ,to provide same day access to a therapist trained in CBT,IPT and DBT.
We have created a stress meter that helps guide people to these resources , you can find it at Providence.org/stress
B) Proactive startegy:
Self care/Wellbeing needs to be proactively built into the workday , not an additional task for an already overwhelmed group. We have created a tool kit to help our core leaders that includes peer support , Schwartz rounds etc.
Connect
There has been significantly more interest and usage of mental health apps for self-treatment. Meditation Apps have been useful for anxiety. Headspace is a leader in this space. UCLA has also developed a Mindful Awareness App for public use: uclahealth.org/marc/ucla-mindf...
CBT for Insomnia Apps have evidence to support their clinical use as well. UCLA has a clearing house website for those Health Apps with supporting efficacy: uclahealth.org/u-bar
Pending
Not evidenced based, but I have had a lot of patients (physicians and otherwise) respond well to a CBT based app called, Woebot. Shine app and Calm are helpful for short bursts of meditation. These are useful during a pandemic, especially during times of social distancing and isolation because they teach important coping skills to control/combat anxiety.