We interviewed our Easter Seals Greater Houston Veterans Services clinical therapy team, Dr. Cristy Gamez, Dr. Amy Harkins, Susana Lewandowski LMFT, and Erica Toskovich LMFT, to learn about the challenges COVID-19 has brought to clients, particularly Veterans and seniors, seeking mental health supports.
What are the challenges of COVID-19 on Veterans and seniors?
Isolation is a key symptom of PTSD. Approaching, rather than avoiding people and crowds and shopping centers is one of the main interventions used in therapy to reduce isolation in Veterans with PTSD. Right now, we can’t use this validated behavioral approach. We are actually telling people who isolate to stay at home, trust less, and be afraid of invisible “wee-beasties”. Adapting therapy approaches to the current reality is a challenge.
Veteran clients who have struggled to keep themselves and their families safe during normal times are stretched to be even more hyper-vigilant, alert, on guard. They are alert to the illness as well as to social implications of the illness – they know what desperate people will do to survive. It’s normal for Veterans to “turn worry into action” – but that action can be positive or negative.
For some seniors, it feels too late/too hard to move to telehealth. Many have tech but don’t know how to use it. It’s hard to coach when you can’t see what they see. Saying “just click on the link I sent you” doesn’t work when someone has a visual impairment, and when a person with a hearing impairment can’t read my lips or see my visual cues, therapy doesn’t work.
For both populations, issues with using telehealth include lack of privacy, problems with connection like feedback or delays, increased demands because of work or kids at home, and newfound financial anxieties.
How do we know telehealth is good?
Technology in general has so many positives. Phones and computers allow people to talk and see others, and to utilize apps that help get basic needs met, help calm, and facilitate sleep. Mental health apps like Calm are very useful. Clients often share screen shots of step trackers – to show how they are moving more. Some clients like to use a mood tracker – to gauge patterns and trends in their mood. Sleep stories are a great resource to help client fall asleep. Some wearable technologies can track sleep. I had a client put the Crisis Response Plan for suicide prevention as his screensaver – that’s a great idea.
We have data showing that telehealth is good. Just this week we saw 25% more people than we saw last week. We had our lowest ever percent of no-shows (7%), which is very low. Oftentimes telehealth, which allows clients to be in a space they are already comfortable in, also allows for “the work” to get started quicker during a session. We have seen that telehealth clients are more proactive, compliant, and responsible.
What more could technology do?
We will need ways to alert people in case of an emergency built into the devices/platforms we use. We need HIPAA compliant virtual group meeting platforms, ways to interact with kids virtually that allows for play, and therapeutic virtual games for all ages for single and multiplayer. We need secure platforms that are HIPAA complaint, can maintain EHR, have tele-health capabilities, are cost effective, easily customizable, and that allow for intra- and inter-agency communication.
And, pie in the sky, we need all of the above in a format that doesn’t overwhelm our clients. There is a steep learning curve. The more simple and intuitive the interface the better.
We also wonder how technology could… help with hygiene promotion… improve trust and confidence with the health care system… increase access to accurate information and education about all sudden crises. Technology is and can change the face of how we provide all services, including mental health.
Overall we are incredibly proud of our mental health team and the word they have done and continue to during the CoVid19 Pandemic. We are equally as proud of our clients!
Christine Ellery, Program Director, Veterans Services, Texas Veterans + Family Alliance, Easter Seals Greater Houston