false
Catalog
Innovative Approaches to Services During COVID 19 ...
Presentation and Q&A
Presentation and Q&A
Back to course
[Please upgrade your browser to play this video content]
Video Transcription
Hello, I'm Amy Cohen, a clinical psychologist and director of SMI Advisor. We're pleased that you're joining us for today's event, Innovative Approaches to Services During COVID-19 Restrictions. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Although this training is not designated for any continuing education credit, you will be able to claim a Certificate of Participation at the end of the training. Because we'd like this session to be as interactive as possible, please feel free to submit your questions throughout the presentations by typing them into the questionnaire found in the lower portion of your control panel. Feel free to do so at any time during today's session. And now I'm pleased to introduce you to the moderators for today's event, Dr. Joan Galese and Raul Almazar. Dr. Galese is the Director of the Center of Innovation in Health Policy and Practice at the National Association of State Mental Health Program Directors, also known as NASHVD. Raul Almazar is a Senior Public Health Advisor for NASHVD's Center of Innovation in Health Policy and Practice, and we welcome them both. Joan and Raul will be moderating today's presentation, and we have a number of esteemed faculty today. We are going to begin with Chris Morrison. Good afternoon, everyone. Thank you for allowing me to have this time to talk to you. I'm Chris Morrison. I'm in charge of the State Public Psychiatric Hospital System in New Jersey. So I'm going to just run through a few things, but let me start with a little bit of a moment of gratitude, why I have the privilege to present many of these things to you. Many of these solutions were developed by my staff, the thousands of employees in the system who worked very hard during this pandemic. So while I can't share all their names on this, I at least want to get out there a thank you for them for everything they did during this pandemic. So with that in mind, we kind of focused on a couple of high-level principles from which the solutions came from. Provide the highest quality treatment by keeping patients and staff safe. Help everybody take better care of themselves so they can take care of others. Get feedback loops so we can evolve the process because we're constantly, everything was constantly changing and build leadership processes that enabled agility and innovation. So from that, and I know I only got a couple of minutes, we focused on both leadership and employee support and patient support. On the employee support side of the house, we did many things from sending out daily mindfulness reminders and teaching mindfulness, giving employees extra breaks for self-care, teaching self-care. We actually had on some of the hospitals, we do drive around parades past the beginning where we'd ask employees to come out. We do clap out sessions where we'd ask the local heroes to come out and we'd have fire trucks and local police and stuff coming by to clap and say, thank you for the things you did. We had online self-support groups where in the beginning, most of it, it was mostly clinicians that went on. Then we actually got some direct care staff to do it. We did everything from them being mutual support where people talked about their issues with COVID, both in work, at home, in providing treatment and used each other as a resource. We were able to get some of the line staff, the nurses, and what we call human service aides in there, not as much as we'd like. We gave them extra breaks and we're currently involving that process, something called staff education and support, where we actually have the clinicians go on the units, cover the units once a week and allow these self-help sessions to occur on the units with the staff, the direct care staff that haven't been able to get off the unit. Other things we did out there for patient support, and I'm kind of going through some of this fast. We create a whole infrastructure using tablets to deliver evidence-based practices from IMR resources to stuff like, I know Joan developed Tamar from years ago, online homework resources that they could do themselves, fund resources, getting the ESPN, radios, TED talks, learning languages. We put as much as we could on there so people could both help themselves and work with clinicians for delivery of care. We did some other stuff too as this evolved. We built outdoor treatment malls so people could actually do groups on ground. Some of them were actually literally permanent outdoor treatment malls. Some of them were pop-up treatment malls where we just created, went to Walmart, got some pop-up tents and created spaces for staff and patients to go out from. We would try to be creative during the holiday time when people were most depressed. One of the facilities created an outdoor winter wonderland where people could get, where staff and patients and their pods could go through the wonderland. We had parades go by the buildings so that people could, that part of building morale out there, and I'm going kind of fast. The other things that we did out there was just to build infrastructure. We bought cell phones for patients. We taught them how to use cell phones. We had peers come in to help teach them how to use cell phones. Even when they were discharged, they would walk out with a cell phone so that they could do telehealth on the outside, knew how to use electronic resources. We provided them and we provided it with a couple months data and other things so that they would be able to use it in the community. How am I with time? Because I can kind of go, I'm kind of going fast, but I want to be- You're good, Chris. Maybe another two minutes, then I'm going to ask you a question. Okay. So just looking at some notes I had here with it. We did some other things just to boost morale. We fed patients and staff here together from our kitchen. We also had special meals come in on days when we were struggling with food service staff. Oh, some other things. We used a lot of peer resources during this, as I mentioned, the tablets. I know Joan and Raul helped us develop comfort rooms years ago. So how do we use them during it? We actually created what appears virtual comfort rooms where people could actually go in with a peer virtually into the comfort room and talk and get some support with that. We also had peers calling onto the units to do check-ins for people that weren't coming into the comfort room. Who wants to talk to me? Who wants to, might not be a little bit concerned with it? And this was during the time when it was harder to get staff and people on the unit during quarantine status. Go ahead, Joan. What's your question? I might- I can share with everybody. Raul, when we first met Chris, I guess it was almost 15 years ago when he had one hospital and he was such a visionary then. Now Chris has really taken over being in charge of support services, clinical services in all of the hospitals in New Jersey. And one of the things that Chris really was very conscious of was equity in terms of staff. And one of the things that we really saw during COVID was the inequity of COVID, not just who got sick, but who had to go to work, you know, who could telehealth, who could work from home and that the unit staff, the direct care staff were the ones 24 seven on the units. And I think Chris, you might talk just a minute about, I think the innovation that you did, how you leveled that out by saying to the clinical staff, you are going to be on the units so we can support the direct care staff. So there isn't that dichotomy between who went to work and who didn't. So you've always been so conscious of that. And I want to be able to just talk a few minutes about how you were able to smooth that out. I think I've mentioned one of the things that we started and that was staff education and support. We realized with a lot of these virtual self-help groups and stuff that we couldn't get our direct care to them. One, we couldn't get them off the units because of staffing issues. And two, they weren't as used to using electronic resources or as Joan worked from home. So we actually, as we brought the clinicians back, we had on many of the units and it's still an evolving process, go and cover the units for periods of time, meaning they had to do the same work a direct care staff would do on a unit. Why we got the direct care staff together would have moderated, it would start with a couple of things. One, a mindfulness routine to kind of get everybody centered and present. Two, talk about a self-help routine, teaching a self-help skill, teaching a skill that might help with dealing with patients. And then a little bit talk about how they were managing the COVID and or how they're managing their patients during COVID and some of the difficult things on the unit. The other thing, just as Joan was saying, we even expanded it out during different times. We had clinicians taking boards in our forensic facility. So I don't know if anybody knows what that is. Sometimes patients are given an order to be observed one-on-one and they have a direct care staff right there with them. Well, in order to relieve some of the direct care, and I'm sure Joan can appreciate this because she's a psychologist, we had some of the psychologists doing it so that the direct care got relief and there was clearly some equity in what we could provide resources. I don't want to paint a perfect picture. We still got a lot of work to do with it, but we're making some inroads and we're going to continue to make inroads on that front. And the idea of it was also to say that not only was leadership supporting you, but your fellow colleagues who we allowed to work from home at different times and everything are also here to support you because you've been here every day during this pandemic. And you know, I think a lot of the innovative practices that you implemented are things that will outlive the pandemic and that there are practices that we really thought about things that have been cemented in stone and the way we operated before. I mean, somebody, a clinician doing a one-on-one is just a great idea. You have someone who is really clinically trained to be able to support the person who's in the most acute distress. What a concept, right? So I think that's wonderful. So Raul, thank you. What I'll say is many of these resources, and Raul, it looks like you've got something to say, there's a website where we started to put some of this out there that's available to everybody, both some of the staff resources, mindfulness exercises we did, some of the trainings we did with staff during it. You may have to put your email address and register it. It was a partnership between my division in the Department of Health and Rutgers Psych Rehabilitation Unit there. So with that. Thank you, Chris. Yeah, we obviously were with you during a lot of this and you did fabulous work. I'm sure one of the questions that people have is, how did you fund all of the things that you just talked about, giving people cell phones? Where'd you get the money for all of this? I think you got to be creative with looking in your budget and realize that you weren't spending money for other things somewhere in the pandemic and where you could reallocate it. Some of it is, for example, like the cell phones. And Joe talked about long term. Now, in these modern days, everyone needs a cell phone. I don't know, in New Jersey, where I'm from, you can't get utilities without a cell phone. So we also marketed it and requested additional funding as part of discharge planning and other things, not just connected to COVID. So I would say a couple of different things. Look where you might not have been spending as much money during COVID in certain areas, for example, like patient trips. We weren't doing trips. So where was that money going? Reallocate it to something else. There were actually grants and other things you could apply for out there. I'm not sure if some of them are out there. Always be looking to apply for grants and resources and even look in your own system where rules may existed, particularly for us, were bureaucracy that can be used to your own advantage to request funding to apply. I'm not sure if I'm answering your question specific enough, Rahul, but. Some of those things are probably secrets, right, Chris? Yes, they're trade secrets. They're probably better for an offline conversation. Chris, thank you so much and thank you for the incredible work. I apologize for the fast talking and if I just tried to do as much as possible. Thank you so much, Chris, for just all the work that you do. You really are an inspiration. So, Amy, can you tell us about yourself and about innovative things that you did from the peer perspective during COVID? Hi, everybody. Thank you, Joan. So as an introduction, my name is Amy Brinkley and I am NASHVD's Recovery Support Systems Coordinator. I am one of the newer staff members for NASHVD. What I did previously is I was Director of Recovery Support Services for the Indiana State Division of Mental Health and Addiction. And so I oversaw all of our peer and recovery support services across the state. Important to note, too, is that I'm also a person in long term recovery from a mental health diagnosis and a substance use disorder. So I've been in recovery now for 12 years, 13 coming up in April. But what I wanted to do, if that's OK, Joan, I wanted to talk about a town hall that Joan and Raul had invited me to be a part of last year. So in May of last year, there was a town hall and we were able to pull together some patients from New York and Illinois who talked about innovative things happening within state hospitals. And so I kind of jotted down some of the barriers and some of the successes that were identified through that. And I would like to share that with you guys. So these were comments made directly from patients. And so some of the barriers that had been identified at that time was that no groups or limited clinical staff were available, which limited the treatment being provided in the state hospital. No visits with family or outside volunteers for a significant period of time during COVID. Programming had all but stopped for a while. Mental health symptoms were exacerbated. There was a lot of conversation around fear and paranoia, even from people who didn't have those symptoms as a part of their diagnosis. One patient even said that it actually set the mental health treatment back 30 years. That was pretty impactful when he shared that and he said it a couple of times. And I think a lot of people were really like, wow, because it was pretty impactful. A couple of people mentioned the court closing. So people were waiting to go home. And with the courts closing down, their their cases were put on hold because a lot of court, a lot of court cases just got stalled. And so they were stuck in the hospital longer than they were supposed to be going home sooner. So some of the successes is the iPad and tablet. So that was already mentioned as well. But they talked about that increasing access to other support. They talked about whereas they would have phone calls with family members, they now were able to have video visits because of the iPad. So during COVID, the isolation was even more significant. And so being able to see family members that they hadn't been able to see for a while made a huge difference. So the iPads were very innovative and very, very much well received. And then a lot of folks talked about access to music and art being fulfilling. Resources to the iPods and tablets were helpful in that. People who had actually been diagnosed with COVID talked about being on 14 day quarantine and the restrictions were even more intense and more liberties were taken away during that. One person said that they had when he was on quarantine, that he had to be in the room with his friends and they were in there for 23 hours of the day. They were allowed out for 20 minutes to make a phone call. And so iPad availability was crucial to keep your sanity, right, because you're completely isolated. And I'll take a second here and I'm not going to share too much, but I wanted to share, you know, my my substance use disorder led me to incarceration. And so when I was incarcerated, I was lucky enough to be part of a therapeutic peer community that allowed me to have access to peer support, number one, but also being able to fellowship and not being isolated. In contrast to that, my sibling who had a substance use disorder was in prison and he had a mental health diagnosis of ADHD and the person did not know how to deal with his his symptoms. And so they just put him in isolation, similar to what we're talking about with the 14 day quarantines, as described by patients in the New York State Hospital. My brother was in that situation for five years. So he came out of the Department of Corrections diagnosed as a paranoid schizophrenic. Having been on multiple medications, having had multiple suicide attempts, and five days after release, he took his life. And so when we talk about innovative practices, I can't stress enough the importance of peer support and access to connection, because when we put people in spaces where they're not connected to other folks, they're not connected to peers, they don't have hope for long periods of time, that has a strong impact on people's mental health. And so he went backwards. I mean, he did not come out the same person. So one of the things that we had started to do in the state of Indiana is we started to create peer programming within the Department of Corrections so that we can get peers. You know, when somebody gets sent to segregation or sent to isolation because of behavior, let's send a peer to check in on him every day, to talk to him, to get them resources, to help them get access to a book, you know, help them problem solve how to access an iPad if they hadn't been able to figure it out yet. And those kinds of things. So peers are invaluable. So those were the those were the main things I wanted to talk about. And thank you, Joan and Raul, as always, for inviting me and for just being a great advocate for peer support. Thank you, Amy. And I have a question for you as well. You'll hear from Beth a little bit later and she'll talk about some of the work that we're doing together in the D.C. Department of Corrections. But one of the things that I think people struggle with as we're looking at developing peer support in corrections is people get hung up. Do they have to be a certified peer or can we think differently about peers in different places? People do peer support organically. Right. But sometimes systems get caught up on they have to be certified and we don't have the time or it just doesn't work in certain conditions. What are your thoughts on as we grow peer support in corrections services, in detention service, Beth, as detention, not prison, for example, how did you do this? How do you do that in Indiana and get around that certification process? Or did you create a unique certification process? So, it's kind of in transition, so there's a couple of things I want to say. So, my personal opinion is that when we talk about certifying peers, and this is Amy talking, not NASHPD. When we talk about certifying peers in the Department of Corrections, I am very hesitant to do that while they're still incarcerated. And I know some people are against that, and they think we should be certifying them while incarcerated. I just disagree from the lived experience perspective, because when somebody's coming out of the criminal justice system, they need resources, they need access to support without the expectation that they're going to be providing it. And I feel like if we give them a certification and we set up that expectation that when they are released, they're going to have a job, they're going to be able to provide peer support, peer support on the inside and peer support on the outside are two completely different things. They're two completely different systems. They're just completely different settings. And so, we want to make sure that we're setting people up for success. So, that's my personal opinion on that. Now, when I was incarcerated, I went through the, it was a therapeutic living environment, and it was called the CLIF Program. And it was based on this peer model. Nobody was certified, but everybody in the program was a peer. And it was based on the value system that I am my sister's keeper, right? Everybody who opted in volunteered for the program. It was a nine-month program. And we were taught to hold each other accountable. We had peer panels. If somebody behaved incorrectly that, you know, affected the community in a negative manner or anything, they were brought before peer panels to have a discussion about where the behavior came from, you know, were they digressing, was it a relapse? And these behaviors were addressed in a peer-based model that was not a certification. It was just based off of community, you know, a peer community. I think that's wonderful, Beth. Amy works with us now. So, as you develop this on the unit you're going to talk about, Amy would love to bring you into the development of the work that Beth is doing that you'll hear about in just a minute. So, thank you. Thank you so much. Thank you, Amy. Now, as a psychiatrist and as someone who's working in the private sector and doing innovative work during the pandemic, can you share some of your experiences with us? Well, thank you, Joan and Raul. I appreciate you giving me the opportunity to talk. I've been listening so carefully and as someone that spent much of my career actually working with people on death row, the correctional component of it is very important. I wanted to reiterate what you really started out with Chris talking about, Joan, and that was the question of equity during this period of time. Certainly one of the things that we looked at in the private sector, and I've got to be very personal about this because I do think that, for me, the COVID was really all about decreasing the power and scientific dynamics. For such a long time, even in the best of circumstances, and certainly when we're looking at a medical model versus a psychosocial rehabilitation model, which best would is, you have that power dynamic. That power dynamic is just as you said, having the psychologist perhaps sit on the boards rather than someone else is a unique experience, and yet it shouldn't be a unique experience. I think that what happened during COVID was it really made us look at some of the myths of treatment and some of the myths of the power dynamic. Who could do the job? What was the job? What was it exactly that we needed to do in order to actually serve the people that we serve? The first thing that became clear is that we all had to deal with our trauma. We all had to understand that this was not just a unique circumstance of trauma, but it was a revelation of an acute trauma on top of longstanding trauma. I have to give Raul just kudos that I can't even express in being able to keep us firmly grounded in what that traumatic experience was, both long-term, but also short-term. For me, the other part that was very important was making sure that, and this is very personal, that there was not this differentiation between essential worker and what that really meant. We have many, many staff that would fit that academic idea of essential worker, but at 74 with multiple comorbidities, a family that we one had to protect, and someone that really had some questions about the quality of the science that was actually being presented. I felt it important to share that power dynamic and in talking with those that we serve, as well as talking with the staff, letting them know that it wasn't that way. I just appreciated their position, but that we're in that position with you. This wasn't a situation of, can we help you, but can we help each other? How can we reciprocate that innovation and that love? It was really a function of people in the corporate suite making sure that we understood and followed and learned from those that were in that day-to-day circumstance. Following with Chris, we really looked at many of the issues of making sure that there was technology available, making sure that there were new methods of visitation, of access to connect, making sure that we did those things to reinforce the caring and the non-medical approach that is so important to me from a psychosocial rehabilitation perspective. It's one of the reasons why I love psychosocial rehabilitation, because I think it makes everyone an expert. It makes everyone that is touching that person, that is attempting to help that person, and it becomes reciprocal. In many ways, I think COVID did that in a very positive way. I personally found myself sharing much more of my life with those that we serve, because I was as scared as they were. I was as worried as they were. I was as concerned about my family as they were. The idea of somehow imparting scientific knowledge was not enough. I had to try to make them understand that I had questions about this scientific knowledge too. I wondered why things would change from week to week. Was that flip-flopping, or was that the evolution that we know occurs in medicine? To really understand it deeply enough to be able to explain it and help them share with them how complex these issues were, and to try to depoliticize many of these factors and make them realize this is complex. This is very difficult. You are going to hear things, and I'm going to be frustrated as well, with things that will change from week to week. We're all in this together. Decreasing that power dynamic, both scientifically and clinically, I thought was really the biggest innovation that came from the COVID. I saw it in the long run as something that will probably change the way we practice forever. I also saw it as a way in which the social determinants of health were recognized finally as really the scientific components, not the pharmacology, not the genetics. Those are all helpful, but it's really the social determinants of health. How are you eating? Where are you sleeping? Do you have a place to sleep? How can we care about you in loving and meaningful and traumatically informed ways? To me, that's really what made a difference in COVID, and I think it'll last long after. I love what you said, George. Go ahead. I can add. George and I have sat on a pandemic response committee since the beginning of the epidemic, and have gone through this together, obviously in the private sector. But I think one of the other incredible parts of what was really significant in what George has done as the chief scientific officer, that people would look to him about all the science around COVID and the pandemic, is what he talked about is that we also went through that whole period of trying to convince people to be vaccinated. When we're talking about the COVID piece, this is not just about practices around what we did in our institutions, it's how did we get people, especially during the early days. George was right. One of the most effective ways George has really been able to talk about vaccination, because we did webinars across the board, multiple, multiple webinars, is really bringing it down to the personal level to talk about, both from a physician and as an ordinary citizen, what it meant to be vaccinated. I think that's been one of the most wonderful things George has done, is that leveling that playing field to be able to speak to how do we manage and what we're trying to do through both layers. When you look back at the history of vaccination, it's fascinating. The first conscientious objectors did not come from war. They actually came from vaccination. In the UK, in the 1800s, they had been vaccinating people with smallpox for 45 years. And there was a significant population that refused to be vaccinated. And the UK finally developed a waiver called conscientious objectives that allowed these folks to somehow not become vaccinated. That doesn't mean that we want people to, or we accept people to not be vaccinated, but it does mean we have to talk with them. We can't throw the science up. You know what I mean? We have to make sure that we understand what they are feeling and their fears. And often those are our fears as well. And to make sure that they make that connection. And, you know, George, I love one thing that I loved everything that you said, but particularly when you talked about, you know, leveling that playing field and how you were able to share the same feelings that those that you serve were having. That's a great equalizer. And I think we've all been trained that, you know, boundaries and don't share anything about yourself or your own feelings. And I love that that wall might have been something that was really significant that was taken down. And I'd love that you shared that the humanness of our interaction between the helper and the person that we are helping when really we're all helping each other. And I love that you said that. And maybe that's one of the silver linings. I appreciate that. I might add that I really learned that in sales school and not in medical school. I was a salesman for IBM before I went to medical school and talking to people that trying to sell something to somebody that they don't want. It's really, it's really what we often are trying to do in mental health, right? I just I just love that. I'd like to bottle that and get everyone else to feel that way. So thank you so much. And Beth, Beth and I have worked together for a couple years now. And Beth came quite a quite a change from the Mayo Clinic directing women's services, women's health services to DC Department of Corrections. Quite, quite a switch. But Beth has been a real innovator in strength based holistic support for individuals who find themselves in incarceration. So Beth, I want you to share some of the incredible work you've been doing. Well, thank you so much. Can you hear me OK? Yes, perfect. Great. Yeah, I've had the pleasure of working with Joan and Raul and Jeremy for the past six years. And it's just been so inspiring to me. And I think it's really making a difference with the residents at the DC Department of Corrections. So in terms of COVID innovations, we've had a real challenge between preventing COVID from spreading. And wanting to really support people with groups and all the other things that have the therapeutic modalities that are going on in the jail in terms of restricting movement versus having people being able to walk around and that impacting their mental health. So the balance between the medical stay in place and being as free to move around in jail has been a real balance. But our programs are greatly halted. However, that was offset by mental health individualized visits, increasing about 14% during the pandemic. And all of our efforts between our health care vendor, operations, the subject matter expert that I brought in in February before the pandemic hit, who's an expert in infectious diseases and correctional health settings, it really led to pretty extraordinary success. So in the DC, I'm trying to give you some things just to put our programmatic, to put everything into a context. So in DC, there were 135,000 COVID cases and there were 1,315 deaths, sadly. In the jail, there were 771 COVID cases and one death, again, sadly. And so there was a sixfold increased risk of dying in the community if you got COVID compared to the jail. So I think our efforts were really successful. It was very stressful in terms of trauma and restrictions and those issues. And it was just an ongoing balance for us to balance pandemic efforts to decrease the spread versus providing people as many liberties as we could. We're very proud of our efforts. To tell you some other things about the DC jail, we have dual accreditation through the National Commission on Correctional Health Care, as well as the ACA, the American Correctional Association. And about 15% of the nation's jails have NCCHC accreditation and about 8% of the nation's jails have ACA accreditation. So there are multiple standards. We're reaccredited every year and we meet or exceed those standards, which we're very proud of. We recently had our opioid treatment program reaccredited and that's through NCCHC and SAMHSA. And they gave us just a fabulous review and we're really thrilled to see some of our innovations, which I'll talk about in just a second. So in terms of what we did to, I'm going to talk about this like an innovation, but I think compared to a lot of jails, like it may not seem like an innovation to you, but it really is kind of best practices and innovations when you compare what's happening to the other jail and other jails throughout the nation. So we had very frequent testing starting very, very early on. We tested people at intake, at day seven, and then at day 14 to make sure that we were picking up COVID to the fullest extent possible. Within the past year, we changed that to intake day seven and we eliminated day 14 because we saw that we were catching people at day one and at day seven. We also test people prior to going to court and we also do, we have about 1400 or 1500 inmates right now, or residents as we call them, and we do a facility-wide COVID testing on a weekly basis of asymptomatic people. So we do a lot of testing to really have a deep sense of the presence of this virus in our facility. We provided PPE from the very beginning and there's all kinds of signage, there's training of residents on how to use it, medicals talking to them on a regular basis about how to use PPE. We also have the Department of Health coming in and doing audits, spot audits of PPE use in our facility. So whether these are innovations or best practices, we can talk about that. One of the huge innovations we had was to accelerate sick call access. So according to our accreditation standards, there are lots of different ways to access the medical team or the mental health team. So there's intake, there is, so if somebody comes in with a chronic health condition, based on how well that condition is controlled, they're either followed up in the chronic care clinic either 30 days, 60 days, or 90 days later, or sooner if there's a concern about the control of their condition. There's also a sick call process. There is an urgent care clinic, we have an urgent care physician there 24-7. And there's a sick call clinic on every single housing unit at the DC Jail. So in terms of the sick call process, the way the accreditation standards are, if a resident wants to be seen for maybe a medication refill that they keep in their cell, or there's something wrong with their hand or their foot, something that's not urgent, but it's more, you know, they need to be seen more frequently than they have maybe a chronic care visit for. So what the process is, is they put in a sick call slip. And according to accreditation standards, there's a nurse who triages the slip based on acuity. And then that's a 24-hour process. And then there's another 24-hour process of the time a resident is seen. Right? So that can take 48 hours for a resident to be seen in a sick call situation. We wanted to enhance access for COVID detection. And so we changed the system. This is a huge innovation that's usually seen in systems only when there's a receivership condition. But we said from the time a resident puts in a sick call slip to the time that they're seen for any reason, not just a situation that could be COVID related, that process is 24 hours. So if the time a resident puts in a sick call slip to the time that they're seen, that we have a benchmark of 90%. 90% of those residents, it's pretty much 100, are seen within 24 hours. And our comparison, the level of care that we provide is supposed to be commensurate with the community. Well, I would argue that this exceeds community access. So we are really trying to robustly have residents seen for any situation within 24 hours. And we have the data to prove that that's done to an extraordinary extent. We also, to help residents who, because the out of cell time has been restricted, we wanted to make sure that a resident who wanted to be seen in the sick call clinic could be seen in the sick call clinic, even if they didn't fill out a sick call slip. So we have physicians and clinicians walking the tiers, asking residents that they need to be seen in the sick call clinic that day, in addition to the usual practice of residents completing a sick call slip. One of the innovations, like Chris talked about, was tablets. So we've had tablets available for, I believe, more than a year to most residents. We have had, we put on there the Tamar curriculum. We've also put on information about COVID that was presented through a trauma-informed care lens. There are TED Talks, there's school, there's DC school, and other courses which happen on the tablets. We've been doing vaccinations since February of 2021, including boosters. That happens on a very regular basis. We've had unobstructed access to medication-assisted treatment with Suboxone, Methadone, and Vivitrol. That delivery has continued. We've also opened up what we call our Women's Wellness Unit, which is, I believe, the nation's only jail-based therapeutic housing community for women who have substance use disorder and or mental health conditions. So we're really proud of this. We've worked very closely with Joan on this. It opened up in August of last year. And there's a lot of programming. I mean, pretty much Tamar and Anger Management are the only groups that are happening right now. But now that COVID is really receding, we're really looking forward to getting the rest of our programmatic work going on, which is yoga, mindfulness. I found an amazing woman to come in and do gardening. We're gonna be starting acupuncture. We're gonna be starting tapping our emotional freedom technique to decrease traumatic responses. And there's lots of other groups that are happening that are planned, that are gonna be resuming at the same time. So those are really largely the patient-based innovations that we've had for COVID. In terms of staff, we've had ongoing PPE, ongoing PPE training. We've had onsite testing of the staff two times a week. We have an onsite vaccination clinic. And in terms of telecommuting, those who could telecommute did telecommute. And that's continuing to some extent right now. Beth, it's so great everything that you've done in the Women's Wellness Unit is just terrific. And before we developed it, Beth and I met with the women who were residents to say what would make a difference, what do you need? And we took their voice in order to develop some of the programs that are there. Except one of the things that they were very clear on was we'd really like healthy food. And I think you're getting there on that too. But it's tough to move things and move systems around. So one of the things that I'm interested, Beth, and maybe Amy can join in on this, is I know we've talked about doing peer support and doing trauma-responsive peer support on the Women's Unit. So I'm wondering your thoughts on that. How do you see that going? And maybe Amy can have some ideas on how to best develop it. Well, through some grant money, through the SOAR grant, we, and the development of the Women's Wellness Unit, we have peer navigators on the unit working with women. We also have mental health clinicians. And soon, once our operations, our officer work staff, once those numbers go back up, we are gonna be continuing having officers and the mental health clinicians co-facilitate the TAMAR groups, which the peer navigators are involved with as well, to support women while they're in our facility, as well as continuing to link them to services that they need upon discharge. You may wanna talk a minute about that linkage with Unity, with your provider, and how you're planning on connecting and continuing the resources and the support, particularly the trauma support that women are getting there into the community, because I think that's really quite innovative. Well, we did training with Joan with some Unity mental health clinicians. I think this was like, you know, shortly after the pandemic began, to make sure that mental health clinicians... So one of the things about our healthcare vendor, which is pretty amazing, is that they're a nonprofit. They started out doing homeless work. So I feel like their heart is in the right place. Their clinicians work in the jail, as well as in the community. There's also a, like a returning citizens, or returning citizens clinic that Unity has specifically. So they're very focused on this community. Their clinicians see residents in our facility, as well as in the community. So there's kind of already a built-in sense of continuity of care. So that was primarily from a medical perspective, as well as an MAT perspective. And then to bolster that further, we wanted to make sure that residents who were participating in the 15 module TAMR curriculum could continue that work in the community. So we trained mental health clinicians to run those groups and to support residents doing that work once they left. So that's how we tried to continue that work. We also have a very, very... Unity has a very robust discharge planning process. It actually won national awards on that. So they, about 40% of our residents are connected to Unity for their healthcare when they leave the jail. So that process happens pretty easily. We also connect them to the other clinics where their primary care may have happened. And to DBHs, the Department of Behavioral Health, to their various clinics in the community, where they were before they came into the jail, or if they're eligible to receive DBH benefits, we work with DBH in the facility to connect them to DBH programs once they leave. Thank you, Beth. Amy, you wanna type in? Sure, I just think it's amazing everything that you've done. You're cutting out, maybe type in the chat. So in the interest of time, we have a few questions, and I would like to pose to the panelists. This first question I think is a very common one that we hear quite a bit. What are some of the changes that you implemented during the pandemic that you plan to keep beyond the pandemic? Start with Chris. I would say all of them. So, short of some of the things that Beth mentioned that were the testing requirements and those things, those go away, but we continue to plan to have the tablets as a resource out there, even as we're beginning the process of reopening our treatment malls, we continue to plan to do some of this work and leveling the kind of playing field, the equity. One of the things that just kind of, George kind of prompted me on as kind of a reminder on vaccination and trying to deal with the power dynamic. Initially, when we were doing some of our vaccination stuff, we were having doctors come in and experts come in, and we kind of hit a wall. So we actually asked out there, we went to food service staff, HSA staff, housekeepers, some of our groups that weren't taking vaccination update and asked the individuals, we stole a little bit from the social media age group, not from us, looking for the micro-influencers, the people that people ask to listen to, and who would, you know, would you be willing, we'll give you a couple of days off, you can go walk around, not off from work, but off your regular assignment and talk to people about your vaccination experience, your thoughts, and give them your opinion on it, that kind of help a more equitable level of decision-making. And they've got us some boosts in vaccination rates. When a human service aide was talking to their colleague about what they thought about it and their experience, and it wasn't as bad or what they believed in it, or a housekeeper was talking to a fellow housekeeper, or a health food service worker. So all those things, using those type of things, looking for micro-influencers as we're doing other changes, using tablets, we've, some of our most popular groups and sessions were all peer-led during the pandemic, if I actually look at numbers. So we continue to wanna increase our use of peer resources that both Amy and Beth talk about. So I would say, I can't think of anything off the cuff that I represented that we don't plan to continue. Thank you, thank you. Amy, any thoughts? You're muted, or your mic stopped working. You wanna type in the chat? Can you hear me now? Yes. Sorry, I don't know what's going on with my audio. It kicked me off last time as soon as I hit unmute. So Beth, back to what you were talking about, I think that what you're doing is amazing. And the two thoughts that I had, one was for the people who have been incarcerated for long periods of time, the existing landscape for treatment and recovery support services has completely changed. And so I'm just wondering about any innovative ideas or ways you've looked at maybe addressing that. So like one thing that we were talking about doing in Indiana, we allocated some of our HRSA and stimulus dollars for was a documentary on existing recovery community organizations, what the peer support landscape looks like and how to access treatment. And they were gonna be putting those in all of the recovery communities and all of the DOCs. So just things like that. I was wondering if you had thought of that. And then second question is for the peers in the program, are the peers peers from the community or are the peers who have graduated the program that are still incarcerated? All right, that was a lot. That's okay. In terms of the peer support, we'd love to have, Joan and I talked about having peers on the women's wellness unit, maybe loosely be partnered up with women who are coming onto the unit and have to serve as a mentor. And we've had that in other programs at the jail with men and it's been incredibly successful. I think part of the condition is that things have been really impacted by COVID. So in terms of a lot of the socialization that hasn't really been able to happen. And then the peer navigators, the other peer navigators have come from the community. Yeah. Thank you. George, any practices you are thinking of continuing? Very quickly. I agree with many of the things that I didn't comment on and it's really kind of more medical. And that is one of the practices we wanna continue is the recognition of the vulnerabilities of those we serve. We had to fight to get clinics and vaccination and testing for those we serve. And it was not only a function of the congregate care, but also a function of mental health. We often found that people did not look at mental health in the same way that they looked at physical health. And consequently, we were not able to get the same resources. So that was a very important one. And it's very important because people that have the diversity that we are talking about, the neurodiversity that we're talking about have accelerated aging. And that accelerated aging makes a real difference in their physical presentation and their metabolism. And we wanna keep that in front of people so that they are treated appropriately. Raul, we might have time for one more question before we'll bring Amy back on. Yes, I was gonna end with Beth around any thoughts on what it sounds pretty clear, some of the things already that you're going to continue past COVID, if there's anything else. And the second question for you that's on the chat is I think this shows how amazing what you talk about you're doing in DOC. But have there been sharing of your program in statistical research in other DOC systems for people to learn from this? Well, thanks. We're really excited about the work that's happening in the jail. And it may be kind of unsexy to talk about great things are happening in correctional health, but we feel like it would be really great for the press to kind of pick up on this. We've talked to them about it, but they haven't really reported on it. But we're very happy with the things that we're seeing. And I know that the Unity Medical Director, Dr. Eleni Donovan, who's fantastic, she and I were planning on presenting the work around our mental health efforts in the Women's Wellness Unit at a national conference in October. I think I'll add one thing before we bring Amy back. One of the things that I think we didn't talk about that has been so innovative is the inclusion and respect and support that we're getting from correctional officers. How do we engage officers in all of this work so there isn't that hierarchy where the officers are often blamed and shamed and they're elevating the role of the officer and the respectability the officer has really made a lot of this possible. Yeah, and I think the work has helped increase empathy and it's given officers an extra role, which I think they wanted. And for them to participate on the Women's Wellness Unit, they have to undergo this trauma-informed care training, go through the trauma camera curricula, and they loved it enormously. And I think it's a real gift to them. Like we can all benefit from trauma-related psycho-ed. We've all been traumatized in various ways. And I think that it helps them understand their own lives, their own families, their own communities. And it really, as Joan always says, it shifts the conversation on some level from why are you here to like, what happened to you? And how can we shift our systems so that we don't re-traumatize people? I think that's a great point. Ralph, I'm sorry. Yep, thank you. What a great panel. Thank you all. And we'll turn it back to Amy. Hello, I don't know, there we go. You know, I think Beth, your last words really summed up a lot of what I heard today, which was empathy. That we've all gained a lot of empathy in the past two years. You talked about correctional officers. Amy's story made us think about people with that, you know, the gift of actually people that have a past peers with past criminal justice involvement and how much we need them to be part of our teams. George talked about sharing and being more transparent with some of his patients than he might've been before the pandemic. And Chris talked about how we have to think from the user perspective with our clients who without a phone, they can't even get, you know, electrical and get utilities paid for. And I think we've all had a little switch of a little bit more empathy in our jobs, both with the people that we serve and with our peers, which has really been a benefit to all of us. And I hope something we carry forward. As we end today, I wanna also recognize the incredible partnership that SMI Advisor benefits from with NASHPIT. They have been an incredible, incredible partner to SMI Advisor. And there are people even on this call today, I know Amy's gonna be on an SMI Advisor webinar in just a few weeks, helping us think through another issue. So we have appreciated this partnership so much. And I wanna thank all the faculty and the audience who joined us today. I wanna take a moment to let the audience know that you can access all of SMI Advisor's free resources, again, free resources at smiadvisor.org. You can browse dozens of live and on-demand courses in a robust education catalog, find hundreds of vetted resources in our online knowledge base and submit questions about SMI to a clinician-to-clinician consultation service. We answer all consultations within 24 working hours. So please feel free to use that service. You can also download our SMI Advisor app to access those same services plus a series of clinical rating scales that rate immediately and provide interpretation. So they're great for during the clinical encounter. If you have any follow-up questions about what we talked about today or any topic related to evidence-based care for serious mental illness, our clinical experts are available for online consultations, as I just mentioned. Any mental health clinicians or peers can submit a question, receive a response from one of our SMI experts. Consultations are free and confidential. Lastly, on behalf of SMI Advisor, I'd like to invite you to learn more about APA's 2022 Annual Meeting. The in-person conference takes place May 20th, 21st through 25th in New Orleans. And the virtual meeting takes place June 7th through 10th. During the live conference, clinical experts from SMI Advisor are leading a variety of sessions on how to improve care for people with SMI. We also have lots of great sessions on Clozapine, digital navigators, making technology work, physical health, and more. I encourage you to take a moment now to browse the agenda at psychiatry.org forward slash annual meeting. Thank you for everyone today for joining us. And I appreciate your partnership in moving forward. Take care.
Video Summary
The video content was a panel discussion featuring Amy Cohen, a clinical psychologist and director of SMI Advisor, Dr. Joan Galese, Raul Almazar, Chris Morrison, Beth Honey, and Dr. George Dawson. The panel discussed innovative approaches to services during COVID-19 restrictions in the context of serious mental illness. Key points included the use of tablets for access to resources and support, the importance of equity and including the perspective of individuals with lived experience, the need for empathy and trauma-informed care, the integration of peer support and peer navigators, the importance of quick access to healthcare services, such as sick call visits, and the use of telecommuting for staff. The panelists highlighted the need for ongoing support and services beyond the pandemic, such as continuation of tablet access, increased use of peer support, and the importance of trauma-informed care. The panelists also emphasized the challenges faced during the pandemic, including limitations on in-person programming and support, increased isolation and mental health symptoms, and the need for continued funding and resources to support these innovative approaches. No credits were mentioned in the transcript.
Keywords
panel discussion
Amy Cohen
clinical psychologist
innovative approaches
COVID-19 restrictions
serious mental illness
tablets
peer support
trauma-informed care
pandemic
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
×
Please select your language
1
English