I'm pleased to moderate today's session, telehealth in the time of COVID-19 for CSC programs, opportunities, suggestions, and considerations for working with diverse populations. Now I'd like to introduce you to the faculty for today's session, Dr. Piper Meyer-Kalos. Dr. Meyer-Kalos holds her doctorate degree in clinical rehabilitation psychology from Purdue University. Dr. Meyer-Kalos has specialized in psychiatric rehabilitation and treatment for the first episode psychosis with interests in recovery, positive psychology, and psychosocial treatment for people with severe mental illness. Since 2009, Dr. Meyer-Kalos has been part of the psychosocial development team of the Recovery After Initial Schizophrenia episode project and has co-led the individual therapy component. Dr. Meyer-Kalos' current research includes an evaluation of four first episode psychosis programs in Minnesota and the National Early Psychosis Intervention Network. Dr. Meyer-Kalos is a consultant for NAVIGATE, Individual Resiliency Training Intervention, Mental Health Best Practices. I will now turn the presentation over to Dr. Meyer-Kalos. Please go ahead. Thank you for that introduction. I appreciate it. And these are the three learning objectives that I'm hoping to accomplish today and that we're going to cover. And the bulk of our presentation is really going to focus on this, the idea of telehealth and what's changed since COVID, since the pandemic, and how we've had to move our interventions or our delivery of services into this telehealth environment. What does that look like? What are people doing? What kinds of things are people finding helpful? So I'm hoping not only to talk about what are some of the challenges, but also what are strategies that people in programs are using across the different roles on a CSC team. In addition, we're going to spend some time at the end of the presentation really specifically narrowing our focus a bit more and talk about some of those telehealth modifications that could be really important when we're talking about working with people from diverse backgrounds and populations. So here's our agenda today. And I want to start out and just say the work I'm going to talk about today, the suggestions that I've compiled, the recommendations, they come from a wealth of services. I'm very, very fortunate to be part of a network of different programs and individuals and colleagues who've contributed to all of this. And these recommendations come from a very generous network of people who are extremely innovative and amaze me every day. And not only am I fortunate that when this process started, I was reached out to from a colleague overseas in Israel who was interested in putting together some of these recommendations. But the minute that I reached out to colleagues in the United States, the welcoming and the generosity that I saw was just, it was heartwarming. And then I was fortunate enough to reach out to my colleagues in China who are doing some early intervention work and they also contributed to this. So in the bibliography at the end of the presentation, you'll see the paper that came out of this and the number of people that contributed to these recommendations. So on that note, we are not done. We are still in the middle of this pandemic and we are still doing the best that we can to make sure that the services that we deliver are the best possible. So I encourage everybody to continue to use that chat box that I've seen throughout this whole conference has been an amazing resource. Please share if you are a clinician, if you are a C specialist, if you are a team leader, if you're an individual therapist, if you're an administrator, if you're a researcher, please share that because I'm hoping that while I'm talking today and going through some of these challenges that each of you will be willing to share any sort of innovations that you have found in your programs as you've made this jump, this leap to telehealth. And I would, again, the generosity and just having people share that would be wonderful. So I just want to encourage people to do that and to share that. So the plan for today is I'm going to talk a little bit about how the pandemic has really affected the different roles on a CSE team, then switch to what are some strategies that we can use to address these challenges and then focus in on what are some ways that we can improve the way we're delivering interventions using telehealth. And lastly, focusing on what are some ways that we could address these needs within diverse communities and individuals. So I'm going to start out a little bit talking about what are some of the effects that we've seen as a result of the pandemic. And you can see here from these pictures, things that have come up for me and that I've heard from programs and from clinicians and individuals all over. We've all experienced some sort of a drop, whether that's feeling like we're less connected or that there have been changes in our productivity or other things or family members that have been affected by this. We've all felt that what has happened since the pandemic began. In addition, it's changed our behavior. You can see here, it's commonplace now for many of us to wear masks all day long where that was not a common thing. When you do that, it changes the nature of how we interact. If we think about face-to-face interactions before the time of the pandemic and now with a mask on, it's different. It's changed. In addition, many of us are not going into work, are not going in, you know, our loved ones aren't going back to school. These are empty places now for a big significant amount of time. And there's a loneliness factor that seems to be setting in. You know, there's this disconnected factor that seems to be setting in. These are just some of the things that I've heard in talking to different programs and clinicians and individuals, you know, since this began and how this has kind of changed and how we're dealing with this. What about how it's changed our programs? And if we think about a coordinated specialty care program, if we think about what kinds of things were going on before this pandemic, when we looked at some surveys of programs, they were telling us that the majority, and when I say the majority, I would say 90 to 99% of treatment was occurring face-to-face. Since it began, those numbers vary pretty widely, but the majority of programs have transitioned to a much higher rate, anywhere from 85 to over 90% is now through telehealth. So that's been a huge change that these programs have had to make since the pandemic began. So now I have a challenge for you. I have a poll that I want to ask you. So if you see here, there's two different ways that you can respond to this poll. You can go to PollEV.com backslash PiperM822, or you can just text PiperM822 to 22333. And the question I'm asking, and it's going to show up so we can all see it, is in one word, describe a challenge that you or your client have experienced as a result of the pandemic. I'm curious, what are the kinds of things that are showing up in your clinics, in your family, in your teams? What are things that you're hearing that are going on? Because, you know, we've heard there's a lot of different ways that this is impacting us, and therefore impacts our ability to deliver treatment and to get the best outcomes. So I'm just going to give everybody a minute to respond here. Make sure that looks like. I'm hoping this will work. It worked this morning. All the best intentions, right? I'll give it another minute. If not, we will just move on, and hopefully you guys can put some of that in the chat. I am surprised that this is not working. Well, I apologize. We will just keep moving now, and maybe we can get to that at the discussion. So I was hoping to be able to compare some of this, and so maybe if you're looking in the chat, you can compare some of the things that I've seen. Here are what we're hearing from individuals that we work with. We're hearing that people are reporting increases in symptoms, that they're feeling increased loneliness and boredom, that they're really feeling that loss of face-to-face contact, that realizing how important that is to the treatment that we deliver. There's also been this change of what do goals look like? It's such a huge part of what we do in most of our interventions that since the pandemic has begun, there's been a change of what are some different challenges that are now cropping up and showing up. Many of the individuals we work with and their family members are dealing with financial insecurity and sometimes even job loss. Even individuals that we're working with are starting to receive this diagnosis. It was interesting when I looked at some in the groups that I work with, some surveys and asking how many individuals on the team that they're working with have been actually positively diagnosed. The numbers were small when we asked early in the stages of the pandemic. I have a feeling that those numbers are starting to increase, so we're likely to see those kinds of positive diagnoses showing up the longer that this goes on. In addition, we're hearing from young people that the difference is in being stuck at home more often and feeling like there's this loss of autonomy, loss of wanting to get out on their own, which is such a normal developmental stage for many young people involved in treatment. The challenges aren't only with the individuals that we work with. We as providers are also faced with pretty significant challenges that we've faced as well. These include this loss of face-to-face engagement. I know for myself and my own practice, it's been a huge loss for me. Mourning this kind of being able to lay eyes on someone and to make that connection and learning how to do that in a different way is challenging. We've also had to learn new telehealth tools. You know, there is a little bit of a learning curve to make this stuff work right and to help the individuals we work with actually connect to that technology. That's not always easy either. In addition, many of us have invested a significant amount of time learning how to deliver these evidence-based practices face-to-face. Now, all of a sudden, we have to deliver these interventions over the phone or by video. That itself can be a huge mountain, a huge change to try to deliver that. There's all kinds of changes that we're seeing. Not to mention, and really making sure that we say this too, is that many of us are dealing with changes in our own homes and lives and family members. We have to make sure that we're paying attention to those as well. All right. I was going to try that, but I'm not even going to try it. My question was about what percentage of individuals are you connecting with through telehealth. I'm assuming that that number has increased. I'm just going to keep going here. One of the first things that we talk about when switching to this from face-to-face to telehealth is, how do I make that jump? I think of it as establishing this safety net. If you look at the research that's been out there and what people are talking about, and then if you talk to people on the ground, there are a few things that you can do to help. Right? There's a couple of things in the beginning when you're doing this, and even when you're in the middle of this, checking in about this with individuals that we work with from time to time. Things like asking about what kinds of preferences individuals have with the technology and how you connect with them. We may feel like we'd love to do video, but that may not be the best preference for the individual that we're working with. We need to have a conversation about that. Asking about their access to technology. Is this something they're comfortable with? We do find that that's true for many young people, but it may not be true for all. Do they need some support to be able to access technology? Talking about what does this look like as a routine? You may have had a set schedule to meet with somebody. Maybe it's weekly. Maybe it's twice a month that you meet with them. Maybe it's for a 45 to 50 minute session that you're used to meeting with them. That may look different now that you've switched to telehealth. That may not be as comfortable. That may not work as easily for the person now that you've switched to telehealth. It's really helpful to have those conversations up front and ongoing. In addition, privacy and the boundaries of privacy have likely changed when somebody moves to telehealth. So consider that when you're thinking about setting up these boundaries and having that conversation. Are they in a small apartment? Are they able to close a door? Are they able to have private conversations? How important is that? These are all really helpful things that you can ask. Last but certainly not least, thinking about what looks different if there happens to be a crisis situation that develops. What can you do and what does that look like over telehealth? Do you have those kinds of things in place and is the person on the other side aware of those if they come up? These are just some helpful tips that people have been talking about and bringing up and I think are a good reminder of what we need to do. I'm going to start talking a little bit about some suggestions for how to address some of these challenges we've been talking about if you're working in the roles of individual therapy or family education. So there are some things as you move to telehealth that can be really helpful and that we've practiced. So I work with a lot of teams in a lot of different places and a lot of these have come from their suggestions and things that they've practiced and given feedback on. In addition, these come from recommendations from other programs across the country and outside. So these include things like really relying heavily on your session structure. The tried and true things that we've learned that we may have got moved away from a little bit as we've tried to get back into this telehealth thing, but coming back and remembering the importance of setting an agenda of checking in with people about their goals and reminding them what we covered in the previous session. These can be really, really helpful things. Now, another thing to think about is the use of handouts is likely going to change. Many interventions that people have been trained in use handouts, but it's really different if you're using a handout over video or over the phone. So this is where we have to think a bit more creatively and outside the box. How can we help that person learn that information? What are some ways that we can do that? Whether that means that you email them the copy, that you share your screen, that you switch to a PDF fillable form, any way that you can think of. These are just some examples that people have done. We've even had clinicians talk about how they've posted, they put it in the mail ahead of time, getting the person to have an actual physical copy that they can talk about why they're on the phone together. So there are many things that you can do. One other thing I want to note and point out is the use of role plays. One of the things we're going to talk about in a little bit is getting back to treatment in many of these telehealth sessions, which can feel challenging at times. One of the ways that can be helpful to do that is not to forget about one of the strongest tools we have, which is using role plays. And I'm going to just say it right now. It's going to be awkward. I've done it. I've done it on the phone. I've done it over a video, and it can be awkward. But in the end, what my experience has been, the feedback that I've gotten and the recommendations that I've gotten is that it can be very rewarding at the same time. There's just a lot of value getting back into and having people practice, having people develop that memory and that experience about around using a role play. So now I want to talk a little bit about some suggestions for some common concerns that come up. We talked about some of those things that are coming up as a result of the pandemic, and these include things like stress and anxiety and boredom. So a couple of ideas that came up when we talked to colleagues and clinicians on the ground are things like taking a break from the news, giving yourself a break. We've been through a lot these last nine months. It's been an up and down situation. Up and down situation. It is not a bad thing to really normalize how we all need to take a break from the news. Also, teaching and practicing mindfulness and relaxation strategies. I would strongly recommend things like here's the perfect opportunity to do a role play in your session. What would it look like if you practice a relaxation or a mindfulness strategy at the beginning and the end of a session that you did? And if you did that for a month in every session that you did, imagine the amount of practice that you would build up with that individual just in the nature of helping them reduce some of their experiences around stress and anxiety. Boredom is another thing that we've seen that's cropped up. And it's interesting, the longer this pandemic goes on, the more that I'm hearing from individuals that boredom continues to be more and more of a problem. So there's a few suggestions here that might be helpful. Things like remembering how we can use behavioral activation in these situations. I put some recommendations in from individual resiliency training. So if people don't know, we call that IRT. And that's the individual therapy component of the navigate intervention. There's the manuals online. It's free for everyone to access. And in there, there's a couple of different modules that I would just suggest that you might take a look at. One big one that we've had a really good response to is the resiliency modules that an IRT, that especially during this time of a pandemic, they are built on this idea of building resiliency through the experience of positive emotions. So I would suggest taking a look around at the resiliency modules. But also, this could be an opportunity if they're experiencing boredom to try things like healthy lifestyles or having fun and developing relationships, which are also modules in IRT. So there's a couple other things that can come up that we want to definitely pay attention to. And these include loneliness and substance use. So there's some recommendations here also to address those issues when they come up. Things like starting a Zoom group. We've had some great success in Minnesota starting a Zoom group that's run by our supported employment and education specialists. And it's been a way for our young people to connect, to feel connected to each other again. We've had it going since the pandemic began, and it's still going. So it's one of those things that can really help people get connected and start to repair or start to make some of those new social connections. Another thing around loneliness is thinking in a non-traditional way about how often and how long we talk to people. There are several ways that it might be helpful to have these shorter but more frequent check-ins to reduce some of that loneliness. You know, in some of the other presentations, they talked about things like helping people navigate social media and encouraging connections to peer support. These are perfect opportunities for this. Substance use is another concern that can come up. This is something that we've been thinking a lot about in Navigate, and specifically in IRT, we've been thinking a lot about, and how do we really meet the young person where they're at? And so here are some recommendations based on some changes and updates we've made to IRT. These include, how often are you asking them about substance use? Is that something that happens every time you see them? Are you aware what that looks like for them? Is there an opportunity, perhaps, to focus on healthy lifestyles? We've seen that there are many young people that are really interested in being healthy and staying well, and might there be an opportunity, if that is something the young person is interested in, to focus on that, which might lead to some decreases in substance use as a result. And the third suggestion there is, could there be an opportunity to set up a behavioral experiment where a young person could try it out, could try it on for size, see what this looks like if they were to cut down or stop using, getting them interested in making those changes. So as I mentioned earlier, there is this notion of how do we keep treatment going? In the early part of the pandemic, it seemed really clear that a lot of what clinicians and people on the ground were doing were kind of plugging the holes, making sure that everything was going okay, and really trying to patch that up. We've been in that mode for quite a while, and the discussions have now shifted on many of the calls that I'm on and programs that I'm talking to about how do I help people get back into treatment? So I thought I'd put together some suggestions and ideas based on what was going on in our conversations. One of the big ones that's been really helpful is to go back and teach that thought feeling model again, to pay attention to what people are noticing, but also normalizing this experience of symptoms and the ability that people have and can learn coping skills and practicing those in session. In addition, there's a really unique opportunity that has come up as a result of this pandemic, where we as a CSC team and members of a team have this opportunity to reach out to family members. I was really struck by another one of the presentations at this conference that talked about the importance of reaching out to family members, which we've always known was really important, but it just reinforced it for me once again. And so I have to say that the pandemic may have changed some things, but it may give us on the ground on a CSC team more opportunity to actually reach out to family members. These family members may actually have a better sense of what's going on with their loved one. And they may, being at home with them more often, they could be a really great ally and supportive person that's backing that person up towards their goal and towards better treatment. It's also on the flip side, it's just as important for us to understand on the ground how the pandemic has affected that family. This is one of those areas that I have a suspicion we're going to start seeing a little bit more of what this looks like. And so we need to be aware that when we're reaching out to family members, that's an issue that could come up. There are a couple of things here that if you're working for family members, I included, things that could be helpful to think about how you might incorporate into your sessions, things like revisiting the problem-solving model together as a family in session, or helping the family members engage in stress reduction or healthy lifestyles. So now I wanted to include some suggestions for peer support specialists and case managers. There are a number of suggestions, some of them that we've also mentioned, but I think that the peer support specialists have a really unique role and often more flexibility than many of the other members of the team to connect with people. And we should not take that for granted. In a time where engagement is really key and we know such an important part of CSC work that we do, we wanna make sure that we utilize every opportunity to engage young people. And peer support specialists, you often have, you are on the pulse, you know what's going on, and you can really reach out in ways that many of us can't. And so this is an opportunity during this time when we're moving to telehealth to really get into that and do more of that. But just as we were talking about for individual and family sessions, things like creating that structure can be just as helpful for you. Just as we talked about before, those brief check-ins may be just important for you. There's also opportunities for you to help people develop fun activities. You are that fun person on the team oftentimes. You are easily accessible and much more easily contacted sometimes than some of the other roles on the team. And you have that opportunity. You can also help people establish a routine. Another thing that we know can be really helpful if somebody is feeling disconnected or feeling lonely. Okay, now let's talk a little bit about supported employment and education. If there's one role that's also had a pretty huge change since the pandemic, it would be our SCE specialist. We all need to go back and give our SCE specialists a little bit of a pat on the back because it's been a big change. So, you know, before this all began, many of these SCE specialists are out in the community pounding the pavement, doing the hard work. And now since it's mostly gone remote for a lot of us, what you're doing now is having to shift what you're doing and helping people get jobs that may be remote, but also work in environments where they have to think about PPE and being safe on the job and how that fears of safety interfere with their daily tasks, how to enroll and do online classwork and what does that look like? There's been a huge change. So these are big changes about this part of what, working remotely and helping people as they transition that way. It's been a huge thing on the ground that many of us have really relied on to help people get through these changes. So these things include thinking about, some helpful suggestions include, you know, thinking about are there some new job prospects that we didn't consider before? Are there some new education prospects and classes that might be helpful with some of that loneliness and boredom? Are there additional benefits that people might need? I would say that recently, I've even had an individual that I'm working with where we've had to reach out to disability services with the help of our SCE to make changes as a result of going online. You know, working online has been difficult and tricky and has created more opportunities for symptoms to increase as a result. And so we've needed to go back and actually ask for more adaptations from disability services as a result. But most importantly, thinking about ways that you might use some of that shared decision-making to explore these work and school opportunities. These are some suggestions for our prescribers and thinking about just as much as everybody else's role, how has their role changed? And in what way can we think about supporting that role as we've gone remote? Just like with many other visits, these visits are also occurring remotely. These are still opportunities to talk about ways we can increase adherence. How does this look if people are spending more time at home, if they're not going out with their friends like they used to, if they're not out at school or on the job in the same way that that looks like? Maybe there are more. It might be that there are more, but these are these opportunities to talk about adherence, but also to make sure that the stuff that we know needs to happen in person, how do we make that happen and how do we make them feel safe? In what way can we as a team support that happening so that people get their needs met? We also have this opportunity to work with the individual, the family members and supportive person to evaluate any changes that are needed in medication. Again, these are some difficult times and we wanna make sure that we're responding to what people need at the time that they need it. So I'm gonna shift a little bit and talk a little bit now about some telehealth suggestions and focusing in on when we're using telehealth, what are some things that we can do differently or think about a little bit differently? So I'm gonna start thinking about e-mental health and this may not have fully been on your radar. I know it certainly was on my radar, but I wouldn't tell you that I have formally done a great job of integrating this into my practice, but I've started thinking about it more. So here are a couple of suggestions that I've been thinking about. Things like, is there a way that we can integrate things that we know are helpful, that we know that we already do with something like an app? So the two suggestions I've included here are something like a mood tracker or a symptom tracker. We all know how helpful that can be to get a sense of how often does this happen? How much does it bother a person or create distress? And what are they doing when it happens? This is some amazing information and we could use an app to do that. So this is just one thought that you could use to integrate it into what you're already doing since you're already using telehealth. Another one is creating a safety plan or crisis planning. So there's a website here that talks about using a safety plan, which you could do online as well. So these are just a couple of ideas, but I encourage you, there are all kinds of apps out there. Do some research, do a little digging, but there are opportunities that we could integrate this into what we're doing already. Another thing to think about is, is there a way that we could address some of the biases that are showing up in our telehealth sessions? So I used an example here about addressing common cognitive biases. And could we use things like teaching cognitive restructuring using something like a whiteboard in your session, sharing a screen and doing some typing together back and forth, using writing on a fillable form as you're going through that so it shows up. So they're not only talking about it, they're not only hearing it, but they're seeing it written. It gives us another opportunity to help that information get through. Another suggestion is for the handouts that you use on a regular basis, might there be an opportunity for you to add those to your local agency website so that anybody could download them? So that if you're talking about it, the person can click on it, the two of you can look at it together. There may be a way to add some resources very simply that way. The last one here that I'll add is adding something like a screener to assess what's coming up related to the pandemic. So I've included something here called the COVID-19 Family Stress Screener. And if you haven't done this with individuals yet before, you might be surprised at what you hear. If you have done this or you're considering it, it would be a way to get a sense of what are some things that you may not have thought about or had time to get to? And how can we track the degree that we're able to really get to those to really help people in these areas? So it includes things like housing, childcare, finances, there's all kinds of things. And what we're hearing from programs that are doing this is it is helping them track where they need to put some resources, where they can really plug those holes and help people out in the moment and meet them where they're at. Okay, I'm not gonna do that because we know that's not working right now. Now, here's the other thing that's been really interesting that came up. And this started coming up, and I would say just a little bit through the pandemic. It became pretty clear when I was talking to programs and colleagues that there's a segment of individuals that we work with that have never been able to engage by video and may never be able to engage by video. But what do we do about them? What does treatment and what should treatment look like for individuals who can only engage by phone? So take a minute for yourself and think about this. If you think about your current caseload, think about how many people on your caseload can only, or that you have only engaged by phone. And then I want you to think about the things we're gonna talk about and what you might be able to do differently to help them get on track or stay on track. So these are some just suggestions that, again, these come from the individuals on the ground, what they're doing, what they're telling me, this is working, this is not working, or I'm still struggling with this. These are the rare recommendations that they're talking about. One thing they're talking about is they're noticing that 45 to 50-minute session doesn't work. So using shorter but more frequent check-ins seems to help, right? Using that structure, same thing we've been talking about throughout this presentation, right? Adding structure so that you've got a plan, so that you're modeling in this time when we may be feeling very chaotic or difficult to focus, you're helping them make a plan and modeling how to do that. Don't forget about treatment, right? Take one of your sessions, your short sessions, focusing on the needs of the moment, but make that second check-in about something that's treatment-focused that could help them with what's going on at the moment, right? So if you're doing that and you're trying to use some handouts, which we know is a stretch and can be challenging, here's what people are saying. Focus on what's really relevant in the handout. Don't read every word. You don't need to read every word. What's the most relevant piece that you're trying to get across? Also, small chunks. We've talked about and have seen some success when you're doing things like focusing just on the front page. Today, we're just gonna focus on trying to understand this front page and what's going on here and how this relates to your situation and can help your situation. Another thing that providers have found helpful is creating a file for yourself where you've really chunked out or made smaller these little bits of handouts that you can either pull up really quickly or you can email out really quickly or you can text out really quickly. So creating where you're just really starting to slice up some of the bigger chunks of handouts and making them easily accessible. Now, I wanna talk about something we've been trying on several teams if you're using, if you're delivering it by the phone. This is a tracking sheet, just as an example. This is completely an example. No, I completely made this up. But a way to get a handle for the folks that you're really doing your phone sessions with, what's going on. You can certainly do it with more people, but it just seems to be it's harder to get that focus when you're doing phone-only treatment. So in order to really, to narrow that focus, to get down to the what's the business, this might be helpful. So you can see here, we've got the name in one column. The next column is we've got what's that person's meaningful goal. Then we've got the current concerns. So these are the things that seem to come up every time you have a call with that person. What do you hear from them? What are those things that come up the most often? You've got them written down, you know that they're likely to come up. The next column there is a list of their strengths. Now in IOT, these come from the Brief Strengths Test that we do. You can certainly put any strengths that you want. If you haven't looked at the Brief Strengths Test in IOT, I encourage you to look at it. It's really great, really helpful. It's a reminder that this is an opportunity for us to really connect to what's really going well for that person, what they're really good at, and how that might address what's coming up. The last column here is I put in some suggestions from IRT. If I were gonna pull this up, and I was working with John Doe, I might consider, before I pulled it up, pulling up something from that IRT resiliency module and making that a specific focus of what we talked about. So ahead of time, before my session, I'm putting this stuff in my column. I'm making a list so that I have an idea, so I'm not scrambling around, but I'm really starting to put a little bit of thought in this. This has seemed to have helped people to get back on track a little bit. Okay, now I'm hoping we're doing okay on time. So now I wanna shift a little bit and talk a little bit about what does telehealth look like or what can we do to improve the inclusiveness if we're working with diverse populations? And I wanna just state outright that I am in this space of learning to do this better just as much as each of one of you. So use your chat. If there are more suggestions that each of you know and have worked, please share them. I really am humbled by the work that people are doing, what I've learned at this conference. It's really amazing, but I also know that I myself need to do more, and I wanna share whatever I've learned with each of you as well. So a couple of things about the importance of tailoring interventions. We know that engagement is really key and our work in CSE program, but we also know that if we're working with diverse populations, we need to discuss relevant cultural issues. It is time for us to come out and start talking about these, talking about things like racism and mistrust and stigma that's associated with treatment. It's time to start having those conversations, and we need to start doing that as clinicians and providers. We also need to acknowledge the importance of having diverse treatment providers on our teams. We need to take a look around and see where there are opportunities to bring in more diverse treatment providers, and this could include community partners. Partners, you know, these are also community partners that we can bring in, that we can learn from, and that we can engage and that can help us engage with the individuals that we work with. Another thing to consider is how we might incorporate racial values into treatment. We need to acknowledge the importance of including racial pride messages to improve unity and overcome these negative opinions into what we do. It needs to be a lens with which we look at our treatment, and there are some suggestions here about using pictures of people with the same identity, but also incorporating those stories of resilience from people who have similar backgrounds. We need to acknowledge that having people be able to identify with treatment of people who are similar to them is really important. In addition, what are ways that we can give those messages of racial achievement, both individual achievement and academic achievement? How could we use something like CBT to help people overcome those messages around lack of achievement? How can we use racial equality messages to emphasize peace and coexistence? How can we tap into things like spirituality to help people cope with difficult times in life? How is that something that's part of their race, part of their culture, part of their tradition that we can also tap into as part of treatment and acknowledge? In addition, how can we highlight and bring to the forefront the messages that people are receiving about the complexities of what people are navigating in this difficult time and around racism? This comes as coming, I'm in Minnesota. I'm not that far from Minneapolis where all the protests were happening. It's been very, very real here. We've seen the difficulty and the conversations and the difficult conversations we've started to start having more often as a result of this. Here are three, and certainly not all, barriers to treatment, but three that I think are worth really talking about a little bit more. Things like stigma. How does the stigma that people experience, how is that affected by discrimination and oppression? How does that affect people's view to get access to treatment? How does this lack of access to services, how does that come out as a barrier to treatment? I'll never forget talking to a team and the provider talking about how the individuals she was working with had a fear of contacting law enforcement. They were in the middle of several protests and they did not feel safe. What does that mean? What does that look like? How does that then serve as a barrier to treatment that we need to be aware of and to address? And the access to technology. I mean, this whole presentation has been about telehealth, but you know what? We don't experience telehealth in the same way, and we can't expect it to be that way. We need to understand what this looks like for the individuals that we work with on the ground. What does that look like if we could provide devices or service for people? What would that mean when it comes to overcoming a barrier to treatment and helping them get access to that? Are there ways to consider alternative access? Is there a more creative way to do this? There was an interesting article that's referenced in the bibliography that talked about the success when telehealth was used in the school setting to help people access mental health treatment. So there are some ways that we can consider some of these alternatives as well. So just some strategies to help increase the relevance here. Things like using these fillable forms, making it easier for people to see, using pictures, making it fun, and making sure that we understand the family cultural context. I will say that one of the things that was brought up, and I think it was really helpful in one of the other presentations, they talked about the cultural formation interview in the DSM. If you haven't looked at it, take a look. It asks, it helps you learn how to ask some of those questions to start that conversation. So I really encourage you, take a look, see what you think. It is ways to kind of get to that cultural context piece of things if you're looking for more help with that. So just some strategies to help increase the relevance to kind of wrap up a little bit more. We've all been affected by this. It's affected all areas of the services that we provide, and there's each role has been touched by this, as well as each of the individuals that we work with. And it's really helpful to talk about it, but it's even more helpful to go back and to try some of these things out. I'm hoping that the slides will give you some ideas of things that you can try. I'm hoping if there are more ideas that people are willing to share them. Like I said, it's just been amazing, the innovation, the kindness, the generosity that I've seen as a result of this overwhelming need. And we're all on the same page here that we want to do better. We want to better engage the people we work with. We want to better assess their needs, and we want people to reach the best possible outcomes that they can have. And then the last thing, just as a reminder, is that we are in this together. This is team-based care for a reason. We need to make sure that when we're doing this work, we're communicating with our team members and tapping into their expertise so that we can continue to innovate as a team. So I have the bibliography here. These are the relevant articles that I referenced and talked about during my talk. And it has the article that really started this whole conversation where we got together all of those recommendations from people across the world that we were able to do together. So I'm really proud of that and proud of all of the collaborators that participated in that. So Piper, thank you so much for your presentation. And just as you had hoped, the chat was a space that people were really building on everything that you had recommended and really helping each other give different tips and ideas. So one thing that came up was, let's say we're going to open back up, which we are hoping we are at some point, right? And one of the audience members said a wonderful thing and said, I love how you're looking at this as an opportunity where we're at right now. And I'm wondering if you can speak for a minute about just a few things that you'd like to keep or to maintain even after we open back up. Really good question. And I have to say here, I'm going to say a little something about some Chinese colleagues that I've been working with because it was interesting. They obviously experienced the pandemic before we did. And so that when we got into the middle of this, what was interesting is that they were seeing more of that opening back up and to see some of the things that have changed. So it's really been interesting to see what does this mean and what does this look like? I think about this as truly as opportunities. I think one of the things we have to keep here is that all these different tools that we now have for engagement, this is not a one size fits all shop anymore. Again, if we looked at before, it was probably 92% to 98% or 99% face-to-face. When we go back to this, I don't think that that's going to be, I don't think it should be. I think we need to meet these young people where they are and understand and take that as an opportunity so that we can continue these different ways to connect with people. But I also think that we have to understand that post-pandemic, whatever that looks like, the nature of what does it mean to have social connections, to go back out into the world, into these jobs, into these school and educational opportunities, it is going to be different. With more opportunities becomes more things that we need to think about how that looks different and how our young people who are struggling with symptoms, how that is also going to be a new challenge. There are many of them, and this is what came through when I was talking to my Chinese colleagues, where they would tell me, and we hadn't heard this yet, we hear this now, but I hadn't heard this yet, where they were saying that many of the young people in the middle of the pandemic felt like they felt everybody understood the position that they were in. They didn't need to connect or they felt nervous about connecting. Now everybody knows how they feel. And now they're going to go back post-pandemic, and what does that mean? What does that look like? Now we're not all the way back out there yet. We don't know how long that's going to take, but it is something to think about. So again, I see this as opportunities, things to take our shared understandings that we've developed and really continue to move that needle forward and innovate and respond as a result. When you think about so when you think about access and you think about now you've primarily been dealing with people via telephone or telehealth or mental health, and maybe you've even had shared group visits online, and we've heard a lot of really innovative things where people start a movie at the same time, and they sort of watch the movie together, they do puzzles together, lots of different things. I'm wondering if you can think a little bit with us about how will you approach this moving forward? Is it the kind of thing where you imagine you're going to ask clients how much they want to do in-person and how much they want to do telehealth? Do you feel like there will be some sort of way that will decide who might be best for telehealth, who might be best for in-person care? How are you thinking about that? I mean, I think it's tricky because here's the big unknown, right? Like it or not, we're driven by payers. We can't separate those two things. These programs are important. We want you to stick around, but it's a fact. It's a reality that we're connected to payers, and the one big thing that we haven't said here is when this goes back to whatever it is, when we go back to whatever it is, are payers going to yank their ability to do that? That's going to be, I think, a big thing that we don't know yet. Let's hope not because the more flexibility that we have, if there's one word I've heard throughout almost all of the presentations these couple of days, it's flexibility. Please don't take our flexibility away. That's what I want to say to the payers. Please don't take that away from us. I think it should be a conversation. I think just like we were saying when we set up, when we intake somebody, whether we do it remotely or in person, that we should say, we have these options. Tell us what works best for you. Here's what we know works best so that you can set boundaries. We've talked about the importance of being able to actually face-to-face, eyeball-to-eyeball. There's a difference in providing treatment when you're eyeball-to-eyeball with somebody. We want to have those experiences too, but it can be a conversation. Ultimately, go back to your payers. Go back to your state people. Go back to whoever will listen to you and really talk about what it is meant to have this flexibility. Several people asked, where can they find the IRT materials? Yes, so navigate consultants with an S, so it's all one word, dot ORG. If you go there, navigate consultants with an S, dot ORG. Yep, there you go. Yep, there you go. Perfect. I love it. Can you also tell us where to find, or the proper name of the COVID-19 stressor so people could find the PDF of that? Yes, it's on the slides. The actual sheet and all of the questions, so people really wanted just to copy it from there, you're more than welcome to. This was just a stress screener that we found here in Minnesota that was being used, and we started using it in Minnesota, so I just used it as an example, but it's just a stress screener, so please just look on the slides that are posted as part of this presentation. All the questions are listed there, and it's just a general stress screener, and we found it really helpful to ask these questions. Perfect. Yes, so people can just scroll down, down the documents, and get the slides, and it's in there. Do you have any, you know, a lot of people really resonated with the beginning of the talk about loneliness, and about isolation, and you know, I think it's not only our clients, but we're feeling that as well, so it, you know, it really resonates. We feel it deeply when we hear that from our clients, and you know, one of the things that people sort of went with that was, what about our clients who do not have homes, and so do you have any suggestions about working with our populations who do not have homes during this period of lockdown? I think it's tricky, and I think that it, you know, that it's a bit on the scary side at the moment if we think of where we are in the pandemic, and I just want to acknowledge for all of you that do that work, you know, bless you, because that's some tough work. I will say that hopefully you've got some opportunities to get people connected to some housing. I know that there have been some places across the country that have really worked to get people who don't traditionally have housing at this moment to get them housing, so I think the degree that you can loop into those is good. I think we have to make the small moments count, right, so if it's a small moment where you get to see them for a few minutes, you can social distance, you can put on your PPE, whatever that is, you can get them some PPE, and have those small moments around checking in. Those are very meaningful. If you can get them some sort of technology, whether that's a phone that they can use, but in this time, you know, it's even more necessary, more important for them to be able to be connected, those are small things that we can do to help people feel more connected. Right, and a lot of people, I mean, I'm just scrolling through the chat, people are like, amen, Piper, I mean, they just really love what you've been saying, and it's, the chat has just been going and going. You know, I think one of the other things that people are sort of wondering about is, can you speak just a little bit about your experience about cancellations or attrition during this period? You know, I've heard from some people, we're actually overwhelmed because everybody can now access, and so we're actually having no room to, but then other people are saying, I'm really having a lot of, you know, I'm missing a lot of clients, they're falling out. So I'm wondering what your experience has been around that. It's very polarized, okay, so it's interesting, because it's extremely polarized. We do have a segment of people where we tend, have actually had more contact with them. Now, if you dig a little deeper, this is, and this is all anecdotal, please, this is not, not a scientific study, but anecdotally, this is what I'm hearing, is if you dig a little deeper, they tend to be the people that we've had better luck engaging to begin with, okay? Then you've got the opposite side, and these are the folks that say, no, I won't do a video. You can contact me by phone, but I'll only talk to you for five minutes. And then, then they start doing things like not picking up. So there are, it is, it is happening. We've got these two polarized things, and I think we just have to acknowledge, number one, people are taking this differently. You know, there's, again, there's not a one size all about how we're responding to this pandemic, and we all have to acknowledge that everybody's having a different reaction to it. So we got to meet people where they're at. And so, you know, that's why I included so much in the presentation about what to do if they'll only talk to you by phone, because it really, I wanted to, people to, I wanted to acknowledge it's happening, and it's not the same. It's a bigger lift when you, when you talk about what we are doing as on the provider side, it's a bigger lift, right? If we talk about that assertive outreach and assertive engagement, we really have to start targeting and thinking about how do we, how do we change what we're doing or, or adjust or adapt our intervention so that we can really meet them where they're at. So it really is quite polarized. It's interesting because there are programs I've talked to where their numbers for recruitment never stopped, never stopped. There are other programs, by the way, where it's been crickets, and they're really having to pound a lot of pavement out there to really let people know where our doors are open, we're still here, we're still accepting people. So just keep that in mind that, that, you know, in the middle of all of this, there is a lot of mental health care needs that are out there. There are people that are likely, you know, what we didn't talk about is what happens when people don't think they can go to the hospital? What happens when family members don't think they can take their loved one to the hospital? When it's, when they don't feel it's safe, when they hear that it's full, what does that mean? And what does that look like? If we think about duration of untreated psychosis, and it gets pushed, what does that mean? You know, so there are consequences to this, and we just have to understand where people are, and how can we make sure that we're visible, that people know how to reach us, and that we can get people in and meet them where they're at. Yeah, it's interesting that you say the thing about the hospital because somebody did ask about that and sort of said, how are you, it was more about how are you educating clients about safety during COVID, and, you know, contact and things like that. And I'm wondering, have you, is that something you're just doing verbally? Do you have handouts that you're giving people about, you know, social distancing? How are you handling that? I don't have, I wish I had time to do some handouts. I'm kind of, I do like to do a lot of handouts, but I wouldn't say that I've had a lot of time during this to do this. So it has been a lot, but, you know, you develop a little bit of lines of things that you kind of go through. And it is one of those things, but guess what? It's different. I've had to adjust it, and modify it, and adapt it so many times for different situations and different people. But there are some things that you have to think about, because it does look different. And I think it involves more of that family involvement. So where are families available? I cannot say it enough, how important families are in this process, and how much we rely on them. And I want to even give a shout out to our family peer specialists, who are also around. We haven't talked about them much that I've heard of this conference, but we have one on our team. Amazing, amazing. So those connections and including family members in this process, when it comes to crisis planning, how are they doing with this? Again, they're home with their loved one all the time. They're seeing it all the time. They may have been going to work, but now they're home all the time. That crisis, whatever is brewing, is going to look different. And we just got to think about that and bring that up. Yeah. I mean, again, you got another amen, Piper, from that one. Because I think people, you know this, and I think you did a really good shout out during the conversation, but this role of peers and family peers and all of these, you know, who really make this all work in many ways, is something that we continue to recognize. And I think one of the reasons we made a whole track for sort of the human experience during this conference, because we realized there's so much value there and so much to be learned. And we really appreciate that. And I think, you know, I was on another session where they were showing a video of, you know, clients at home and what they're doing and, you know, how they're exercising at home and how they're making routines. And I mean, one of the things that was very prominent in the chat during your talk is setting up a routine for clients. If you used to go to the gym, make a room into the gym. If you used to go to work at eight, put your tennis shoes on at eight, even though you're not going to work. So this idea of routine, I think both for us who are, you know, going through this as well, as well as our clients and our families, that seems so important. And I'm sure that's a big part of what you're, what you're working with your clients as well. Well, and not only our clients, but I would say our other team members. So this is important. The routine has changed. Guess what? I can't just go next door to my office of my colleague and say, I need some help with this. I'm struggling with this. That was a really difficult session. You know, I just sometimes need to tell somebody that was a really difficult session I just had. I'm feeling it. I just need a moment. Can you just sit here with me? We don't have that same thing anymore. Let's not forget that. And remember, we still need to do that for each other. So it's not only establishing a routine for us, for our clients, but it's for us as a team and making more room for those spaces. How do we make more room for those spaces?

telehealth

COVID-19 pandemic

diverse populations

delivering services

mindfulness

relaxation techniques

stress

anxiety

inclusivity

service delivery