Harvard Street Neighborhood Health Center offers comprehensive, patient-centered, and evidence-based Behavioral Health services for individuals and families. Our licensed clinicians provide outpatient treatment for many issues including anxiety and depression, trauma and PTSD, major mental illness, insomnia, and family and parenting challenges. Behavioral Health services also include counseling for substance use disorders, smoking cessation, and psychological testing for adults and children.
Harvard Street offers integrated Behavioral Health services during patients’ medical appointments to provide immediate interventions and support in receiving long term services. Our Board-Certified Psychiatrist provides evaluation, treatment, and medical compliance support for an array of behavioral health disorders. Our providers are community partners with the Boston Public Health Commission’s Neighborhood Trauma Team Network as well as the statewide Gun Violence Prevention Program, providing a full range of services to individuals impacted by trauma and violence in the community.
Telehealth During the Pandemic – A Report from Dr. Paige Shaw, Clinical Psychologist, Harvard Street Neighborhood Health Center
The Harvard Street Behavioral Health Clinic serves a strikingly underserved community, a community that includes individuals with little or no income, persons of undocumented status, homeless individuals, veterans, and others whose access to health care has, in many cases, been insufficient. At this time of coronavirus, our rapid deployment and implementation of Telehealth procedures on behalf of our patients has made it possible for our behavioral health (BH) department to continue providing its valuable services. Following are some impressions of the value of this alternative method of service delivery.
- Even though our department is working from home, productivity has seen an unprecedented rise for all providers, meaning that providers are seeing more patients, and with greater frequency and consistency than before, which is key to achieving patient goals.
- Patients are adapting well to treatment in this format; they have been appearing on time for their sessions and have been returning to treatment after a hiatus.
- Utilizing the new Telehealth system, the department devised and implemented a system to allow for virtual warm handoffs so that we can continue to provide integrated behavioral health care.
- A number of the BH providers are offering patients more flexible session offerings, making it possible for both patients and providers to meet each other at times that work with their schedules.
- Transportation for clients – a major roadblock when clients must travel to the clinic for appointments – is no longer a hurdle. Again, this saves clients time and money that may be in even shorter supply during this stressful and economically challenging time.
- Telehealth spares patients the need for childcare in order to engage in treatment, which has long been a hurdle for many parents. Particularly considering that many children are home engaging in remote learning, telehealth behavioral health spares parents the need to find child care or bring children along to their therapy or psychiatry follow-up visits. Further, nap times and, in the future, school attendance, free a harried parent for Telehealth contact without forfeiting precious downtime for travel.
- Patients are participating where and how they can. Most are able to do this from home, because they understand that in order to have a confidential session, they have to be doing the session in a private place, and for them that is home. But we also have patients who are participating from work, literally making the time and space during their work day – supported by managers who don’t have to lose their workers for more than the patient hour. For other patients, who don’t have the benefit of privacy in the home, our work together has evolved to include family, which normalizes therapy by making it less rare and hidden.
- For patients who need access to their provider, but are more housebound because of chronic illness, this service makes it easier for our clinic to provide some degree of in-home service without having to use precious time in transit or negotiate with ride services.
- Depressed or agoraphobic patients who have difficulty leaving the house for their appointments have the ability to maintain continuity of care without disruption.
Behavioral Health insights from the Telehealth experience
First, our patients may have multiple factors operating that often preclude them from accessing care. They are constantly coping with multiple stressors due to social determinants of health issues including economic factors, educational factors, housing issues, access to effective and efficient means of transportation, inability to take time from work or home responsibilities, a history of generational trauma. Our patients frequently contend with several of these stressors daily, making it difficult for them to participate in regular therapy appointments.
All of these factors contribute to or exacerbate our patients’ physical health issues. These in turn perpetuate and worsen their emotional health issues, in a cycle that is difficult to break, and then carries to the next generation. Telehealth isn’t perfect, but it remediates several barriers to access for these vulnerable patients.
Behavioral Health Telehealth now and in the future
Historically, Massachusetts’ regulations for teletherapy made it difficult to provide this service to patients. Providers needed to be certified to do teletherapy. They had to meet requirements to deliver teletherapy services that included expensive technology, an approved setting, and more. Several months ago, prior to the pandemic, I attended a Massachusetts League of Community Health Centers meeting about the regulatory and practice challenges in Massachusetts that precluded the widespread adoption of teletherapy. The discussion covered how some states prioritized this service, particularly for patients who have a variety of barriers to accessing their health care providers. One important factor: these states require insurers to cover telehealth services, citing that those services are proven to meet the health care needs of a complicated population, ultimately saving money and more importantly, providing improved care.
Ours is certainly a complicated population, but until COVID we didn’t have the support from the Commonwealth to ensure that patients have this service so that their health needs are met during a time of crisis, whether that is a global pandemic or a far more localized and individualized one. Now we have had fully reimbursable telehealth services for several months, the results are dramatic. Patients are participating week after week, telling us that they like and want to continue to use this service model. Our no-show rate decreased significantly. It is clear that by using telehealth, we can continue to grow our capacity to serve our community and meet the needs of our patients.