How Non-residential Therapeutic Programs operate during COVID-19
Co-Authors: Darrell Fraize, Tracy Bailey, Joanna Lilley, and John Tobias
Prior to COVID-19, therapeutic young adult programs without a residential component had already mastered supporting clients remotely. Structures in place existed to provide young adults with clinical and coaching services, yet each young adult was living independently. In a time when physical distancing and sheltering-in-place have greatly impacted how programs deliver residential services, non-residential, therapeutic programs have made a different type of pivot.
Below are two examples of how non-residential, therapeutic programs operated before and how they evolved to meet the mental health needs of clients while providing the utmost safety for them in accordance with CDC and WHO guidelines and regulations. Families who believe that the safest place for their young adults to complete treatment is from home could benefit from continuing therapy in a tele-health format.
How Non-residential Therapeutic Programs operated prior to the COVID-19 crisis:
Onward Transitions has been using HIPAA compliant video, phone and messaging systems since before opening in 2016. Members utilize G-Suite products to stay in continuous contact with staff and with each other, as an integral part of and complement to the in-person service delivery. Prior to the COVID-19 crisis, Onward Transitions members connected with each other and with staff at our two physical sites in the city of Portland, ME for both individual and group therapy and coaching sessions, for 11 community meals per week, for planned and spontaneous group activities, and on staff-led social outings in the community.
Red Cedar Transitions had multiple potential points of contact with clients. Staff would meet either in an office setting, at a client’s residence, or out in the community. Staff would also meet for social outings weekly and minimally have a weekly in-person group coaching session.
How Non-residential Therapeutic Programs are evolving during COVID-19 :
Onward Transitions indicated that it has been a much easier transition than anticipated. Staff have observed an even greater level of engagement by members after going 100% online as of 3/14/2020. The eight full-time staff keep programming scheduled and alive between 9:00 am and 7:00 pm during the week, and 9:00 am and 5:00 pm on Saturday. Onward Transitions continues to have a clinician on-call 24/7.
Onward Transition members have voiced their comfort with this format, and recognize that their anxious symptoms are reduced by participating in structured routine of virtual social gatherings, games and contests, individual therapy and coaching, and group therapy and educational sessions.
All told, Onward Transitions supports 58 hours of live, synchronous, online programming with members each week. The Google Chat program remains active after hours among members, staff on-call and sending messages for the following day.
Onward Transitions staff are coaching members who are students as they make the shift to online learning, and seeking organizational help in their Blackboard and Moodle classroom formats.
Onward Transitions therapists are able to engage in tele-health family therapy sessions with the loosening of interstate restrictions through a HIPAA compliant Google Meet program. Staff are still helping members manage their living spaces through video tours so that they are staying on top of medications, food and supplies, cleaning and trash removal.
Red Cedar Transitions has moved individual and group coaching and psychotherapy sessions to a HIPAA compliant video platform as of 3/16/2020. In addition to individual online psychotherapy and coaching sessions, clients also get two group coaching sessions per week.
For the health and well-being of Red Cedar Transition clients, there is now an six-day-a-week online group workout they can choose to participate in.
Red Cedar Transitions believes the transition to video sessions has been smooth and effective to this point. Furthermore, the transition to video has been one of the myriad transitions we’ve had to make in most realms of our lives. With clients, staff have been utilizing the broad social changes that everyone is making to underscore the importance of living mindfully, deliberately and flexibly. And with an emphasis on the idea that on both personal and social levels, as individual humans we’re all in some state of transition all the time. What a more poignant time than now to explore and inhabit that life lesson?
Programs are adjusting accordingly to the social context of the COVID-19 crisis, and their young adult participants are responding as well as they can. These non-residential peer-support networks fill an immediate niche, due to the hundreds of thousands of college students who recently returned to their childhood homes in March. Losing one’s support network can derail academic, social, physical, and mental progress. As the research indicates, therapeutic programs can help young adults mitigate these losses and continue to move forward.
For those young adults who have returned home after their college campuses closed or after completing a primary treatment program, engaging in tele-mental health and an online community can be extremely helpful in managing anxious and depressive symptoms. The CDC¹ recommends that people living with preexisting mental health challenges continue treatment and monitor for new or worsening symptoms. Additionally, the CDC suggests taking breaks from the news, taking care of our bodies through base wellness activities, engaging in activities that bring joy, and connecting with others.
The National Alliance on Mental Illness² (NAMI) recommends that people living with mental health challenges mobilize their emotional support systems, including maintaining structured routines that mirror their work/study lives beforehand and staying in contact with others frequently through online platforms. In particular, NAMI proposes:
Research tells us that seven percent of communication is accomplished through our words, including email, 38 percent is voice and a staggering 55 percent is body language and visual. For people with mental health vulnerabilities, and even for those with extroverted personalities, the lack of face time can be challenging. Using technology to simulate this can offer a solution to bridging this gap.
The American Psychological Association (APA) recently posted an article³ citing research that managing stressors sooner as opposed to later can stave off larger, longer-term mental health challenges. The article goes on to warn against the mental health impacts of isolation in self-quarantining.
The implications are clear, that humans are social creatures, and managing our mental health is of critical importance to our well-being. This is perhaps even more true for young adults already managing a mental health challenge. Connecting with trained and licensed professionals and prosocial peer groups through tele-health formats are important ways to stave off a relapse back into unhealthy patterns.
Isolation is a often common thread in most mental health struggles--substance abuse, depression, anxiety, etc. Moreover, this time in our collective history is requiring that we isolate ourselves, which, as we know, can foster conditions that are ripe for intra and interpersonal difficulty. Being conscientious about how we’re spending our time is imperative in any attempt to thrive during the uncertainty that is COVID-19. Creating healthy habits and patterns of values-driven action are empirically supported antidotes to the despair and anxiety that can emerge as a result of isolation. Connecting with a licensed professional can be useful in designing and implementing a life that is rich and meaningful; even in the midst of our current social isolation.
For questions or comments contact:
Darrell Fraize via email.
Tracy Bailey via email.
John Tobias via email.
References:
¹https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
²https://www.nami.org/getattachment/Press-Media/Press-Releases/2020/COVID-19-and-Mental-Illness-NAMI-Releases-Importan/COVID-19-Updated-Guide-1.pdf?lang=en-US
³https://www.apa.org/news/apa/2020/03/covid-19-research-findings
