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Fighting to Breathe – If the Air is Toxic for One, it’s Toxic for All

Posted By Karen J. Hardin, Monday, June 1, 2020

Written by: Kelly Martincin, PhD, Co-chair of OPA Communications and Technology Committee, Chair of OPA Public Sector Interests Committee


As with all CTC blog postings, this column is not intended for medical, legal, or ethical advice; it is purely for information sharing and is the experience of one psychologist attempting to be useful to her peers during a very difficult time.  While I typically do try not to disclose too much personal information in these blog postings, I feel it’s important to share that I identify as a White, cis-gender woman.  My lens of privilege cannot be ignored as I share my thoughts on race and social justice.  Similar to many others, I often feel powerless to change the horrible dynamics that sometimes feel overwhelming in society, but then I am forced to remind myself that my privilege also gives me power to help.  That is what I am hoping to achieve, at least in a small way, with this blog post today.   

Sadly, I sit at my computer again and my heart is heavy. The tragic murder of George Floyd has provided yet another example of a Black man who did not have to die, and this is becoming all too familiar.  Perhaps you saw my CTC blog a few weeks ago on social divides where I touched on many things that are examples of how we are divided as a nation.  In that article, I mentioned my sadness over the Ahmaud Arbery and Breonna Taylor killings as well as the deeply personal reactions of several of my patients, how they, as people of color, felt unsafe doing everyday things such as jogging or even sleeping in their own beds. As I prepare for work this week, I know I will again be having these conversations because we need to be having these conversations.  People of color need to be seen and heard, and not just by their psychologists.  

The recent murders sadly capture what has already been apparent for many months.  Racial disparities are present in all levels of society.  As highlighted in my previous blog posting, racial minorities are dying of COVID 19 at higher rates than Whites (see CDC website for more info) and unemployment rates are higher for minorities than for Whites (see Bureau of Labor Statistics if you’d like to examine the specific data; employment rates of Blacks was nearly double that of Whites prior to the pandemic).  Furthermore, a 2019 study from the University of Michigan, Rutgers University, and Washington University found that death from excessive use of force by police is the 6th leading cause of death for young Black men and Black men are 2.5x more likely to be killed by police than Whites.  Any one of these facts is highly disturbing, but taken together it’s absolutely breathtaking what a profound structural issue we have at every level of society.  We’re failing dramatically, and we have to do better.  

As one lone person, I sometimes feel rather helpless as to what I can possibly do to help this situation.  As a White person, it’s hard not to get stuck in feelings of guilt about how I’ve benefitted from my privilege and wonder if I’ve ever participated in systems of oppression (it’s nearly impossible to think that I haven’t in some way participated in oppression).  I’m certainly not perfect and I have a long way to go in learning about my privilege and how I can help dismantle racist ideologies in society, but here are some thoughts on ways each one of us can DO SOMETHING: 

  • Acknowledge that we are not in a post-racial society.  I try to avoid using phrases such as “I don’t see color” because color is present, it’s part of our culture, and we can celebrate our differences.  Our use of language should reflect this. 
  • I’ve been trying to take more time to learn about my privilege as a White person.  The author Peggy McIntosh was particularly helpful in providing concrete examples of how privilege is active in my life.   If you are interested, now might be a good time to also examine aspects of privilege in your life and how this might be shaping your worldview. If you feel you have a good handle on the literature available of White privilege, step into the literature on White fragility.  This literature has been helpful for me in understanding why more people don’t step forward into the difficult conversations and act on the problems with race in society today as well as understanding some of my own emotions and struggles. 
  • Be on the lookout for microaggressions, both from yourself and from others.  A microaggression is a brief comment or action (intention or unintentional) that transmits a derogatory message about a stigmatized group.  Often we react to microaggressions by thinking “Was that racist?” or “That was a little bit racist.”  If we’re wondering if a comment or action was racist, it was probably racist and we should say or do something.  There is no such thing as “a little bit racist,” it’s just plain racist, so speak up.  Similarly, if someone gives you feedback that a comment wasn’t entirely appropriate and you weren’t intending to be offensive or were joking, try not to be defensive and take the feedback to heart. Accept that we are all guilty of microaggressions and they are often unintentional.  We should all do our best to remove offensive language including jokes from our vernacular.  
  • Don’t get distracted from the bigger issues.  Like many others, I’ve been horrified by the violence that has resulted from some of the protests this past week, both in my own community and around the country.  I’ve noticed in various forums on social media and on the news that some people have used this as way to distract themselves from the bigger issue of the huge racial disparities in our nation.  While this is difficult to view and should not be encouraged, the violence of these protests is a symptom and not the disease.  If we want to stop this violence, we must work towards racial equality, plain and simple.  Don’t lose focus on what is most important – equality for all. 
  • White people, we can’t focus on our feelings right now.  One area I commonly get caught in is feelings of guilt or shame and wanting to apologize for being White.  I have to realize that this is not about me or my feelings.  We have to put the thoughts and feelings of people of color center stage at this time and make sure they are seen and heard.  It’s far more important that I focus on listening and really understanding the experiences of people of color from their standpoint and I can focus on my own reaction later.  
  • What about supporting Law Enforcement?  Isn’t that ideologically at odds with Black Lives Matter and other groups working to advance racial equality? No!  Definitely not!  We should all support law enforcement and promote healthy dialogue right now too! I’ve self-disclosed a great deal in this blog and I will share one more very important thing.  My partner is a law enforcement officer.  This past week our home has been full of important, heavy conversations about our mutual horror at the death of George Floyd and others.  I promise that you can support Black Lives Matter, believe that there must be huge changes in our nation including elimination of police brutality, while also support law enforcement officers all at the same time – I do.  Law enforcement must be included in these conversations if there is ever to be any meaningful change.  We must support those officers who serve for the right reasons and want to promote healthy change in the culture of law enforcement while also engaging those who might be ambivalent about change to educate them on the opportunities that can come with advancement of peace and equality.  

These are only a few small things that I, as one lone person, can do immediately to try to make a difference.  I encourage you to consider what you, from your unique position and perspective can do.  As psychologists, we each entered this field to make a difference.  The time is now.  Action is needed.  Most of us likely cannot make large sweeping changes on our own, but if we could all find a handful of small ways to make changes, imagine what we could all do together.  


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Using Survey Results to Confirm We Are All In This Together

Posted By Karen J. Hardin, Wednesday, May 27, 2020

Written by: Keelan Quin, PhD - Co-Chair, Communication and Technology Committee | Bailey C. Bryant, PhD

 

Using Survey Results to Inform Decisions- Dr. Keelan Quinn
Since March of 2020, the United States has been completely turned upside down with the spread of COVID-19 in the United States.  A state of emergency was issued and quarantines were put in place.  Social gatherings were canceled and many common household items were sold out and became unavailable.  Unsurprisingly, our field of psychology was also deeply impacted as so many of us were expected to work remotely from home using telepsychology.  As quarantines began lifting this month, many of us began questioning what we should do in our practices.  Should we return to in-person sessions or continue telepsychology?  If we do return, how do we remain safe?  

Dr. Bailey Bryant, a psychologist in the Cincinnati area, came up with the idea of using an online survey to help her make some of these difficult decisions.  She distributed this survey to an online community of clinicians, of which 60 were able to respond.  As of May 15, 2020, the majority of clinicians who responded continued seeing clients through telepsychology only.  For those who decided not to return to in-person sessions, they indicated they would re-evaluate that choice in a few weeks.  Almost all who were returning to the office were making changes to their practices in some way whether in day-to-day practice or in the physical space.  There was no consensus regarding the clinicians’ confidence in their decision of whether or not to return to the office.  “It is super confusing at best” and “This is SUPER stressful” were two quotes included in survey results to describe this decision-making process.  You can see all results as well as many powerful quotes provided by clinicians here.  

The use of surveys in the field of psychology is nothing new.  For decades, they have provided valuable information for research and evaluations everywhere from universities and hospitals to agencies and private practices.  Another way to use surveys in psychology is for clinicians to gather information for decision-making purposes.  Below illustrates a detailed account of how Dr. Bailey did just that.

When Are Therapists Returning to the Office?  The Results Are In - Dr. Bailey Bryant
I’m a psychologist, a therapist, a practice owner, and a highly confused individual. The past two months were quite the emotional roller coaster as I transitioned my group practice to telehealth overnight. In early March I struggled to make the decision to shift to telehealth due to analysis paralysis and so I did what all healthy adults do- I turned to Facebook (tongue in cheek). I put up a Facebook poll in the Cincinnati Area Therapist Network group and quickly saw the emerging trend of therapists making the call to go to telehealth only. The poll and the comments tipped the scales and gave me the data, support, and confidence to make the shift. Once I decided to transition to telehealth only, and after I brushed up on my telehealth ethics and sent out my consent forms, I breathed a sigh of relief. The next few days were a bit challenging but then I settled in and I have been in front of a computer screen ever since. 

Flash forward to today and I find myself again stuck in analysis paralysis. As restrictions are lifting, people are emerging from the shadows and therapists are starting to come out from behind their computer screens. Now I feel more confused than ever. We are allowed to leave our homes and patron businesses, but should we? We can meet with clients in person, but is that safe? How do I proceed in opening my doors to clients? Is it any safer now than it was in March? How do I clean the office? Do I take clients’ temperatures? There is a never-ending thread to pull and my anxious brain is having a heyday finding all the loose strings.

I took the liberty to create another survey asking therapists in the Cincinnati area about their plans for returning to in-person sessions and the precautions they intend to implement. This survey was somewhat more sophisticated than my initial poll and I was shocked when 60 mental health therapists responded. When I viewed the results of my first Facebook poll in early March I felt that I had data to support a decision; I did not have the same experience with this most recent survey as results were divided and there was no consensus.  If you review my results here, you will see that the philosophies on our responsibilities as practitioners to prioritize safety also varied widely. 

Reactions- Dr. Keelan Quinn
After reviewing the results of Dr. Bryant’s survey, I felt a sense of relief that I am not alone when I ask the question “What do we do?”  Like many others (I hope), I am interrogating every professional contact I see with “What are you are doing to stay safe?,” “What do your clients think?,”  “Can we get in trouble for returning to the office?,” or “Are people really suing over a public health crisis?”  These are scary times, but knowing what others are doing provides reassurance and helps calm my anxiety.  I feel better learning from others and hearing examples of what they are doing.  Seeing there were are no certainties or perfect answers among the survey results was initially disappointing, but then oddly validating.    

Reading the quotes within the survey results was especially powerful.  Some discuss interesting ways to meet client needs, while others focus on how some are taking precautions during this COVID-era.  Many of the quotes repeated the same worries that cycle through my head using my exact words- Will I lose clients?, Will I have to stop working?, What if I unknowingly contract COVID and pass it along to others?, or Am I being careless by working in the office with those who cannot do telehealth?  For someone who always has a plan A, B, and sometimes C, the uncertainty of the world today has been difficult to acknowledge and adjust to.  This experience with COVID has been a great life lesson that continues to teach me that I cannot control everything.  In the past couple months, I have become more patient, accepting, and, above all else, flexible.  Before, I would not have been able to handle the unknown, but with this experience, it is getting a bit easier each and every day.  This survey provided me a sense of validation and connection.  Knowing I am not alone and that there are no right or wrong answers now was especially comforting.  

What I do know as a certainty is that my clients still need services.  They are experiencing just as much stress and confusion as we clinicians do, and I refuse to abandon those who have come to depend on their appointments.  I am more than happy to focus on what I can control and that is how I provide clinical services.  The only thing we can do is think through the options, make an informed decision based on our beliefs and clinical judgment, document, and proceed.  

Dr. Bryant has created another survey focusing on how clinicians are making the decision of whether or not to return to in-person services.  I imagine the results to that survey will be just as informative and helpful in calming my nerves as the last and I look forward to seeing what comes up.  Go here to TAKE THE SURVEY.

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Disclaimer: This post is for informational purposes only and it is intended to assist other clinicians in the practice of psychology.  It is not intended for legal, ethical, or medical advice.  

Dr. Bailey Bryant is a Licensed Clinical Psychologist in the Cincinnati area.  She the owner of Hello Mental Health and Good Therapy LLC as well as the founder of Health Match 360.

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Mask Shaming and New Social Divides during the Pandemic

Posted By Kelly Martincin, PhD | Communications and Technology Committee Co-Chair, Tuesday, May 19, 2020

Written by: Kelly Martincin, Ph.D., Co-chair of OPA Communications and Technology Committee, Chair of OPA Public Sector Interests Committee

As with all CTC blog postings, this column is not intended for medical, legal, or ethical advice; it is purely for information sharing and is the experience of one psychologist attempting to be useful to her peers during a very difficult time.  This past week, my heart has been a bit heavier than usual during many of my therapy sessions with patients.  Instead of talking about common symptoms of depression and anxiety that were coming up earlier in this pandemic, new themes of feeling “othered” have begun coming up.  One patient mentioned that she has been wearing a mask not only because she worries about her health, but also because “what will others think?” if she is out at the grocery store and not in a mask.  She worried that she would be judged as someone who is being reckless and callous to the health of others.  It has also come up on the listserv and in conversations with colleagues about those who cannot wear masks due to pulmonary or other medical conditions - are they experiencing judgment and discrimination?  Perhaps they are, and these are individuals who are already at high medical risk of complications if they were to contract COVID 19.  To add a new layer of stress and fear of judgment on top of the health-related terrors not likely to be helpful for these individuals.  

Several other patients this week brought up current political divides in our nation at the moment, including feelings of fear and sadness related to protests in Michigan, Columbus, and even events in Washington.  Some of these patients identified as Republicans, some as Democrats, but the common theme was feelings of fear and feeling “misunderstood” by “the others” and the belief that there is a growing gap between “us and them” in our nation.  Each had worries about their health and the health of their families, each had worries about the economy and wanting our nation to be prosperous, but it was clear that they believed there was no opportunity for productive dialogue with people whom they perceived to be “the others” at this time.  

In yet another demonstration of how we are divided as a nation, other patients were bringing up personal reactions to events from the news this week; particularly, events related to the shooting deaths of Ahmaud Arbrey and Breonna Taylor.  We had discussions of their thoughts on how they feel being a person of color right now, fears for family members that reside in Kentucky or Georgia, and fears of participating in everyday activities such as jogging or going to sleeping alone in one’s home. They continue to have fears for their health and safety and are asking big questions about race and equality that are not easily answered, but must not be ignored.  

As psychologists, we’ve all rooted our life’s work in the advancement of health and wellness for others.  Social justice is woven into everything we do, however advancement of mental health is simply not possible when division is negatively influencing lives.  Currently social division is present in small ways such as worries about interactions at the grocery store, in ways that some consider to be more ambiguous such as political divisions, and in some of the most serious ways - ways that compromise the literal safety of many individuals engaging in common daily activities.   While the pandemic is obviously not responsible for this division, it is likely highlighting tensions that were already simmering.  Also, not every major disaster results in this sort of division.  Recall the days after September 11th when our nation felt united in every way.  It is possible to band together and make a change.  

If you are similar to me, you may feel as if these are huge problems and you are just one person, so where does one even start to make a difference?  How can one even begin to advocate for others or even begin to conceptualize how to impact social justice initiatives in any meaningful way in the midst of a pandemic?  I personally start with education, first for myself and then I try to share what I learn with others.  For instance, some people might not be aware that African Americans and Latinos are dying of COVID 19 at higher rates than other racial groups (see the CDC website for more information).  This is obviously a new phenomenon and I look forward to seeing peer reviewed research on why this might be and what can be done. Having conversations about this, having conversations about healthcare disparities, and having educational conversations with one another using information from reliable resources on these topics is an important first step in the advancement of equality.  

Next, we all need to be active in our nation’s political process at both the state and national levels.  During the pandemic, OPA leaders have been in touch with state leadership about ongoing mental health services during the crisis, but your voice should be heard too.  Not sure who your congressman is?  Click here and enter your zip code  (my congressman conveniently has his email listed, your’s likely does too).  Don’t forget this is a major election year!  Have you moved recently or do you need to double check that you are registered to vote?  Visit the state’s voter registration site for more information.  Your local government likely has similar pages for any local needs that are easily found in a quick Google search.  Make sure the issues that are important to you are heard by representatives at every level of government.  

Finally, we all might be continuing to shelter in place and adhering to social distancing guidelines, but there are still ways to make others aware of critical issues that are going on in the world right now.  I use my personal social media to share causes I care about and I also follow OPA’s social media pages for updates on what OPA is doing for social justice and advocacy.  If you want to be more involved in OPA’s efforts, OPA has committees for advocacy and diversity that would love to have your help!  Please reach out if you would like to be connected and help with these efforts.  


Have questions or an idea for a future CTC blog post?  Email Dr. Kelly Martincin

 

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Considerations for In-Person versus Telepsychology Sessions as we Return to the Physical Office

Posted By Karen J. Hardin, Monday, May 11, 2020

Written by: Keelan Quinn, PhD., Co-chair of OPA Communications and Technology Committee


As Ohio's Stay at Home order gradually begins lifting, many psychologists may slowly begin returning to the physical office. Although the original choice to close and that of whether to return may not be yours, depending on the setting where you practice, the choice of which clients/patients to see in-person versus through telepsychology may be.  Like so many other scenarios in this field, there are no concrete answers as to how to make this decision. To help with this process, the American Psychological Association (APA) has provided a number of guidelines for us to consider as we brave this next phase of COVID-19.  

Considerations for In-Person Sessions
APA published an excellent article written by Galietti, Wright, Higuchi, and Bukfa (2020) describing the process of returning to the office.  It can be found here and I highly recommend everyone read this informational piece.  Among other considerations for the process of returning to the physical office included in the article, the following are guidelines specific to determining whether in-person services are necessary:  

  • Review state and local orders: verify whether or not in-person sessions are advisable before moving forward with in-person sessions.  
  • Technological access and competence: consider whether the client/patient has continued and secure access to a telepsychology platform and is able to understand and use it competently.  Treatment may be impacted if issues arise in any of these areas.
  • Progress and mental health risks: consider the diagnosis, whether the service is ongoing, and if the client/patient is making progress through telepsychology.  Those who may benefit from resuming in-person therapy may include those who appear to be worsening, are in acute crisis, pose of safety risk, or who require a more intense level of care that is not met via telepsychology.  
  • Next phase of treatment: consider whether it is feasible to continue working with the client/patient remotely of if the next steps of treatment may require face-to-face contact.
  • Review the physical risks: psychologists need to be aware of any and all physical health risks, which include the possible transmission of COVID-19 during in-person sessions.  Assess the client/patient’s health and consider whether the individual’s behaviors (e.g., willingness to follow social distancing rules and other health-conscious recommendations), health, occupation, and exposure to others place him/her at a higher risk for contracting the virus and spreading it to others through in-person sessions.  
  • Clinician health: do not put your own health, or that of your family, staff, or other patients at risk.  You are not ethically or professionally obligated to offer in-person services to your clients/patient.
  • Documentation: just like every other aspect of therapy, it is very important to document each step of the process you take when making this decision.  This includes noting the client/patient’s clinical progress, discussions about the benefits and risks of telepsychology, plans for next steps, and rationale for why you believe providing services via in-person or telepsychology is clinically appropriate.  APA is currently working on an informed consent form for in-person services specifically for this period of COVID-19.  A sample can be found here.  


Telepsychology Guidelines
The majority of psychologists have undoubtedly been using telepsychology as a primary delivery of services for the last couple months. For many, the transition to telepsychology was sudden and mandatory as businesses and offices were immediately closed to reduce the spread of COVID-19.  Although using telepsychology may now be second nature for many of us, it is always helpful to review the recommended guidelines of use.  A copy of the guidelines provided by Ohio Psychological Association (OPA) is found here while APA’s guidelines can be found here

Both associations highly recommend an assessment of the appropriateness of using telepsychology for each individual client/patient.  This includes examining the potential benefits (e.g., accessibility, convenience, etc.) of delivering telepsychology services relative to the risks (e.g., additional screen time, not in-person, safety, etc.).  Both should be communicated to the client to help him/her understand potential options.   

APA provides additional guidelines that may be helpful to determine which clients may be appropriate to begin or continue telepsychology services.  The following suggestions under the Standards of Care in the Delivery of Telepsychology Service guideline are just a few to consider in this decision-making process:

  • Progress and mental health risks: consider the diagnosis and whether the presenting concerns can safely and efficiently be treated through telepsychology.  
  • Client/patient preference for telepsychology: many individuals continue being hesitant to leave their homes and enter public places, and for good reason.  Take into account each client/patient’s physical health status and comfort level regarding coming into the office.  Client preference does not have to be the sole determinate of whether or not to continue telepsychology. 
  • Client/Patient competence: consider the client/patient’s familiarity with and competency for using the specific technology platform involved in providing telepsychology services.  
  • Remote environment: assess carefully whether the client/patient has the capacity and access to resources necessary to continue services via telepsychology.  This includes verifying the client/patient has a confidential space for services with limited distractions and interruptions.


Whether you decide to work in-person or to begin/continue through telepsychology, it is important to examine each client/patient individually.  Assess the appropriateness of in-person sessions versus telepsychology for each individual client/patient and the unique presenting concern.  Continue monitoring client/patient progress no matter the choice you make.  It does not have to be a permanent decision or an either/or scenario; some clinicians are electing to provide a combination of both options depending on the specific case.  Examples include seeing new clients/patients in-person until rapport is built before transitioning to telepsychology services; scheduling an in-person session every third or fourth session; and asking those at high-risk to be seen in-person.  No matter your decision, documentation is extremely important during this time.  Note each step of your decision-making process, discuss it with clients/patients, and add it to his/her file.  

Have questions or an idea for a future CTC blog?  Email Keelan Quinn.  

Disclaimer: This post is for informational purposes only and it is intended to assist other clinicians in the practice of psychology.  It is not intended for legal, ethical, or medical advice.  


References
Galietti, C., Wright V., Higuchi, S., and Bufka, L.  (2020, May 1).  COVID-19: When is it OK to resume in-person services?  American Psychological Association Services, Inc.  https://www.apaservices.org/practice/news/in-person-services-covid-19

Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. (2013). Guidelines for the practice of telepsychology. American Psychologist, 68(9), 791–800. https://doi.org/10.1037/a0035001

Ohio Psychological Association Communications and Technology Committee.  (2008).  Telepsychology guidelines.  https://telehealth.org/wpress/wp-content/uploads/2013/11/TelepsychologyGuidelinesApproved041208.pdf

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Doing therapy with masks and other considerations as we all face the “new normal.”

Posted By Karen J. Hardin, Wednesday, May 6, 2020

Written by: Kelly Martincin, Ph.D., Co-chair of OPA Communications and Technology Committee, Chair of OPA Public Sector Interests Committee


As with all CTC blog postings, this column is not intended for medical, legal, or ethical advice; it is purely for information sharing and is the experience of one psychologist attempting to be useful to her peers in a very difficult time.  To share a bit about my background, I’m a health psychologist working in interdisciplinary care environments. I have been working from home only part time, spending 60% of my time in the medical clinic working  with the medical team whom I’ve grown to love as family and who don’t have the option of working from home.  I work for a large hospital system where many decisions about masks and other personal protective equipment (PPE) are out of my hands, so I realize I don’t have to make many of the decisions that colleagues in private practice might be making.  I’ve spoken with friends who wonder “Should I wear a mask when my patients come back to the office?” or similarly “Should I ask patients to be wearing masks in my office?” and “How often should I be sanitizing surfaces?” and “When should I be transitioning from mostly telepsychology back to regular appointments?” and “How long can I delay testing appointments?”  All of these are obviously complex questions with no easy answers.  Even then, the answers might vary widely from person to person and practice to practice.  Here I’ll provide some resources and considerations that  myself and some other practitioners  will be doing in the coming months to give others food for thought as you decide what is right for you, your patients, and your individual practice.  

Recently, the listserv was very active with the “to mask or not to mask” question.  I come down on the “wear a mask” side of the argument.  The CDC has recommended we all wear masks due to the risk that we all may be carrying COVID 19 for weeks before showing symptoms.  I am still doing mostly phone or video appointments and will be for at least another month, if not longer per the guidance of leadership at the hospital where I work, but on the rare occasion when I do see a patient in person right now, I always wear a mask (it has recently become mandatory in my facility, but this is consistent with my values on this subject).  We also wear masks around the office when it’s just staff to avoid possible employee to employee transmission of the virus, and patients are asked to wear masks when they are in the clinic.  I have frank and open conversations with patients about this experience.  What typically starts out as “this is weird that we’re both wearing masks'' often quickly turns into “I’m afraid of…(insert health/finances/future)” and becomes a very deep and meaningful conversation.  Having worked in medical settings, this was not the first time I had done a therapy session wearing a mask and my concern is always that I am less able to convey non-verbal information.  This is a similar concern during the many telephone sessions that I’ve been doing lately.  When wearing a mask or doing telephone sessions, I’ve begun sharing “I’m smiling” or “that makes me feel very sad” when I know my face is less able to express what I would prefer to share.  It’s not a perfect solution, but it’s one thing I’m able to do.  An additional worry I have is for individuals who have sensory impairments.  I have yet to come across this, but I worry that masks will get in the way if a person is hearing impaired and relies on lip reading and facial expressions.  I look forward to hearing what colleagues who work closely with this population might be doing to help with this while still taking precautions.  One thing I’m noticing though is that the mask conversations are becoming less frequent.  Wearing masks in public is quickly becoming the norm.  Major store chains are now requiring masks for both employees and shoppers, so I think many people are coming to expect this in healthcare settings as well.  I will personally continue to invite the conversations with patients I see in person, but I have a feeling that it will become less and less of an issue.

I was recently discussing sanitation in the office with a colleague and how to keep everyone as safe as possible in the office.  Presently, I am wiping down my office with hospital approved sanitizing wipes once a day or before and after I see a patient in person in my office (which is rare, as the majority of my appointments are presently phone and video). The staff in the clinic where I work continue wiping down the rest of the clinic multiple times a day.  My office will also almost permit me to sit nearly six feet from another person.   I’ve spoken with colleagues who are coming up with great creative solutions for situations where sitting six feet apart is impossible, such as assessment.  There are products on the market such as clear acrylic barriers that sit on stands and have cut outs in the bottom, so you can sit closely at a table and administer assessments with some protection between you and your patient (these cost roughly $150).  I’m sure others will be coming up with other great ideas for sanitation when the time is right to transition back to mostly in-person services. 

Speaking of the time being right to transition back to in person services, when will that be?  As I said earlier in the post, for my location, my leadership has indicated that we will continue providing primarily telehealth services for a while yet, but this is what they have determined is right for our location.  I have had some great opportunities to talk to psychologists around the state of Ohio who work in many different settings with many different populations and they are doing many different things.  This is a highly personal decision that each psychologist will have to make for him and herself and the patients.  Each practice is far too different to offer any kind of blanket thoughts on the subject.  Luckily, we have some great resources to help you as you make that decision:  

  • If you are looking for general information on COVID 19, national policy, or keeping yourself and others safe, the Center for Disease Control is the place to start.  They have a wealth of information ranging from highly technical info geared at physicians to symptom checklists and suggestions for coping that is meant for all audiences.  
  • For concerns more specific to Ohio, OPA’s Pandemic Resource page has a wealth of information!  Info on inter-state telepsychology laws, the latest insurance info from Dr. Jim Broyles, and so much more is available on this page.  It’s updated regularly so check back often.  
  • American Psychological Association also has a great resource page on a very wide variety of topics.  They also have been offering free seminars on topics such as telepsychology, but these have been filling up fast so keep an eye out for these offerings! 
  • The Suicide Prevention Resouce Center has info specifically on treating patients via telehealth during COVID 19.  This is a great reminder of best practices for some of our highest risk patients.   
  • You’ve likely heard that domestic violence has been on the rise due to COVID 19.  If your patient or someone else in your life needs resources, check out the National Coalition Against Domestic Violence website. 

Some extras: 

  • Headspace is offering free meditation during COVID 19. 
  • For a cool distraction, the National Park Service website has “virtual getaways.”  This one honors Asian American and Pacific Islander Month, featuring Minidoka National Historic Site.  If you or your patients are missing travel, there is a lot of really neat content online for “virtual travel.”   
  • If outdoor distractions aren’t your thing, The Metropolitan Museum of Art in New York has an excellent Art at Home section on their website full of awesome content.  

Have questions or an idea for a future CTC blog post?  Email Kelly Martincin.

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Is Zoom the right choice for your practice?

Posted By Kelly Martincin, PhD | Communications and Technology Committee Co-Chair, Tuesday, April 28, 2020

Zoom... What psychologists might want to know before implementing use into your practice.  

Over the past month, many psychologists across the state have been learning a great deal about telehealth and videoconferencing.  For some of us, the curve has been very steep, for others the transition has been a little easier.  For me personally, I’ve used the teleconference platform Zoom for meetings previously, but it has now become a part of my daily life as so much more than meetings.  Get-togethers with friends, family events, and even my book club has moved to using this popular platform in the wake of the COVID 19 pandemic.   Most importantly for OPA members is that many psychologists across the state are adopting it for telepsychology.  Even though I work for a medical system that provides its own telepsychology platform, I did the research for what many practitioners probably want to know about Zoom.

Is Zoom HIPAA compliant?  Yes and no.  This depends on what plan you are using.  Zoom’s most popular plan is the free option, which has a few limitations including not being HIPAA compliant and limiting the user to 40 minute sessions.  The free option doesn’t have important features such as a Business Associate Agreement (BAA), which is an agreement of shared risk in the rare event that there would be a breach of privacy, thus it is not HIPAA compliant.  Zoom does offer a HIPAA compliant plan starting at $200 a month for 10 hosts.  This might be a bit pricey for small practices, but it could be a good fit for larger groups.  Keep in mind that right now there is a government waiver in place that we are not required to use HIPAA compliant platforms due to the pandemic, so you are able to use the free Zoom account as long as you take reasonable precautions to protect your patients’ privacy.  It is unclear how long that waiver will remain in place, but the State of Ohio will likely give us plenty of warning for when it will expire.

Speaking of patient privacy, what about security?  Similar to everyone else, I was very concerned when I heard about “Zoom bombing” (cases of interlopers disturbing meetings in a troublesome fashion).  Some of these stories were a little humorous (students interrupting a school board meeting and making noises of various bodily functions), but some were horrifying (a man’s dissertation defense being disrupted in a malicious fashion).   For telepsychology, any of the above would clearly be completely unacceptable.  Zoom has multiple security features that you will be able to use on the free version.  Sessions can be password protected and there is also a neat “waiting room feature” where the host can see who is waiting to enter the meeting and only allow the proper people to enter (an awesome feature for group therapy).  Once you are in the session, you can also click the “security” icon in the bottom middle right of the screen to “lock” the meeting and no one else will be able to enter after that.   Also of note, since these events began occurring, the Zoom team has been working diligently to enhance their encryption services (there any many news reports about this) and they are rolling out new features all the time.  

What special features might be helpful to know about when I’m doing therapy?  Beyond knowing how to use the security features mentioned above, one of the most helpful features to know about when working with patients would be the screen share feature (click “share screen” icon in the bottom middle of the screen).  This allows you to show what is on your computer screen in the event you would want to show your patient a handout or brief film clip.  With this feature, there is also a white board option that turns your screen into a white board for you to illustrate a point.   For group therapy, the chat box can be helpful for people to add text for questions or comments while someone else is talking (“chat” icon bottom middle of screen).  There are also features for creating a poll or recording the session if those would be helpful to you.  A final fun feature I’d like to mention is the ability to change your background (for example, the screen would show you sitting in a tranquil meadow or whatever image you choose instead of your office).  Friends who work with child and adolescent populations say this is a big hit with kids!  To do this, find the up carrot (^) next to the “start video” icon and click “choose virtual background.”  From there, find the plus sign (+) in the lower right of the box to “add image” and add a previously downloaded image from your computer.  Then you can click on that image and whatever image you have chosen (for Zoom meetings with friends, it’s my favorite Australian beach!) is now your background.  If you want to undo this, it’s the same process; once you are in the “choose virtual image” feature choose “none.”  

The decision about whether the use of Zoom is right for you and your practice is a highly personal one, but many people are finding it helpful to at least be familiar with the platform as more and more meetings are being held on Zoom.  It is possible that this will be a trend that will continue even post-pandemic due to the ease of use and popularity of Zoom. 

Have a topic that you’d like to see covered in a future Communication and Technology Committee's (CTC) blog post?  Please email Dr. Kelly Martincin, Co-Chair of the Communications and Technology Committee and let CTC do the research for you!

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Transitioning to Telepsychology with Doxy.me

Posted By Keelan Quin, PhD | Co-Chair, Communication and Technology Committee, Thursday, April 23, 2020

Like many others in the field, I had to transition from working directly with clients in the office to working remotely from home performing telepsychology. This was a difficult transition, one I am still getting used to, and I am sure I am not alone. After looking into different platforms with multi-leveled plans, the small private practice I work with chose to utilize Doxy.me. This is a HIPAA-compliant, audio and visual platform. Here is my personal experience with Doxy and what I have learned in the last few weeks.

Plans: Doxy offers three different plans to clinicians- Free (no charge), Professional (pay for individual users), and Clinic (pay for multiple providers). All three plans are HIPAA-compliant and offer unlimited minutes and sessions, personalized rooms, and low definition (LD) video. Of course, the plans for pay offer additional features such as higher video quality, group meetings, room passcodes, text/email notifications, file transfers, screen shares, etc., but the Free plan is just as secure and easy-to-use for both clinicians and clients. All three plans also offer easily accessible Business Associate Agreements (BAA). A BAA is a written agreement between the clinician and the platform that clarifies each party’s responsibility when it comes to the client’s personal health information (PHI). It is important for all healthcare providers to have a BAA available to them and on file for liability reasons. 

Security: Security is nonnegotiable in our field. This is why I appreciate that all three plans meet HIPAA requirements, offer secure data centers, encryption on both ends, and do not store patient data. The easily accessible BAAs are helpful as well. 

Connection: You can personalize the name of your virtual therapy room. The name and link never change, making it easier for recurrent clients to connect. The website can be emailed through doxy with the Free plan; it can also be texted, but additional payment is required. I simply type the link into an email or text and send it directly to my clients. When they click the link, they are asked to enter a name to notify you when they enter your virtual waiting room. You are able to see how strong your client’s connection is as soon as they sign in. 

Dashboard: The Dashboard is the main page that provides you with all your information and options (even those not part of your plan). You see the link for your therapy room that you can copy, a preview of what your client sees, and your waiting room along the left side of the page. The client’s name they typed in shows up when they enter the waiting room along with a timer showing you how long they have been waiting.

Calls: A timer starts next to the client’s name as soon as you start the call. This is only seen by the clinician and is really helpful for insurance purposes. When a call is in place, buttons appear for the following options: to put the call on hold, toggle your video on and off, toggle your microphone on and off, and end call. 

Problem Solving: Although the video quality on the Free plan is not always the best, I can almost always see my client. The only issues with lagging occur when the client has poor connectivity or service. I seem to have the most difficulty keeping a stable connection when the client is on a cell phone (rather than a laptop or computer) and/or when the client is moving around within the session. Putting the call on hold briefly and reconnecting is helpful; if that does not work refreshing could help. 

Overall, Doxy.me offers a great free plan that can be upgraded for pay to gain access to additional features. It is secure, offers an easily accessible BAA, and is easy to use for clients and clinicians. Although no service or connection can be guaranteed, I’m glad I chose Doxy for this new era of telepsychology. 

Disclaimer: This post is for informational purposes only and to assist other clinicians looking for telepsychology options; I am in no way endorsed by Doxy.me. 

 


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