By JULIE MINDA
April 21, 2020
The Telebehavioral Health Concierge service that Providence St. Joseph Health had rolled out by the end of 2019 for employees in Washington state and Montana — and that it plans to expand systemwide by the end of this year — is providing a much-needed outlet for overtaxed health care staff during the COVID-19 epidemic.
"COVID-related stress has dominated many of our recent conversations with caregivers," says Joshua Cutler, manager and clinical lead of the Telebehavioral Health Concierge for Providence St. Joseph Health. "It adds to already-intense challenges related to anxiety, relationships, depression, work and other issues that people were already experiencing before this crisis."
Providence St. Joseph developed the concierge service to take down the hurdles to timely mental health care for its employees and their dependents. The service provides quick access to counseling by phone or video connection. Cutler says since the COVID-19 crisis began, the service has seen its highest volumes since its launch, and volumes continue to grow.
Providence St. Joseph has obtained emergency licenses for its out-of-state mental health professionals to provide care in California and Oregon, so it can expand the service there. It also is reassigning displaced mental health professionals in facilities in all seven of its states to its employee assistance program, which is distinct from the telehealth concierge program but which also can provide mental health care.
Providence St. Joseph says by the end of the year the confidential concierge service will be available to all 119,000 system employees in seven states — including clinicians, non-clinicians, full-time workers, part-time workers and employees' dependents.
The employees' mental health electronic medical record is completely "walled off" from their electronic medical record. Only members of the telebehavioral health team have access, says Dr. Arpan Waghray, system medical director for telepsychiatry.
When Providence Health & Services and St. Joseph Health merged in 2016 to form Providence St. Joseph Health, their legacy sponsors, along with the board and executive leadership, said that the system would prioritize and expand mental health care.
Waghray led a listening tour throughout the Providence St. Joseph service area to determine how best to carry out that commitment. That survey confirmed that not only community members but also its own employees lacked sufficient access to mental health care. Waghray says many employees said that either they or their family members had given up on seeking mental health care for an acute condition because it was so difficult to navigate the mental health system. In many cases, the mental health issues had then worsened.
Dr. Todd Czartoski is chief executive of telehealth and chief medical technology officer for Providence St. Joseph. He says an estimated 30 percent of people in the U.S. will have a mental health issue at some time in their life. And, because of job stress, the risk of mental health issues is especially high for health care workers. This is particularly so for frontline clinicians who often experience emotionally taxing situations with their patients, Czartoski says. Even before the arrival of COVID-19, there was a scarcity of providers and so they were being asked to do more with fewer resources, Czartoski says.
According to statistics provided by Providence St. Joseph before the COVID-19 pandemic hit, about 44% of health care providers overall and 50% of physicians showed signs of burnout, including stress, anxiety and depression. "It's hard to take care of others if we're not in a good place ourselves," Czartoski says.
Czartoski says among the many challenges to mental health access reported by Providence St. Joseph employees is the length of time it can take to find a qualified provider who is accepting new patients and who has appointments open at the time the clinicians can be away from their jobs in patient care. The concierge service smooths that path.
Josh Cutler, manager and clinical lead of the Telebehavioral Health Concierge service for Providence St. Joseph Health, conducts a tele-mental health visit with a health system employee.
When Telebehavioral Health Concierge clients need mental health assistance, their first call is to Providence St. Joseph's patient engagement center, where staff help callers navigate the health system, including by scheduling their phone or video appointments with one of five licensed clinical social workers who exclusively provide mental health aid for employees and their dependents. Providence St. Joseph plans to expand this team during the phased rollout of the employee concierge service.
Cutler assembled, manages and is part of the team of counselors. He says the protocol they follow starts with an assessment of the client's mental health condition and needs. The counselor talks through potential treatments that might include providing several telehealth sessions of cognitive behavioral therapy.
The counselor may direct the patient to some of the digital cognitive therapy tools Providence St. Joseph has developed with partners.
The social workers may refer patients who might benefit from pharmacotherapy to a psychiatrist or other qualified prescriber and set up an appointment. Or, they may do a "warm handoff" to the employee assistance program, which can identify a private psychiatrist or psychologist who is accepting new patients and schedule an appointment.
Cutler notes that some people are using the concierge service as a bridge between existing mental health appointments, when they need someone to talk to but are weeks out from their appointment. Whatever course clients take, the clinical social workers follow up with them to assess how they are doing.
Cutler says the goal of concierge mental health is not to solve all the clients' mental health concerns with a couple phone or telehealth visits. The goal is to help patients gain stability, learn to access tools available to them, and develop a plan for better mental health.
"We have very effective treatments — people just need access," says Cutler. "We want them to feel supported and to have what they need."
Mental health parity
Employees and their dependents each have access to 10 sessions with the counselors per year, per mental health issue, at no cost to the client.
Cutler says the counselors are finding that there is a significant reduction in mental health symptoms within three to five counseling sessions, as tracked by standard measurement tools. In addition to stress, anxiety, depression and burnout, the most common issues the counselors help clients address have to do with family strife.
About 1,600 people have used the concierge service since the launch, and these numbers were growing as service areas were added and as more people learned the program was available. In information provided before the pandemic, Czartoski noted about 20 percent of the people accessing the service were physicians and said the quick uptake of the service showed that there was a large unmet need that was being addressed.
Waghray adds, "We are empowering people to help themselves. And, we would love to get even more upstream of these mental health concerns. We're aiming to get to a place where we think of — and treat — mental health like physical health. We want to be proactive and preventive, not reactive."
» View a video about the concierge service
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