Community Voices Clinic Efforts to Provide Mental Health Services During the COVID-19 Pandemic

Lehigh University’s Counseling Psychology Program partnered with the Bethlehem Area School District (BASD) in 2012 to create the Community Voices Clinic (CVC). CVC is a school-based mental health clinic where doctoral students coordinate training and supervise master’s students to provide therapy services to students in the schools and the Lehigh Valley community members. This partnership has been successful in providing hundreds of hours of free in person, face-to-face mental health services to BASD students and community members that would not have had access to therapy otherwise. The clinic is staffed by Dr. Arpana Inman (Director), Katherine Melo Li and Monica Kim (Program Coordinators and Supervisors, both enrolled in the Counseling Psychology Ph.D. program) and master's interns and practicum students. Current master’s interns include Stephanie Kurylak, Haleigh Jacob, and Katharine Mariancci and current master's practicum students include Laura DeFelice, Jaclyn Haiem, and Mercedez Fuentes. 

In March 2020, when the COVID -19 pandemic required a lockdown of schools and other sites, Dr. Arpana Inman, the director of CVC, and doctoral supervisors and coordinators, Katherine Melo Li and Monica Kim, began preparing the clinic to move to providing telepsychology services. Due to this early intervention and plan, we were able to take specific steps in transitioning the CVC work to its current virtual format and continue to provide the much needed services. Three important steps were taken the week before and after the closure of BASD schools for our trainees to receive the needed training to engage in telepsychology services and for our clients, community partners, and trainees to be informed of our shift to these services and access therapy:

1. Identification of resources for telepsychology services
   • Identified online resources (articles, videos, webinars) that would support telepsychology work in the clinic for young children, adolescents, and adults.
   • Communicated with BASD administrators and guidance counselors regarding resources being distributed by the district that might help facilitate telepsychology services.
   • Conducted a literature review of the efficacy of telepsychology through video calls and phone calls. 
2. Training for the provision of telepsychology services
   • Created and distributed an official manual on CVC telepsychology policies and procedures.
   • Created and provided a list of online training resources focused primarily on the ethics and procedures for telepsychology offered through the American Psychological Association; National Register of Health Service Psychologists; and PESI, Inc.
   • Created and provided a list of helpful online training and resources for working with children and adolescents through telepsychology
   • Developed and provided CVC-specific virtual training for the ethical implementation of telepsychology.
   • Provided regular virtual individual supervision and peer supervision to support transition to telepsychology.
3. Ethical Engagement of Telepsychology Services
   • Collected client and parent contact information in a virtual HIPAA compliant format that all trainees would be able to access off-site
   • Triaged clients for their level of risk to determine who needed to be prioritized to receive virtual therapy and which clients needed to be referred
   • Communicated with BASD school administrators and other community partners to inform them of our plans and how to consult about specific clients.
   • Contacted all clients before the official closure of the schools due to the Stay at home mandate instituted by Governor Tom Wolf to let them know about the new modality of the clinic.

Our shift to telepsychology services has been guided by ethical practices recommended by the American Psychological Association (APA).  Trainees have been trained in the APA guidelines to provide telepsychology services (APA, 2013). These guidelines along with our practical experience over the past two months has led us to create a list of best practices to facilitate telepsychology services to clients.

Triage clients’ needs and assess access to technology to determine appropriateness for telepsychology services

Unfortunately, not all CVC clients have access to computers or smartphones with video capacity. For this reason, it was important that CVC trainees and supervisors worked with BASD administrators and community partners to better understand each clients ability to access technologies, their level of competence with video conferencing software, and other computer programs so they would be able to sign forms and engage with their trainee clinician for their online session. We made sure to have a thorough understanding of what platforms we had available that were HIPAA compliant, and what documents needed to be signed so that it could be explained to each client and stakeholders. We came up with alternatives if the most convenient was not possible. CVC trainees have gone as far as mailing consent forms to be signed and mailed back to supervisors so that they can engage in treatment.

Make an appointment with each client to discuss and practice utilizing technology before scheduling the first telepsychology session

As the COVID-19 pandemic has mandated that members of the Lehigh Valley community quarantine at home, moving school, work, and social lives to a virtual platform, people have found themselves busier than ever. With attempting to meet their basic needs, mental health services have not always been at the forefront of people’s minds. The CVC trainees have found that scheduling an appointment to talk about the specifics of telepsychology with clients or their clients’ parents has allowed those parties to focus on the conversation regarding mental health and identify steps they would need to take in engaging in these virtual services.

Create an Emergency Response Plan with clients

An Emergency Response Plan allows the client and therapist to know what steps need to be engaged in, if for some reason the client experiences an emergency during the telepsychology session and in-between sessions. Normally, during in-person treatment, these steps include having an emergency contact and information on the nearest hospital to CVC that would accommodate a mental health emergency. With telepsychology services, these steps need to be explicitly written and reviewed with each client, since services are being provided over some distance; and what would have applied at the clinic, no longer applies to the client's current circumstances.

Ensure Privacy via the location where telepsychology services are offered

CVC therapists are all working from their homes to provide telepsychology services to our clients. As our homes are not typical settings set up to ensure the confidentiality of our clients, we have created space in our homes that account for noise levels, green backgrounds, limited intrusion from family members/pets, and video camera placement to create a setting where our main focus can be on our clients mental health. Assessing space and encouraging clients to have a designated therapy area helps to facilitate telepsychology. 

Schedule Breaks throughout the day when providing telepsychology services

In her article, Jiang (2020) described the lack of energy we are experiencing from the high level of video calls each day and the need to incorporate some recuperation time throughout the day. CVC trainees have been encouraged to schedule breaks in between sessions where they can stand up and step away from their computers for at least 15 minutes between telepsychology sessions, supervision sessions, or training to decrease their experience of burnout from this online modality. 

Finally, our list of online trainings and resources is ever growing and changing, but here are some resources we have found that have allowed us to continue to provide the best care to our clients in this new climate of telepsychology:

• Free Practice Resources to Enable Quick Telehealth Adoption During COVID-19 Social Distancing Measures - This website offers a helpful webinar providing training on essential facets of implementing telemental health in addition to other practical resources, free of charge.
• Resources for Mental Health Practice During the Current Pandemic- An excellent compilation of an array of practical resources to help train and implement telepsychology by Dr. Rod Goodyear and Dr. Carol Falender
• National Register of Health Service Psychologists-This website also offers a practical and vast array of helpful and essential resources to implement telepsychology.
• Online Play Therapy Techniques to Support Your Child & Teen Clients Virtually with Jackie Flynn- This FREE webinar is for child therapists that work kid clients remotely in response to the COVID-19 epidemic. It was free of charge.
• The Abundant practice podcast episode titled, “Online Play Therapy” provides a different perspective on how to utilize play therapy with kids through telepsychology services.
• Resilient Lehigh Valley's Creating Calm, Together resource site- a mindfulness and social emotional learning lesson plans and resources for students, educators, parents, and caregivers.
• First 5 Association of California- provides COVID-19 Social/Emotional resources that help Coping with Stress for children and families- in English and in Spanish.
• Connecting with children and adolescents via telehealth during COVID-19-Advice for child and adolescent psychologists.

Authors

By Katherine Melo Li, M.S., Ed.S., Monica Kim, M.A., M.Ed., & Arpana G. Inman, Ph.D.

Katherine Melo Li is completing her fourth year as a doctoral student enrolled in Lehigh University's Counseling Psychology Ph.D. program. Her adviser is Dr. Susan Woodhouse and her research interests include mental health clinician attitudes towards providing services to people with Opioid Use Disorder (OUD) and Latinx mental health. 

Monica Kim is completing her fifth year as a doctoral student at Lehigh University's Counseling Psychology Ph.D. program. Her adviser is also Dr. Susan Woodhouse and her research interest is in the area of infant attachment. More specifically, she is examining how an infant's physiological ability to regulate emotions interact with a main caregiver's care behaviors and links to infant attachment security.