The second week of April saw our community settle into the COVID-19 era with better established telehealth practices and a better sense of what the near-term would hold for the provision of healthcare. This knowledge did little to diminish the uncertainty of the long-term outlook for healthcare teams, particularly for primary care where the economic impact is taking a toll as clinics look to control costs and lack of revenue while also caring for anxious patients. There are also ongoing practical issues for many clinics with populations without good access to technology and limited resources to pay for cell phone contracts. What is a clinic to do in a situation where patients are not accessible other than physical contact? These and other questions persisted even as our list serve quieted some. Below is a summary of our weekly conversations.

As a service to members and to the general public we will be posting weekly updates of our conversations and resource sharing efforts here. Because these are taken from email conversations, examples provided may refer to single clinics or situations. We hope this inspires, encourages and educates everyone as to the work that integrated care team members are doing in near real-time to the evolving pandemic. To Join CFHA and support integrated care, use this link: click to join.

Note that a compilation of key COVID-19 resources can be found on CFHA’s Technical Assistance website.

Member-Provided Information

Patient & Provider Care

• A webinar aimed at helping behavioral health providers manage stress during quarantine while working with Latinos is set for Tuesday, April 21st at 1:00 PM. Additional information and registration is available at the following link: https://mhttcnetwork.org/centers/national-hispanic-and-latino-mhttc/event/manejo-del-estres-durante-la-cuarentena-para
• A COVID-19 specific questionnaire was developed for insertion into a number of child health studies in an effort to identify the aspects of the pandemic that affect their research findings. The questionnaire and information to register their use (at no cost) is provided in the following links (English and Spanish): https://public.3.basecamp.com/p/m4JZWuL1rSLMjod43GswK5R5 https://public.3.basecamp.com/p/uf3dHHoG33EHcf884pXmYbfN

• A number of newly updated and developed COVID resources are available at the following link: https://www.healthcaretoolbox.org/tools-and-resources/covid19.html 
• A member has shared their clinic’s plan to provide psychological support to family medicine providers:

An Exemplar Of A Provider Wellness Protocol Shared By Member Dr. Dan Mullin

Goal

Minimize the lasting impact of trauma experienced by Family Medicine providers working at Memorial Hospital during the COVID surge in April and May of 2020.

Context

•   When basic biological and psychological needs are not being met, trauma is occurring.  During the COVID surge providers will be at increased risk of work conditions in which their basic biological and psychological needs are not being met.

•   Passive approaches to promoting provider wellness will not impact a sufficient number of providers.  Many providers will not ask for help, even if given the opportunity to call a number, or participate in a “wellness session.”

Population to be Served

Family Medicine providers at Memorial Hospital, including hospitalists, those working on labor and delivery, rounders, and residents.

Strategies

– We will use a “Psychological First Aid” approach to regularly and rapidly determine if basic needs are being met, or not.  Think of this proactive system as being similar to “surveillance.” We want to quickly determine if basic needs are not being met during the surge.

– Behavioral science faculty members will regularly contact providers via text message, or email, or phone.

– Initial contact frequency will be every ~ 3 days for each provider.

– Contact will then be adjusted to the provider’s preferences.

– Providers will be asked if their needs are being met.  Examples of questions include:

– What made the last shift difficult?

– Anything you need to make the work easier?

– Did you learn any tricks or strategies about how to safely get work done under these conditions?

– Would you like help talking to any of the families of the patients you are caring for?

– What can you do to take care of yourself today, how about tomorrow?

– What is one thing you did really well at work today?

– How might we help your colleagues cope with the current conditions?

Each contact will include two parts –

Part 1: Assessment of working conditions. This part will be reported to the Senior Leadership Team and Residency Director.  This content is focused on working conditions.

Part 2: Any other support you think you need?  Anything you want to talk about? This content will not be reported to Senior Leadership Team.  This may include discussions of the individual’s thoughts and feelings. Individuals in need of mental health treatment will be directed to the appropriate treatment options.

Addressing Unmet Needs

The usual departmental, medical group, and hospital channels for addressing providers needs will remain the primary mechanism for meeting provider’s basic needs.

This Psychological First Aid program is intended to be a redundant early warning system to indicate that providers are being exposed to conditions which are likely to result in psychological trauma.

Dr. Mullin will lead the behavioral science team who is contacting each provider. He will lead the collating of responses to identify themes.  When unmet needs are identified they will be reported to the Senior Leadership team, who will address unmet needs as best as possible.

Expected Outcomes

1) Decreased rates of post-surge traumatic symptoms, among providers

2) Decreased rates of PTSD, among providers

3) Increased retention of providers, less medical leave, retirement, or attrition

Many thanks to Emma Serrano, CFHA Intern, for her assistance in compiling the above information.