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Updated: August 24, 2020 Nonprofit Notebook

Pandemic upends nonprofit therapy treatment model

Photo | Contributed CHR therapist Nicolle Wargo working with a child via telehealth. Wargo works in CHR’s Child Outpatient Clinic in Bloomfield.

Jane Garcia has gone on scavenger hunts with her young clients, played board games and even traveled around the world via Google Earth.

A licensed professional counselor and art therapist at Community Health Resources in Manchester, Garcia has been doing all of her work with young people in recent months via videoconferencing or “telehealth,” a mode of treatment that she said had been both challenging and rewarding.

“I think I can safely speak for other therapists and say that telehealth is exhausting,” Garcia said. “It is tiring on the eyes and the body. As we are also impacted by the pandemic, … staying fully present for so many sessions, every day, and continuing to hold space for our clients, could partly be why it seems more draining on multiple levels.”

But telehealth offers many benefits, Garcia added, allowing more flexibility and creativity in her work with children suffering developmental trauma.

“The variations in play and fun with screen-sharing has been a blast,” Garcia said. “There have been some in-real-time moments when being able to share something and look together has made a positive impact.”

In a few hectic weeks in March, Garcia and her coworkers at Community Health Resources joined many Connecticut nonprofits that provide mental health, substance abuse and other forms of counseling in abruptly shifting from in-person to remote services using video conferencing and phone lines. Now nearly six months into the switch, providers are taking stock and looking ahead to a future where more human services are provided online and remotely.

Heather Gates, President and CEO, Community Health Resources

“People appreciate having the flexibility to use telehealth right now because it helps keep everybody safe,” said Heather Gates, president and CEO of Community Health Resources (CHR). A nonprofit with 27,000 clients across central Connecticut and 900 employees, CHR spent more than $100,000 in the first weeks of the COVID-19 lockdown to acquire the technology needed to make its counselors available online.

“On March 13, everybody’s realizing we need to change our service delivery model,” Gates said.

Pay parity

Since the bulk of CHR’s $67-million annual budget comes from government programs, the nonprofit looked to the state to approve the switch to telehealth.

“It was something that we knew could make a difference,” Gates said. “It was an absolute lifeline for the people we’re serving.”

Gov. Ned Lamont responded quickly, signing an executive order on March 10 that relaxed rules on the use of telehealth for a range of health services and required insurers to reimburse virtual visits at the same rate as in-person visits. Legislation passed in July extended the new rules until March, which attracted opposition from the Connecticut Association of Health Plans, which represents major carriers including Aetna, Anthem, Cigna and United Healthcare.

Susan Halpin, Executive Director, Connecticut Association of Health Plans

The insurers fully support wider use of telehealth, but object to imposing reimbursement parity without allowing for the usual negotiation process, said Susan Halpin, executive director of the association.

“Mandating anything in statute in terms of reimbursement from our perspective just goes in the opposite direction of trying to control healthcare costs,” Halpin said.

Other concerns include treatment quality and HIPAA compliance in telehealth, along with the risk of duplication of services. For example, some patients may seek both telehealth and in-person visits when only a single visit would suffice, Halpin said. The surge in telehealth has also corresponded with declines in vaccinations, which are often provided in tandem with in-person doctor visits.

“We have to be careful not to promote one modality over another,” Halpin said. “We want to make sure people are getting the care that they need, and that may be in-person care. There’s still a lot to be learned about how this mode is going to best serve consumers going forward.”

State Rep. Catherine Abercrombie (D-Meriden)

State Rep. Catherine Abercrombie (D-Meriden), co-chair of the legislature’s Human Services Committee, said she supports extending parity beyond March due to enthusiastic feedback on telehealth from nonprofits and others.

“It’s been so successful from a provider’s point of view, but more importantly, from the consumer’s point of view, it has been working,” Abercrombie said. She said she has heard from families with autistic children who have thrived in virtual meetings with health providers and social workers who are using teleconferences to successfully help troubled clients.

The pandemic jump-started a long process of approval for telehealth across payment models that had left the state lagging in terms of adoption of new technologies, she added.

“Connecticut has been a little behind when it comes to telehealth,” Abercrombie said. “[Adoption during the pandemic] validated what some of us thought we should be doing for years.”

At Community Health Resources, many counselors and their clients hope the transition to telehealth will have lasting impact, Gates said.

An immediate advantage from the switch was reported by many clients who had struggled in the past to make it to appointments, Gates said.

“We serve so many individuals who have major transportation problems that we knew adopting telehealth would improve access to care,” she said. “Going forward, telehealth will be a permanent part of our service delivery mode. It has been a lifeline for our clients and it has been a lifeline for providers, it has been absolutely critical.”

As the clinical supervisor of CHR’s Child Outpatient Clinic in Manchester, Garcia said she expects to continue to offer counseling to clients through videoconferencing technologies long after the pandemic ends.

“I think telehealth is here to stay and that is a good thing,” Garcia said. “I think I will always want to use it, at least as a back-up option.”

This story was done with support from the Hartford Foundation for Public Giving.

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