MEBS Counseling, a community-based behavioral health provider, offers children and their families evidence-based behavioral health services in the Northern Kentucky area. The agency delivers counseling and community-based services, including psychotherapy, behavioral health assessments and targeted case management (TCM), for children and adults with complex emotional and behavioral needs.

THE PROBLEM

MEBS treats a vulnerable population. Most of its patients fall below the poverty line, and most qualify for Medicaid. These patients face difficult socioeconomic barriers that limit their access to care. Many live in rural areas far from the nearest provider, and many do not have access to transportation or the time to drive to a facility. To reach these patients, most of MEBS’s services and support are provided outside of the agency. It works across schools, community centers and in the home to reach patients where they are.

"However, our patients are distributed across eight counties in Northern Kentucky," said Jill Veach, program administrator at MEBS Counseling. "With just over 50 providers, our resources were stretched thin across nearly 2,000 square miles. To reach more people in this vulnerable rural population, we needed a better way to connect patients and caregivers remotely."

When COVID-19 hit, telehealth suddenly went from a goal to a necessity, she explained. MEBS could not afford to discontinue its behavioral health services, for the sake of its vulnerable clients, its team members and the overall agency. To prevent the transmission of the virus while ensuring continuity of care for the community, MEBS needed a virtual care option.

PROPOSAL

MEBS already had been using Azalea Health’s electronic health record software since 2014. Azalea Health is a health IT vendor that offers an EHR and telehealth tech, and is offering clients free telehealth services for one year to fight the pandemic. In early March, MEBS began to look at Azalea’s telehealth system to help facilitate remote patient care.

The Azalea telehealth system is integrated into the EHR, making it easy for providers to document information and access a patient’s medical history during a session, and for patients to access their own medical records and engage with their care, Veach said. Providers also would be able to use the telehealth app to message patients between appointments to further promote patient engagement.

"Being able to stay calm and work around patient anxieties and curveballs does a lot to ensure the success of telehealth."

Jill Veach, MEBS Counseling

And the telehealth app had a familiar look, feel and functionality that enabled providers and patients to spend less time learning how to use the technology and more time engaging in their appointments, Veach said.

"Another draw toward this telehealth solution was its HIPAA compliance," she added. "Although patient privacy rules for telehealth were relaxed in the early days of the pandemic, Azalea’s telehealth solution still gave providers and patients the peace of mind that their data was protected and secure. Also, early in the pandemic, Azalea Health announced that it would offer its telehealth app for free to providers using Azalea EHR. At that point, adopting this telehealth solution became the obvious answer."

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MEETING THE CHALLENGE

Within 24 hours of the initial COVID-19 National Emergency declaration on March 13, the MEBS team had the telehealth system fully operational. Administrators worked with the vendor to pull together supporting documentation and schedule training sessions for providers. The vendor provided the education and resources needed to get providers up to speed on how to use the telehealth app quickly.

"We were able to provide all approved services with telehealth," Veach said. "This includes evidence-based ‘wrap-around’ intensive services including individual, family and group therapy delivered through a team-driven, community-based approach. The platform was easy to use, allowing our providers the freedom to experiment and get creative with their telehealth interventions to meet patient needs and facilitate engagement."

Staff use the vendor’s systems for all of their clinical, operational and financial IT processes. There is no other EHR that they leverage, so they did not need to integrate the telehealth episodes of care into another system. All the documentation in the telehealth app went directly into the EHR, saving time.

"Overall, patients have responded well to telehealth visits," Veach reported. "With a large population of kids, the technology provided some unanticipated benefits. Using a phone, computer or tablet device is often a reward for kids. And most children are very comfortable using technology. In fact, there was one patient who was selectively mute. Our clinician had never heard his voice until the first telehealth visit. The technology helped the child feel more comfortable and relaxed, which added clinical value that we wouldn’t have otherwise realized."

The staff’s biggest concern when the shelter-in-place order was announced was ensuring care continuity. Staff members wanted to make sure that their patients had access to their caregivers and that treatment could continue uninterrupted. The staff has always been challenged with too few resources for their massive service area, which is why they were looking to telehealth before the pandemic. COVID-19 was a catalyst for adoption, and helped MEBS demonstrate to its clinicians and patients the value of telehealth.

RESULTS

Within one week of telehealth going live, MEBS was able to increase patient encounters by more than 100. By the third week, more than 700 patient encounters were facilitated through telehealth for psychotherapy alone, with an average of 10-15 visits per provider, per day. That brought MEBS close to its normal volume of patients with telehealth alone.

"One unanticipated result was that many children were more comfortable talking with a provider through a screen than they were face to face," Veach remarked. "We did not anticipate that telehealth could make kids more relaxed, open and willing to talk. But the reality is that many children today are very familiar with technology and virtual environments, and engaging them via telehealth meets them in their world."

But the most meaningful result for MEBS was just keeping the agency open. Many providers are struggling right now, particularly in rural areas. Social distancing makes it difficult to see clients as normal, and that takes a toll financially. If MEBS did not have the telehealth option, it probably would not have been able to keep its doors open, and a lot of clients would not have gotten the care they needed, she added.

ADVICE FOR OTHERS

"Daily support calls were critical to our successful telehealth adoption," Veach advised. "These calls addressed questions, triaged technical challenges and served as a platform for providers to share lessons learned from their telehealth sessions. By the fourth session, attendance dropped significantly as providers felt comfortable using the technology."

Clinically, one needs to be prepared for creative approaches to keep younger children engaged on the telehealth platform, she added.

"An example of this is having kids build something with Legos on the side of the screen that makes them feel happy," she suggested. "Kids also enjoy listening to stories, so bibliotherapy has been useful to help kids learn about emotions and coping techniques. We also had success using puppets and interactive videos to keep kids interested and involved."

One also should be prepared to find the right balance of documentation and engagement with the patient on the screen, she said. That means balancing the chart and the camera view on the screen so one can see both at the same time, she said.

"And lastly, you have to be comfortable 'rolling with the punches,'" she concluded. "Not every patient is technologically savvy, and not every service area has consistent broadband access. Being able to stay calm and work around patient anxieties and curveballs does a lot to ensure the success of telehealth. We work to create a sense of control and calm in the clinic setting; there are just small adjustments that need to be made in the telehealth setting to set the same tone."

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
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