Bridge Counseling Associates is a nonprofit agency and certified community behavioral health clinic based in Las Vegas – in Clark County, Nevada, the southernmost county in the state, which is the seventh largest by land size.

THE PROBLEM

In order to provide needed services in rural communities where professional behavioral health services are virtually unavailable, Bridge needed to provide services via telehealth. Bridge evaluated a few HIPAA-compliant telehealth programs and Zoom’s was determined the best and most cost-effective for the agency’s purposes.

Two years ago, Bridge was asked to provide temporary behavioral health services in Elko County, Nevada, a rural, frontier county with a population of less than 53,000 located in the northernmost region of the state.

This was a good experience: Bridge had eight of its clinicians provide telehealth services during a limited period, right as the agency knew its future plans included the expansion of telehealth services throughout the state.

That work in Elko County proved very successful and prepared Bridge for what would follow when the COVID-19 pandemic struck.

PROPOSAL

“At the time we began telehealth services, our principal concern was assuring that the telemedicine technology solution would be simple to use, but equally important was HIPAA compliance,” said David Robeck, president and CEO of Bridge Counseling Associates.

“Our work is very sensitive, as our clinicians delve into the personal lives and thoughts of very vulnerable people to screen, assess and diagnose, and provide patient-centered and evidence-based treatment.”

The agency employs 50 dual-licensed clinicians and provides services in multiple languages, including Spanish, Korean, Japanese, German, French and Urdu, so the telehealth system needed to be language-friendly and culturally sensitive.

"The placement of FCC equipment in medical clinics specializing in seniors and other Medicare recipients will allow that clinic to offer depression screening for Medicare patients to prevent suicide."

David Robeck, Bridge Counseling Associates

Most of Bridge’s clients also are socioeconomically challenged and have little experience using computers and virtually none with any two-way video technology. Most of its clinicians had little or no experience working with two-way video technology, either. Only one or two had any experience doing assessments or providing treatment online.

“Fortunately, HIPAA-compliant Zoom proved to be very simple to operate from both ends,” Robeck remarked. “In addition, its high standards provided enough confidence and complete reliability to assure both clients and clinicians that their work together was safe. And a safe environment is what both sides require for a client to open up sufficiently to vocalize their mental health and/or substance use challenges and accept high-quality, professional treatment.”

The reliability of the Zoom connection prevented unexpected interruptions during sessions that could have frightened clients and frustrated clinicians, he added.

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MEETING THE CHALLENGE

Working with another nonprofit agency in Elko County, Bridge Counseling was able to schedule and engage clients where each had privacy and appropriate technology. Rather than have one clinician become expert at providing telehealth, Bridge had eight clinicians share the work and learn to provide telehealth services.

The agency selected senior clinicians with Nevada mental health licenses, including marriage and family therapists, clinical professional counselors, and licensed clinical social workers. Each also was a licensed alcohol and drug counselor.

“Most of the remote clients were identified as Spanish-speaking, but with 14 bilingual Spanish-speaking therapists, this was not a real challenge for Bridge,” Robeck said. “One challenge did present itself and this involved minor children who spoke fluent English, but their parent or guardian was an exclusive Spanish speaker.”

An English-speaking therapist specializing in the treatment of children could provide the services directly to the child. But with Zoom, it was also possible to add another clinician to the telehealth conversation to interpret for the parent so they could be fully informed. When it was time to move forward with one-on-one conversations with the child alone, the parent and the Spanish-speaking therapist could simply leave the Zoom call.

RESULTS

Bridge’s initial experience in testing Zoom and beginning telehealth service – along with the expanded experience of time, sessions and number of clinicians with linguistically diverse clients in the Elko County example – provided the agency with the confidence to fully add telehealth as one of its core-service fundamentals, Robeck stated. The experience with Zoom assured Bridge that it had a solid, reliable, go-to telehealth vendor it could trust, he added.

USING FCC AWARD FUNDS

Earlier this year, Bridge Counseling Associates was awarded $91,460 for laptops, cameras, telehealth equipment, internet service and software licenses to significantly expand telehealth capabilities during the COVID-19 emergency and to continue to provide mental health and substance abuse treatment, psychiatric care and medical wellness services, including that for persons who currently have, or are recovering from, COVID-19.

“The award funds from the FCC were perfectly timed to continue and expand behavioral health services during this COVID-19 crisis,” Robeck said. “Bridge is the oldest and now the largest nonprofit behavioral health agency in Southern Nevada, if not the entire state. We continued to operate face-to-face until April 9, 2020, in part because telehealth equipment was so limited. Even if it could be ordered, it wasn’t readily available.”

Bridge Counseling is an essential agency serving some 4,000 clients annually, and seeing 1,100 clients weekly. Their mental health and substance use disorders had to be checked and treated regardless of what was happening with the pandemic.

While most officials and media were focusing on the number of cases and deaths resulting from the coronavirus, Bridge was looking at the historic data for suicides and drug overdoses, which equaled 1,400 in the prior reporting year for Nevada.

“The COVID data has been difficult to collect, test and report, but we knew our behavioral health deaths collected were real and those numbers were with every behavioral health agency in Nevada working at capacity,” Robeck explained. “What would happen if we closed and there was no alternative treatment or even engagement available? Telehealth would have to be the solution.”

Bridge needed to provide computers to each of its 50 clinicians, at a minimum. It also needed them for targeted case managers, peer-support specialists, and staff, including back- and front-office workers and administrators, should Bridge’s two locations be forced to close.

It also required Zoom license purchases for each of the nearly 80 employees of the agency to assure that the work would resume and be HIPAA-compliant. (HIPAA waivers during this period did not protect agencies or clinicians from civil liability.)

“In addition, Bridge leadership needed options to communicate with staff in a way that our professional clinicians and other employees would believe they were an important part of the team that was limiting suicide and drug overdoses all while living in the throes of a medical pandemic,” Robeck said. “Staff needed to remain upbeat and fully engaged.”

Bridge realized that at some point COVID-19 could disappear or lessen to such a level that clients can return to in-person treatment at its two locations. But the investment made at Bridge with the FCC funds will not stop paying dividends in the community. Nevada is No. 51 in the nation for providing behavioral health services, in part because of the expansive area of the state, but also due to a transient population drawn by the resort and gaming industries, Robeck explained.

“Bridge Counseling will continue to use the assets made available by FCC funding throughout the state and for years to come,” he said. “For some time, it has been the plan of our board of directors and leadership to develop and expand behavioral health services to small and rural towns throughout this rustic state.

“Those opportunities will require technology placement of laptops and stands in remote public service agencies such as fire departments, sheriffs’ offices, nonprofits or rural clinics where behavioral health clients can access services,” he added.

Additionally, Southern Nevada urban cities including Las Vegas, Henderson and North Las Vegas have become the home of snowbirds who live in this warmer climate half the year and senior transplants who retire here for the weather and the benefits of local resorts. FCC assets help Bridge provide depression screening for Medicare clients.

“We’ve learned that many Medicare recipients lose a spouse and feel isolated in their adopted western city,” Robeck said.

“Others develop alcohol, drug and gambling problems that would otherwise not be identified or treated. The placement of FCC equipment in medical clinics specializing in seniors and other Medicare recipients will allow that clinic to offer depression screening for Medicare patients to prevent suicide. Bridge professional mental health therapists will provide these screenings via telehealth and recommend further treatment as indicated.”

The FCC funding solved several COVID-19-related issues in Bridge’s community, and it serendipitously helped address unmet challenges among the population throughout Nevada, Robeck noted.

“We don’t believe Nevada will remain at the lowest spot in the nation for providing behavioral health services much longer,” he concluded.

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