Telehealth, Internships, and COVID-19

School of Social Work Masters Candidates, Stephanie Turrentine and Heather Burke share their recent internship experiences related to the expansion of telehealth services during COVID-19.

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.

Stephanie Turrentine (ST): The Baby Fold
Heather Burke (HB): Return to Employment placement at McLean County Center for Human Services

What are some of your general responsibilities in your internship placement?

  • ST: I provide counseling services to a small caseload of families, assist with our Nurturing Parent program, and will provide in-home parent centered services under the new DCFS program, Triple P.
  • HB: I am working with the Recovery Court probation program in McLean County, which involves providing counseling and case management for participants in that program. I am required to meet with them 1-2x/week, provide updates back to the judge and the rest of the team (which includes representatives from the Probation office, Chestnut Health Systems, an officer from Bloomington Police Dept, the State’s Attorney’s office, the Public Defender’s office, as well as representatives from McLean County Jail) and generally assist them throughout the 2 years they spend on the program. I am also working with clients that live in the Center for Human Services group home on achieving various goals using Motivational Interviewing.

How has COVID-19 impacted the delivery of services via tele-platforms?

  • ST: Prior to the COVD-19 outbreak, my agency had been set up to be a primarily mobile workforce, so the transition for staff was not too out of the ordinary. While we had not necessarily been equipped to use telehealth services initially, we were quickly able to transition into providing telehealth services with the necessary software/applications with staff already being set up to work remotely anyway. The impact on services has been significant as this is a uniquely stressful time for both our families and our staff and therefore providing some services, such a trauma work, proved to be ineffectual during this time.
  • HB: COVID-19 absolutely affected the provision of services through telehealth. As we transitioned from meeting with people in-person to over the phone/Google Meets, it was a whole new ballgame to figure out how to do so and still provide the quality of services we are known for.

Do you feel there are barriers to access for the populations you work with?

  • ST: Some of the barriers to using telehealth primarily have been the access our families have to the appropriate technology. Many telehealth options require some kind of smart device and a stable internet connection, two things that even if our families do have, aren’t necessarily always reliable, and therefore created an additional barrier. Also, as I mentioned, this is a uniquely stressful time that has seen parents wearing many different hats and spending the majority of their time with their families, and sometimes answering the phone when your therapist or casework calls is the last thing you want to do.
  • HB: The population I work with definitely had access problems when it came to telehealth. Because I work with the chronically and persistently mentally ill, they tend to have struggles with keeping a phone in-service/not losing phones. I had a few clients who didn’t have phones or who only had a certain amount of minutes each month which made it very difficult to stay connected and provide the badly needed services. Luckily programs like Safelink and Assurance Wireless provided unlimited minutes and data for three months during the pandemic. The clients I serve also rarely have internet service or webcams which made video calls almost impossible.

Which platforms are you using and what challenges have you encountered in using these services?

  • ST: We are primarily using Microsoft Teams when possible, however we also have access to Zoom, FaceTime and telephone calls. The challenges with platforms like Teams and Zoom is again whether or not the internet connection and the functionality of the application itself are stable that day. Additionally, FaceTime is a great option as our agency provided cellphones are iPhones, however, not all of our families have an iPhone, so providing services over that medium is can sometimes be difficult. Finally, phone calls are perhaps our most used form of connection with our families, however, I personally feel like I’m less able to provide adequate services through this method as not being able to see our families somewhat diminishes our connections with them.
  • HB: We have been using Google Meets for any video chats for 1:1 appts as well as for virtual groups. We chose this platform due to the inclusivity that allows clients to call in if they don’t have a phone/computer capable of video-chatting in. We had some bumps in the road early on of clients not knowing how to mute themselves or unmute themselves after being muted, as well as just general etiquette issues (asking other people in the house to leave the room, not having background conversations, etc). Luckily it’s never dropped a client or not allowed them to join the groups though.

Are Telehealth services optional for clients?

  • ST: At this time, telehealth services are our primary mode of service, however we have began in-person meetings on a case to case basis for our departments that are not required by DCFS to meet in person with their clients.
  • HB: Telehealth services were the preferred method of service provision for about 4-6 weeks during the initial shut down order from the Governor, but clinicians in my department were allowed to see clients in person after that. I never had a problem with clients refusing telehealth services. Specifically for my Recovery Court clients, telehealth services were not optional but for those clients that struggled with some of the accessibility issues, the Recovery Court board helped with purchasing phones, phone cards, extra minutes, etc.

Have you had any specific Telehealth training?

  • ST: I have participated in a few trainings about providing effective services through telehealth that have primarily discussed the effectiveness of telehealth as a mode of service, and the particular challenges one might face in providing telehealth services.
  • HB: I have not had any specific telehealth training.

At this point, what is the most beneficial thing you have learned from your placement?

  • ST: One of the most beneficial things I have learned in my placement is the power of connection. As this is also my place of employment, I have been in this process of virtual learning and working since March. Now that we are getting to a place of meeting with some families in-person, I realized how important maintaining a connection is for this work, even if it’s just a brief phone call. While it has been difficult to provide the high capacity of services we once provided, maintaining a connection through this whole situation has helped keep families engaged during these difficult times.
  • HB: I’ve been reminded a LOT during this time that clients know themselves best. As clinicians we tend to sometimes value our own assessment over a client’s but when your assessment is based only off what the client is telling you, you really learn how to listen closely and deeply to what they are saying (both directly and indirectly).