Prior to the pandemic, the show-rate — the percentage of appointments for which clients show up — was about 40% on average, she said. However, the show-rate has more than doubled. That was a direct result from a change in March when the federal government issued a temporary waiver, allowing treatment providers to hold video and telephone sessions without restrictions, she said. The waiver was granted after the government encouraged people to practice social isolation as a way of slowing the COVID-19.
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The show-rate has historically been low because people have challenges that caused them to miss appointments, Jones-Kelley, noting that those challenges include transportation, child care and the like.
Previously, new clients were required to have face-to-face interviews with therapists before remote counseling could be considered. Even then, the remote sessions had to be by video conferencing, and that presented another obstacle because many people don’t have access to computers, internet service or smart phones. But all of that’s been eliminated as part of the government’s temporary waiver, and the sessions are being held primarily by telephones, Jones-Kelley and others say.
“Everybody’s got a phone,” she said, noting that some providers are also using text messaging to keep in touch with their clients. “Now, a phone call allows people to access services and have a consistent level of engagement with their therapists. But it took a pandemic for us to get there, to be that innovative and to just think outside of the box about how we serve people where they are.”
Federal laws aside, classic substance abuse treatment providers traditionally did not take on new clients or start treatment without a urine drug screen and in-person assessments. Now many have had to adjust to the new method, said Brian Merrill, assistant medical director at OneFifteen, a not-for-profit treatment facility in Dayton. The providers’ perception was that they could not effectively help people — whether they had an opioid addiction or if they were suicidal. But many of the services treatment providers offer can be done via telehealth, although there may be situations where an in-person session is required, he said.
“In reality, if that person is suicidal, they were suicidal before the visit; our presence doesn’t increase that,” Merrill said. “So I don’t think we should think of (telehealth) as an inherently more dangerous practice because that person was having those thoughts anyway, and now we have some avenues to intervene.”
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Another advantage that telehealth offers is that people who may be ashamed to be seen going into treatment facilities can now get the help they need from their own homes, said Merrill, who is also a psychiatry professor at Wright State University.
Given the success of telehealth tactics for substance abuse counseling so far, Jones-Kelly and others say they would like the federal government to permanently lift the restrictions. She and her counterparts from across the state have communicated those sentiments to U.S. Sens. Rob Portman and Sherrod Brown. Both are in support of loosening the restrictions permanently, their offices said this week.
“The federal response to the coronavirus crisis has thus far focused on cutting red tape and regulatory relief to expand telehealth options for opioid treatment, and an increase in alternate delivery methods for patients quarantined at home to maintain their access to opioid treatment providers,” Portman said during a conference call with mental health leaders from around Ohio in April. Jones-Kelley was on the call.
Brown is always in favor of exploring new ways to help those struggling with addiction, he said in a statement Tuesday, adding that he supports increasing access to care, including telehealth.
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People who are dealing with mental health issues or are battling addiction while in social isolation are some of the most vulnerable in these times, experts say. Without access to health professionals, people could die from suicide or accidental drug overdose.
As of Monday, there have been 110 accidental drug overdose deaths in Montgomery County since January, with more than half — 61 — in the city of Dayton, according to Public Health Dayton and Montgomery County. The deaths peaked at 37 in March, and nine people have died so far in May.
In comparison, a total 99 people died of drug overdose between January and May 2019. A total of 20 people died in March of that year, although the death toll during those months didn’t peaked until May, when 26 people died. I all, 285 people died of accidental drug overdose in 2019, according to Public Health Dayton and Montgomery County.
Substance abuse counselors say people need to have access to counseling, even if they are struggling with things other than opioid addictions.
“I think the fact that you could engage — with phone being most viable — where the client has that capability, you’re making a connection,” said Lisa Carter, CEO of South Community Inc., which provides behavioral health services and is located in Dayton. “We want to be and need to be relentless in our engagement so that if the client has that capacity to be able to talk by phone and or video conferencing, that we’re doing that reach out on an ongoing basis, keeping the consistency of their treatment towards their treatment planning, as well as being able to provide crisis services and those kinds of things that any of us might be experiencing with the increased isolation.”
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Phones may be the most viable options, but not everyone has access to them. So after the lockdown order went into effect, the staff at South Community and OneFifteen scrambled to find solutions that would allow them to continue helping their clients. OneFifteen set up a room at their facility, 257 Hopeland St., where clients who don’t have a phone can go and call their treatment providers.
South Community, 3095 Kettering Blvd., issued old flip phones to their 18 clients who did not have access to phone. Others have their own phones, but can’t afford to purchase minutes, so through a grant from the Dayton Foundation, South Community buys the clients minutes to be used for their therapy sessions.
“If we’re going to be relentless in our engagement, we have to make sure that they have a way in which to engage,” Carter said. “We try to have some type of contact so that folks don’t feel completely isolated. So for us to be able to at least get around it in some kind of a sharing capacity to increase that contact is good.”