Face to face remote check-ups are here

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In the wake of social distancing declarations, Gov. Charlie Baker ordered all health insurance groups to allow in-network providers to "deliver clinically appropriate, medically necessary" services to members via telehealth, without co-pays, effective March 15.

Also known as telemedicine, the practice uses digital technology to perform non-procedural kinds of care, like counseling, health assessments, intakes and more. People should always consult directly with their health care providers to determine the best course of treatment to address their particular needs.

While the practices of telehealth will vary from primary care to specialized medicine, the policy change has particularly changed the game for mental and behavioral health providers.

"The approval to do telehealth was tremendous. It allowed us to keep functioning like we do and continue to help people like we do," said Brien Center Director of Emergency Services Becca Phelps-Smith, who also oversees the center's crisis team.

She said a couple of years ago, Berkshire Health Systems donated a Cisco Webex DX80 system to help the program integrate digital health practices. Phelps-Smith said the system has been put into good use in recent weeks for patients who needed to see a behavioral health clinician.

"I was here in the ER [emergency room] the other night and we had four patients that needed to be seen. We were able to triage one person and set them up with a clinician," who was in a remote location, she said.

Equipped with a camera and monitor, DX80 systems are set up to communicate only with each other, but they essentially work like FaceTime, Phelps-Smith said, likening it to the popular video calling app.

The Brien Center has the system set up in its Pittsfield, North Adams and Great Barrington locations. The DX80 machines are also in the emergency departments of Berkshire Medical Center in Pittsfield, Fairview Hospital in Great Barrington and Berkshire Health North campus in North Adams. Being on a closed network, she said, the DX80 communication is "pretty clear," unlike other dial-in networks. The emergency services director said telehealth won't work for every patient or every situation.

"If someone was very agitated or under the influence I wouldn't put them in front of a very expensive machine," she said. Main DX80 system components range between $1,100 and $4,800.

But, Phelps-Smith said, telehealth "is the next best thing to being face-to-face with someone."

Being able to clearly see and communicate with a patient in real time allows clinicians and patients to still read each other's body language, hear vocal tones and language patterns, and have a discussion.

The Brien Center and other service providers have begun using the increasingly popular Zoom network and other videoconferencing platforms to hold meetings and do outreach during these times of social quarantine.

Meeting patients where they're at

While Phelps-Smith said she's been grateful to have been an early adapter of telehealth practices, other providers are just getting used to them.

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Meghan Garofoli, administrative director for The Counseling Center in the Berkshires, said the center's eight practitioners are all reaching out to make arrangements with their clients. She said they collectively see between 150-175 active clients between Pittsfield, Williamstown and Great Barrington, through the nonprofit mental health agency.

She said when the decision was made to temporarily close the physical practice spaces due to the COVID-19 outbreak, "the first thing our clinicians said to me was "well, what about our patients?"

Garofoli said the center is using a telehealth system called VSee, considered a trusted brand, because she's heard anecdotally of other systems becoming inundated with users and crashing. So far, so good with VSee, she said.

The transition to telehealth means transitioning to a new system of record keeping, billing and patient privacy protocols. It also means making sure patients understand what telehealth is and how to access it.

"Some members of our elderly population are not as technologically savvy, or they don't want to use it. So some of our staff are just reaching out with a phone call to check in and see how they're doing," Garofoli said.

Beyond using telehealth practices for one-on-one counseling, The National Alliance on Mental Illness (NAMI) is urging its affiliates to explore other opportunities to keep people connected.

NAMI Berkshire County Director Stephanie Adornetto recently participated in a virtual town hall meeting with national NAMI leaders. "They told us we really need to step up our technology to get virtual support groups going," she said.

All of the organization's in-person group meetings have been cancelled indefinitely, so NAMI Board of Directors are working together to update the organization's website with resources, tips and other educational materials.

NAMI Berkshire County is partnering with Berkshire Pathways to apply for grants to establish these virtual connections and also to perhaps revive some older methods, particularly one called a "warm line."

NAMI Board of Directors member and Berkshire County Department of Mental Health site director Chris Haley said it's an "old term from the '80s" for an alternative to a crisis line. Anyone feeling in need of support can call and reach a peer who has also lived through trauma so the caller can talk it out with someone who can relate to what they're going through.

Adornetto said though she knows she can find volunteers, she hopes grant funding can be used to hire peer workers to operate the support line.

Berkshire Pathways Program Director David Brien said he's hoping to find the funds to help the people the organization serves access cell phones and computers, something he said many of the program's approximately 100 active members do not have.

During a recent press conference, Gov. Baker touted the initial successes of integrating telehealth in Massachusetts. He said he's heard anecdotally from practitioners that "it's a really effective way to protect their patients and protect themselves."

Jenn Smith can be reached at jsmith@berkshireeagle.com, at @JennSmith_Ink on Twitter and 413-496-6239.


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