Voices From the Crisis: Delivering addiction treatment while balancing new risks
For Dr. Lynn Morrison, the biggest challenge to ensuring her clients get the addiction treatment they need is dealing with the fact that everyone is in the same boat.
“A lot of our emergency preparation plans assume that a building has burned down or a location can’t be accessed,” the president and CEO of Brandywine Counseling and Community Services said. “In those cases, we normally have agreements with other companies to help us. That’s not the case here. This is impacting everyone.”
Implementing social-distancing guidelines – such as keeping clients 6 feet apart – when you’re handing out daily methadone treatments to 600 people or more during the morning hours and many of your staff is working from home can be a challenge. On top of that, Morrison has to take into account that many of her clients may possibly be at greater risk of relapse based on the social isolation.
“Things have gone so fast,” she said. “We’ve moved to a telehealth scenario using Zoom (teleconferencing services) and made sure the platform was large enough to roll out to counselors and practitioners [the doctors, nurse practitioners, and physician assistants who prescribe medication] so they can do their work from home. While many are responding well, others are struggling with the technology.”
The federal and state governments have helped by relaxing their guidelines, allowing companies like Brandywine that are considered “essential” health care facilities to send home more medication than someone might normally be eligible to take home. The new guidelines allow more “stable” patients to receive 28 days of take-home doses, while less stable could potentially receive up to 14 days.
That leaves Morrison and her team having to make their best judgment about the extent to which a patient can manage on his or her own. In many cases, patients who they’ve been treating longer will get additional doses to take at home while not offering the take-at-home options to someone who might also have additional risk factors, such as physical and/or mental-health issues.
“We are trying to balance our social responsibility of not spreading COVID-19 with not giving them too much medication – it’s a very fine line – and it’s up to the provider to make their best judgment whether the patient is stable enough to manage on their own,” she said. “The people who have been stable for a long time probably like [the new approach], but we are being extremely cautious and making sure they can handle the medication responsibly, for example, that they can lock up the additional medication.”
As a result, Brandywine’s Lancaster Avenue clinic has gone from handling 600 clients in person each day to about 150, with another 150 through the telehealth services. Morrison also says Brandywine is trying to create new ways for people to stay connected, recognizing that it was easier before to see people when they had to come in every day. The Newark office has gone from seeing 300 clients in person each day to about 75. Telehealth and phone calls are being used to monitor client’s mental well-being and compliance with take home medication.
“We’ve added the telehealth services, Facebook groups, and programs like managing parenting when your children are home,” she said. “We’re trying to keep stress levels down and we’re finding it best to have our staff teach clients how to use Zoom – how to download and access it. We’ve created a lot of tutorials because it’s important we help create structure and a sense of community for our clients. We’re making calls, reaching out, and generally doing well-being and medication checks.”
“In those first few weeks, we went through each business line to determine what we needed to do to sustain our ability to serve each client,” she said. “We’ve moved our prevention programs online. It was huge going through all those different lines; now we’re finetuning and documenting the process improvement for the future and how we can put changes into practice more quickly.”
Asked what she’s learned in the first few weeks of the crisis, Morrison quickly said she’s seen the benefit of being more flexible and decentralizing decision-making, putting it in the hands of her staff and leadership team.
“I created a running journal that captured what we did and when. If something like this happens again, we won’t have to reinvent the wheel,” she said.
By Peter Osborne