Since 2016, IRETA has been contracted to implement and do consultation work with therapy groups at opioid treatment programs (OTPs) in southwestern Pennsylvania. More recently, our clinical quality improvement (CQI) staff has begun working with additional OTPs in the central and eastern parts of the state. At the time of the initial COVID lockdown in March, our CQI team was observing and providing feedback for in-person therapy groups at a total of six OTPs across Pennsylvania.
In addition to being present for group sessions, our CQI team attends staff meetings of the OTPs as necessary and assists with writing clinical procedures. The CQI team also has helped hire staff by sitting in on interviews and provides staff with clinical training. In normal times, our CQI strategy is very hands-on.
The lockdown presented our CQI staff and the OTPs with the challenge of switching completely to telehealth with very little notice. IRETA’s Director of Clinical Quality Improvement Services, David Reazin, MHS, answered some questions about what it was like to adapt to telehealth so quickly and what some of the pros and cons of virtual groups are.
Director of Clinical Quality Improvement Services
What was involved in making the initial switch to telehealth?
We started by having virtual groups where clients would call in through BlueJeans©, a secure video conferencing platform. Like we did in-person, we would observe the virtual groups and provide feedback before and after the sessions. We are mostly listening now, however, rather than doing visual observations. Some of the groups moved very comfortably to having online sessions while others found it more difficult. One agency we work with has a room that is big enough where folks can social distance in person and wear masks. Rather than being completely virtual, they have adopted a hybrid model, where people can either come in person if they are comfortable or dial into the session virtually.
What were some of the challenges you faced when going virtual?
Therapists are not able to see the client. We are only able to hear them, so there’s no way to read body language. You can’t see their eyes. It’s also difficult when people need to wait their turn to talk. Some clients dominate the sessions and the big challenge is to move on to other topics or have other people speak. It takes a little bit of skill so that you’re not offending anyone. Having continuity and getting clients to come regularly to therapy sessions is also a challenge. They are less committed to coming to a virtual session.
We have also run into challenges when it comes to the size of the sessions. An online group with 4-6 clients is very workable, but once we get to 7-10 people, it can become quite unmanageable, so that means we need to have more sessions with fewer people to have the most effective therapy.
Unfortunately, our clients that are suffering from the results of the pandemic are really suffering. There is an increase in substance use and isolation. This is also a population that has compromised immune systems due to being in early recovery from substance use. The big challenge is making sure these folks are getting effective group therapy without potentially being exposed to the virus.
Have there been any benefits you’ve seen in moving to a telehealth platform?
Some of our clients that are not able to attend therapy sessions at the clinics regularly are now able to engage in the virtual sessions more consistently. It is beneficial that IRETA’s CQI staff doesn’t have to travel as much. Our expenses are less and it’s much easier to communicate with one another.
While IRETA doesn’t have anything to do with distributing medication, it has actually been beneficial for clients in methadone maintenance programs to be able to get take-home doses with the recent loosening of restrictions. There haven’t been any issues with this because clients are still called in randomly to get tested for potential misuse of take-homes. I have not heard of any misuse happening. The amount of take-homes a client gets also depends on how long they have been a part of the program.
I believe the virtual platform is definitely here to stay. I don’t see us ever getting rid of this, even as we are able to meet again with clients in person.
