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A Q&A with Adult & Child Health COO Dan Arens about Telehealth Transition

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When the COVID-19 pandemic hit, it affected virtually every aspect of our lives. The virus forced health care agencies to adapt and adjust like no other entities.

Clients were suddenly encouraged into quarantine, reducing their ability and willingness to access primary care and behavioral health care visits. Employees felt equally insecure in providing a service that has always been, until recently, face to face. Adult & Child Health, like nearly everyone else, needed to evolve quickly or risk leaving thousands of under-resourced men, women, and children without access to care.

In late February and early March, when COVID-19 began spreading to the U.S. and Indiana, A&C’s leadership was paying close attention. On March 13, when schools began to close their doors and transition to e-learning, A&C effectively transitioned 95% of its medical, psychiatric and counseling service visits from in-person to telehealth delivery models with very minimal loss of client engagement.

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How we transitioned to telehealth

Adult & Child Health Chief Operating Officer Dan Arens oversaw much of the transition process and relied heavily on the expertise of A&C’s leadership teams and direct care staff who really drove the hard work. “It was so amazing to see the lengths to which our staff were willing to go to make sure our clients were still being taken care of,” he said. “Our 70-year face-to-face business model was upended and re-designed in a matter of weeks. That’s a remarkable testament to what can be accomplished by a mission driven team.”

He shared his thoughts on the transition process, how it’s working today and what it means for the agency and health care in the future.

Q: Which changes we’ve made to our health care services and access in the wake of COVID-19 do you think will be temporary, and which ones will remain permanently?

Dan Arens, Adult & Child Health Chief Operating Officer.

A: “Since the on the onset of COVID in mid-March, A&C has effectively transitioned our services from a face to face model to a televideo model and kept the large majority of our patient base engaged in services. From skills development work in the schools, to homeless services, family therapy, registration, and medical services, for the most part, access to our full continuum of care has remained intact via televideo.

We’ve found televideo to be a very effective tool under the pandemic circumstances.  The decision to continue these services under a telehealth model really falls to our payors. Under COVID-19, the rules around telehealth billing have been relaxed; if those rules continue to allow telehealth, A&C Health would be happy to continue to offer services under the telehealth model. I suspect, access to some services under telehealth will remain permanently (i.e. therapy, acute medical/psych visits, etc), while others will return to face-to-face only.”

Q: Is telehealth actually preferable to our traditional in-person patient visit model? If so, why?

A:“Our clients have really adjusted well to the telehealth model. I believe people appreciate the option; especially those with mobility, transportation, work schedule, or other barriers to care. That said, every client is different in their comfort level with telehealth. In an industry based so heavily upon building relationships, discussing emotionally difficult topics, and working across support networks, telehealth does present its own set of challenges.  Our staff have been really creative in these areas during this emergency, but I believe a mix of face-to-face and telehealth options is the best solution.”  

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Q: We serve a specific population compared to traditional health care facilities/agencies. Will telehealth be beneficial to our client demographic long-term, and if so, why?

A: “Many of our clients do experience multiple barriers to care; perhaps moreso than traditional health care.  Telehealth certainly does expand our clients’ options for access to care.  Beyond the common barriers like transportation, telehealth does afford us a different approach to treating people who experience mental health challenges that make it difficult for them to attend services in person. 

 “I believe telehealth has also allowed our agency to reduce the number of clients who present at ER’s for non-emergent services. Whether for primary care or behavioral health services, telehealth has allowed us to be more nimble in working urgent care patients into same-day visits.” 

Steve Dycus uses an iPad to set up his telehealth services at Adult & Child Health.

Q: What changes do we still need to make as an agency (or as an industry) to make telehealth a viable long-term health care access option?

A: “Long term, I believe COVID-19 has forced us all into telehealth models and we’ve collectively demonstrated the remarkable benefit of telehealth.  Insurance payors, providers, and patients adapted really quickly. As with any new process, we have some work flow adaptations we’re working to implement, which will improve client care, follow up, registration efficiencies. The beneficial components of face-to-face health care (like connectivity, body language, empathy, compassion, etc.) don’t translate as effectively via tele-video. Those aspects of the visit are very important to good care, so we, as an industry, will need to find creative ways to keep these traits present in a tele-visit model.”

Q: How have our clients responded to telehealth? Not just in terms of individual feedback, but participation in the process (i.e. have no-shows increased, decreased or remained flat)?

A: “We’ve not had a chance to do a patient satisfaction survey and compare pre-COVID versus during-COVID statistics, but I can say our no-show rate has gone down, clients have voiced appreciation that A&C is still providing care. Many other mental health, substance use, and safety net providers closed their doors for weeks at a time due to COVID, leaving people without care. I’m very proud of our staff’s dedication to serving our clients. When a 600(ish)-person agency transitions from a full face-to-face service model to a 95% telehealth service model in about 10 days, you know you have staff who care about those they serve.”

This table shows how A&C transitioned from in-person to telehealth visits.

This chart (at left) clearly demonstrates the successful transition of visits in our clinics from face-to-face (blue) to telehealth (orange). For scale, pay close attention to the one-month date range. Also notice, our visit counts per day ended higher via telehealth then they started via face to face. 

A similar comparison was made among our traditional mental health center services. We experienced about 7% of our patients disengaged in care during the first months of COVID. Those who remained engaged were highly effective in transitioning to telehealth. We have seen an overall reduction in the duration of our visits, which is to be expected as people assimilate to telehealth.

Q: As an integrated care agency, is our experience with telehealth unique compared to other, more specialized agencies? Are there particular service lines that have benefited more from telehealth, and if so, why?

In speaking with many other safety net mental health and Health Center agencies, A&C was certainly one of the fastest to adapt and transition to a telehealth model; including the ability for our staff to work remotely to see clients.  This was no small feat and was rooted in our IT department’s ability to make rapid changes in tech platforms, onboard machines, and do all kinds of behind-the-scenes techno magic while our clinical staff were concurrently learning how to operate, and provide strong clinical care, under a telehealth model. 

I believe A&C’s experience was unique because we moved so fast. Our clients experienced minimal interruption in care compared to other centers closing their clinic doors completely.  Agency-wide, telehealth has allowed us to continue nearly every service line in some capacity.  Beyond the direct care staff, this transition impacted every admin/support department as well. Our facilities crews, front desks, clinical quality, HR, analytics, accounting, and revenue cycle departments all played a front or back end role in this transition. It’s probably fair to say the transition to telehealth impacted every person, every job, every department. And I personally appreciate every person’s role in this process.

I’d never ask to relive the COVID-19 pandemic, but I have been truly amazed by our staffs’ response under the pressure of this pandemic.  So many staff stepped forward to lend a hand, put in late hours in planning, and work outside their comfort zones to make sure the people we serve continued to be served.  It’s been a humbling experience to say the least.”

Want to learn more about our Telehealth options? Call us at 1-877-882-5122 to see what options work best for you and your family.

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Adult & Child Health Receives CCBHC Designation

Adult & Child Health, a leading community mental health center in Central Indiana, is thrilled to announce it has been designated as a Certified Community Behavioral Health Clinic (CCBHC). This designation is announced alongside the exciting news that Indiana was selected as one of 10 new states to join the CCBHC Medicaid Demonstration Program. By becoming a CCBHC, Adult & Child Health can unlock critical resources to address the growing need for mental health services in Indianapolis. This includes crisis care, improved staff recruitment and retention thanks to sustainable funding, and the ability to expand their service offerings. CCBHC will allow Adult & Child Health to offer competitive compensation and top-of-market wages, making them a more attractive workplace for qualified providers. With the rich history and commitment of Adult & Child Health to making a difference, they can achieve even greater impact through this transformation. “Indiana’s selection for the CCBHC program is a major step forward in strengthening mental health resources for residents,” said C.J. Davis, CEO, Adult & Child Health. “This designation allows us to make a significant impact by expanding access to essential mental health services in Central Indiana. We’re committed to ensuring our community members have the resources they need to live healthy and fulfilling lives.” The Biden-Harris Administration announced the additional states being added to the CCBHC program earlier today. Adult & Child Health had been selected by the state to be a CCBHC if Indiana was selected, but the decision of which states would be selected to join the program had been pending until today. CCBHC is a transformational program that provides sustainable funding for designated organizations and has been shown to increase access to mental health and substance use care, reduce homelessness and substance use, decrease use of emergency rooms and hospitalizations and improve overall health outcomes. It requires that designated CCBHC organizations provide 24/7 crisis services, outpatient care within 10 business days, medication-assisted treatment for opioid use disorder, care coordination and support services, as well as other evidence-based treatments.

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Homeless Resource Team Celebrates Outstanding Scores & Client Outcomes

Adult & Child Health’s Homeless Resource Team (HRT) is celebrating the recent achievement of outstanding Continuum of Care (CoC) scores. The Indianapolis scoring metrics are aligned with those developed by the Department of Housing and Urban Development (HUD) and are meant to evaluate project performance and rank projects based on CoC priorities. Homeless resource and housing projects are evaluated on areas such as data quality, length of time individuals are in the program, cost effectiveness, returns to homelessness, mainstream benefits (i.e. whether clients have been connected to food/food stamps, phone, and other resources), insurance access, and client source of income. A&C’s projects ranked first and third in Permanent Supportive Housing (PSH) and second in Rapid Rehousing (RRH), with zero exits to homelessness. Two areas in which A&C’s projects scored especially well were data quality and severity of barriers, which are testaments to HRT staff’s efforts to accurately and thoroughly track their data and to connect their clients with the resources they need to remain housed. “People not returning to homelessness is important; that’s why we retitled ‘Case Manager’ to ‘Housing Stability and Engagement Coordinator,’ said Brian Paul, Team Leader. This shift in language helps emphasize the team culture of striving to connect clients to services and ensuring that they’re able to meet their basic needs. “Ten years ago, we were not where we are now,” Brian said, explaining that the team utilized the CoC metrics to target and focus on challenges they could solve and areas where they could improve. The team’s hard work, attention to detail, and focus on client outcomes continues to pay off as they rank at the top of homeless resource projects in the Indianapolis area. Below: HRT Street Outreach Professionals Chad Hunter and Kristi Petrey purchase outreach supplies with an Aldi gift card donation. Click here to support HRT’s mission by helping to provide resources for Central Indiana’s unhoused neighbors. You can also support A&C’s 2024 National Health Center Week Drive here.

Sarah Miller, PMHNP-BC

Sarah Miller works with the addictions team, general psychiatry for adolescents and adults, and the competency restoration team. She is board-certified as a Psychiatric Mental Health Nurse Practitioner. Her specialties are working in addictions and with people who experience serious mental illness.

Miller graduated from Indiana University with a psychology degree and went back to school for nursing. She received her nursing degree from Indiana Wesleyan University and worked in a nursing home and also spent time working in a group home with adolescents. She received her master’s degree from Vanderbilt University.

She enjoys hanging out with her family and her two dogs, and going to sporting events.

Joanna Chambers, MD

Dr. Joanna Chambers is a psychiatrist who began seeing Adult & Child Health patients in November 2021. She graduated from Medical College of Georgia with her Doctorate of Medicine in 1996 and completed her residency in psychiatry at Yale University School of Medicine. In addition to bringing a wealth of experience, she currently serves as an associate professor at Indiana University School of Medicine where she teaches Clinical Psychiatry. She is certified in Addiction Medicine and has a special interest in treating pregnant and postpartum women. She is President of the American Academy of Psychoanalysis and Dynamic Psychiatry Organization as well as a sitting member of many medical association boards. Recently, she has won the Residents’ Award for Teaching Excellence in 2020 from Indiana University and has received “Best Doctors Award” in 2010, 2011, and 2014. Dr. Chambers is incredibly active in the medical, academic, and research realms of medicine. She is currently accepting new patients on Wednesdays.