Throughout the long history of Washburn Center for Children, mental health therapy has been done face-to-face. Washburn therapists meet children and families in their homes, at school or at Washburn’s offices in Minneapolis, Brooklyn Park and Edina.
For everyone involved, in-person just felt like the way things should be done, particularly in the nonprofit’s Crisis Stabilization Program, an intense, wrap-around support program designed to help families of children with severe emotional disturbances navigate daily life while avoiding out-of-home placement.
Then COVID-19 hit the state, and Minnesotans were expected to stay at home for everything but essential services. At Washburn, this meant changing the way they’d been doing things for over a century in a matter of days.
Tom Steinmetz, Washburn CEO, said that before COVID forced drastic change, telehealth therapy options at the center were “very limited,” but the organization had actually already started the slow process of expanding the technology required for offering virtual treatment to its clients.
“We were planning and preparing to start piloting telehealth more broadly,” he said. Washburn leaders figured the organization was still a long way from launch, but then, he explained, “the Coronavirus forced us to figure it out and dive in very quickly.”
This timing was a coincidence, Steinmetz said, but it clearly helped Washburn stay ahead of the game and continue to provide services to clients: “Because we had already made a huge investment in our technology and the technology packages we provide for our therapists, we were able to make the shift to telehealth for all services within a matter of 48 hours.” By March 19, all Washburn services were shifted to telehealth.
Even programs that are typically high-touch, like Washburn’s Crisis Stabilization Program, needed to make the virtual shift. The program, designed to assist high-risk kids often coming out of hospital-based or outpatient psychiatric treatment, offers wrap-around services headed by a case manager focused on supporting the child and family in all aspects of their lives.
Jenny Britton, Washburn’s director of child and family services, explained that crisis stabilization case managers play a central role in a family’s recovery.
“They make sure that everyone in the child’s life has the resources and support they need in order to work through what’s happening now and to achieve what is on their long-term treatment goals,” she said. What makes this approach different from typical case management is the singular focus and coordination of the case manager. This helps the family move more smoothly through often complex systems.
“The crisis worker’s job is to focus on care coordination,” Britton explained, “to figure out how the services are working together, what their goals are and if any pieces are missing that we can bring on board. It’s a nice wrap-around approach to helping families find some stability.”
Before COVID, the crisis team worked within a 35-mile radius of Washburn’s Minneapolis headquarters. Case managers regularly hopped in their cars and drove, traveling to meet children and families in homes, schools and at other sites. These days, that work has all shifted online, Britton said. Case managers contact schools and outside care providers via text, phone or email, and schedule therapy sessions and parent meetings via Zoom’s health package.
Though the statewide shutdown caused many Washburn clients to pause treatment, Steinmetz said that as soon as word got out that all services were available virtually, families quickly began to return.
“Starting in mid-March, when the initial school closings and social distancing requirements were put into place,” he said, “we saw a lot of cancellations as families just paused and waited. But since then we’ve actually seen an increase in families calling and reaching out and seeking care.”
After the initial pause, Britton said that requests for Washburn’s services was back up to normal, if not higher than normal levels.
“We’re just as busy as before COVID, and because we aren’t traveling right now we have more capacity to see clients than ever,” she said. “We just want to be helpful. We want to be a support for families in this unusual, stressful time.”
‘It has been a lot of learning for us’
The quick shift to telehealth required Washburn staff to be flexible. Not every therapist was immediately comfortable with the technology, Britton said, but she was impressed with how many dedicated themselves to figuring it out so they could continue to serve their clients.
“It has been a lot of learning for us and our clients about how to do therapy in a different way,” Briton said. And many therapists, now that they’ve adjusted to the change, say they are seeing unexpected benefits of telehealth. “We’ve seen kids and their families in so many different settings. We’re actually having a lot of fun when kids take us on tours of their rooms, of their safe places at home. Despite the adjustments, we’re actually seeing some really beautiful results from telehealth. It’s been a fun experience.”
Steinmetz said that now 95 percent of Washburn staff are working remotely: “We have a small crew of facilities and front-office staff who are in the office. Occasionally a therapist will go in alone to hold a telehealth session from their office, but almost everyone else is working remotely.”
Some clients have reported that their homes don’t have the technology required to support Zoom calls. Britton said that in some of those cases, Washburn staff has been working with schools to provide hotspots, laptops or tablets. Other alternatives have also been developed.
“The data we have so far shows that we are able to do video therapy sessions with clients about 90 percent if not more of the time,” Steinmetz said. “In those rare cases when we can’t, say if the family doesn’t have the technology or has a bad internet connection, we can do the session as a phone call.”
Britton said that Washburn clients tend to have three different reactions to the telehealth shift. One, she said, is that is that therapy continues as usual with few interruptions. “When that happens,” she said, “that’s beautiful to see.”
A second common reaction is that some kids and families seem to actually prefer teletherapy to in-person treatment. “We’re seeing some kids and families that are more engaged with telehealth than they were in person,” she said. “There is a level of intimacy that happens in a face-to-face session with a therapist, but some families feel more comfortable in their homes or on the computer. I’ve seen some families and children open up in deeper ways.”
A third reaction is that families say they don’t like telehealth at all. “Some people really prefer face-to-face,” Britton said. “Kids are tapped out on screens with distance learning. Calling them back in for a therapy session, that’s hard. Some kids and families are choosing to say, ‘This isn’t my thing. I want to wait until face-to-face is back.’”
Britton said she misses in-person interaction as much as anyone, but she also said she’s feeling privileged and honored that her clients are willing to take the leap and try out this new approach. And there have been times when the new technology has provided welcome lightness in a world that can too often seem dark and frightening.
“We’re seeing some really positive engagement,” she said. “There are times when connectivity issues can be stressful and some kids are funny about having you on a screen. But they’re also excited to see you and try a new ways to communicate on their terms. It’s fun, actually. The kids are in charge, and they take you where they feel most comfortable. We’ve done sessions in closets and outside and even under the bed.”
Steinmetz believes that Washburn’s rapid shift to telehealth was essential to not only keeping the organization afloat but also to maintaining the essential services that it has provided to children and families for so many years.
“What we did here was so critical,” he said. “For children and families, continuity of care and access to mental health services is so key to their health and well-being. We had to do it. We just couldn’t let our families down.”
Crisis care from home
Washburn Center’s Crisis Stabilization Program has been a lifeline for Taylor Hamlin. When she first got involved in the program three years ago, Taylor was an anxious, frightened and sometimes angry 13-year-old who was in the process of transferring out of a partial inpatient program for children with mental illness. Her mother, Nicole Hamlin, was desperate to find someone who could help her daughter safely make the transition back to school.
Taylor, Nicole explained, “had undiagnosed autism and extreme anxiety.” Staff at the inpatient program suggested that the family reach out to Washburn to see if they could help. The family enrolled in Washburn’s Crisis Stabilization program, where they were paired with Barb Kukuroboman, a therapist and case manager.
“Barb was working with Taylor to not only be able to regulate her own emotions but also helping her to self-advocate at school and in life,” Nicole said. Even when she was physically bullied by another girl, Nicole said that Taylor didn’t report what happened. She kept the abuse to herself.
“Taylor didn’t have the right coping mechanisms,” Nicole said. ““There were times when she would shut down and sit there and not talk. She was an easy target. Barb helped her realize her own self-worth.”
Kukuroboman stepped in to advocate for Taylor at school, helping her to get the services she needed and working with teachers and administrators to make sure she had the appropriate supports. She saw Taylor for therapy twice a week, at home or in school. And when she felt that the school wasn’t able to provide the supports Taylor needed, Kukuroboman helped the family find her a spot in another school that met her needs.
“Through Washburn and Barb, we’ve seen amazing transitions with Taylor,” Nicole said. “She got a full diagnosis of autism. She got a mental health caseworker. She is now in a school for kids with autism where she is fully thriving. Her grades are fantastic and she every morning she wakes up wanting to go to school. Barb has been everything for Taylor — from a therapist to an advocate.”
When COVID-19 forced schools to close, Nicole was worried that Taylor’s treatments would no longer be available. “This would have been a problem for her,” she said of her daughter. “She’s really been doing well, but without Barb’s support, I wondered if we’d lose a lot of her progress.”
But then Nicole learned that Taylor’s therapy appointments could continue online. Taylor accepted the change easily, she said, and her twice-weekly sessions with Kukuroboman continue almost as if nothing has changed.
“Because we can’t do the visits in the office, we do the telehealth every Monday and every Thursday,” Nicole said. “They meet for an hour after Taylor is done with her school. It is something Taylor looks forward to.”
Nicole thinks that being able to continue the routine of therapy without a break has been beneficial to her daughter’s mental health. “I think that COVID would’ve been a lot more disruptive for her if the telehealth option hadn’t been there,” she said. “I just feel lucky that we had this option. Thanks to Washburn and Barb, Taylor has grown by leaps and bounds. I’d hate to see that go away now.”
The telehealth shift has gone so well for many families and therapists that Steinmetz said Washburn is making plans to continue telehealth options even after COVID-19 loosens its grip on the state. He said that enhanced support from state regulators and insurers around reimbursements for telehealth helped make the rapid shift feasible.
“After the governor’s executive order there was a really quick and supportive shift to expand insurance coverage for telehealth services,” Steinmetz said. “That was really critical for us being able to make this shift across all of the that we provide and continue to provide. Mental health care support is so key for many kids and families.”
With his eyes trained on the future, Steinmetz said he hopes that support will continue so that even after this pandemic eases, telehealth will continue to remain a viable option for all families: “As we look further down the road I hope that expanded coverage will continue because there are huge benefits to being able to offer mental health wherever it makes sense for each family.”
Having telehealth as an option for treatment has significantly expanded Washburn’s reach, Britton said. While in the past, service areas were limited to the distance therapists and other providers could travel by car, technology has erased many of those boundaries.
“During this time, while we are doing telehealth, we are serving 11 counties. That’s significantly more than where we were able to reach in the past. We get lots of referrals from hospitals and inpatient units around the state. Now we can serve these kids so much easier than we could before.”
Telehealth might actually make mental health treatment an option for families who might otherwise have not been able to receive services, Steinmetz said. Imagine a busy family with three kids and working parents.
“In-person therapy might mean driving across town after school and during rush hour and figuring out child care,” he said. That can be a burden that puts therapy out of reach. “If we are able to use telehealth to connect with that parent and child at home, that may make the difference between them getting help and not getting help.”
There are regions of the state where access to mental health services are limited, he added. Telehealth makes it possible to reach families in those areas. And even just having the option to call in therapy during bad weather could also reduce no-shows, Steinmetz added: “We live in Minnesota, and there are times where we have polar vortexes and snowstorms. When you can provide that service via telehealth, that could be the difference between that child getting help on that day or not.”
Because it feels important that people know that Washburn is still running at full steam, Britton said that she and other representatives are reaching out to hospitals and treatment programs that typically make referrals to their programs.
“We are saying, ‘We want to provide the services that kids and families need right now.’ We know there is a huge need. This is a scary and uncertain time. We know there are kids and families in crisis that could really use our services, and because of the space and time provided by telehealth, we have the capacity to get them in right now.”
Steinmetz said that lasting impact of COVID-19 may be increased mental health issues among the general population. He’s already seeing that in increased reports of suicidal ideation, anxiety and stress. The state’s mental health system was already underfunded before this pandemic hit; he hopes that the strong support he’s seen in past weeks won’t let up anytime soon.
“The broader coverage for telehealth was very helpful,” he said. “There needs to be a major investment in the metal health system. There is every indication that rates of anxiety, depression and trauma are going to increase, especially in the short term. We have a mental health system that was already severely underfunded: We really need to address this issue for the health of the state.”