Your private therapy practice during COVID 19 is not the same and the therapy world was quite different just a few short months ago. What do you need to know going forward? This blog will review safety of your practice and patients; new policies and procedure that practice owners may consider and alternative approaches to in- person therapy.
The therapy world was quite different just a few short months ago. Clients were coming and going. We were sitting face-to-face, shaking hands and planning for the next session. We were attending conferences and workshops with colleagues. Seemingly overnight, all that changed with the onset of the coronavirus pandemic. All of a sudden, it seemed like the world went on lockdown. For maybe the very first time, we found ourselves in the exact same situation as our clients. We all had to learn to live in a more physically distant world.
The emergence of COVID-19 has required us to rethink the way we provide therapy and the way we run our private therapy practice. The needs of our clients didn’t’ disappear with the pandemic. If anything, the need for mental health care is greater than ever. Most of us are working from home now and providing therapeutic services via telehealth. Some of us were ready for the transition. Many of us were left to make the shift quickly and without a safety net. Now, as the country slowing moves towards reopening, we wonder what therapy service delivery will look like.
Will you return to your private therapy practice to offer face-to-face services?
Will you maintain telehealth for now?
Or will you provide some combination of the two modalities?
After the initial adjustment to telehealth, many therapists are finding that working with clients online is a great fit for them and for their clients. Therapists are discovering the practicality of flexible scheduling and being able to reach geographically distant clients who previously were unable to access therapy. Clients are discovering the convenience of online scheduling and therapy. They don’t have to drive, use valuable personal time from work or find childcare in order to access therapy.
Providing therapy virtually avoids the risks of exposure and the need for enhanced safety protocols that are just not practical for some office settings. Having to distance clients, disinfect the space multiple times a day, maintain a steady supply of sanitizing products and personal protection supplies can be overwhelming. It also means less time to offer to clients if you’re a small office.
The biggest complaint heard from therapists early on was the lack of reliable, affordable videoconferencing platforms. The free sites were quickly overwhelmed with the sudden need for videoconferencing. Telehealth tech needs seem to have stabilized but as more therapists choose to remain virtual and demand for virtual services continues to increase, the need for reliable technology will continue. TheraPlatform was there from the beginning of the pandemic and remains a reliable, accessible and affordable telehealth option for therapists of every discipline.
Making the Decision to Provide Face-to-Face Services
As practical as telehealth is, there are circumstances when face-to-face may be needed, even during a pandemic. You may have clients who are asking for face-to-face sessions. You may have clients who are declining, or their treatment requires face-to-face contact.
You are under no ethical or professional obligation to provide face-to-face services, especially if you have concerns about safety. In fact, many professional organizations are encouraging telehealth sessions when possible and advocating for therapists to determine whether there is a need for a face-to-face visit. Not only is your health and safety at issue, your staff, your family, your client and their family’s is too.
Keep in mind, there is no 100% safe protocol to avoid COVID-19 exposure except isolation. If you choose to reopen your office, you want to take the extra precautions necessary to provide the safest experience possible.
Safety First – Know Your Risks
The CDC and public health authorities tell us that the COVID-19 is still present in the general population and highly communicable. It continues to spread in some areas while other areas are seeing a decrease in cases. Viable treatments and vaccines remain months away at best. Does this mean you can’t return to private therapy practice? That depends on your level of comfort and personal risk as well as that of your clientele.
The recommendations for safety haven’t changed much since the coronavirus first emerged:
• Practice social distancing and remain at least 6 feet apart from the other person(s)
• Frequent hand washing and/or use of hand sanitizer
• Frequent disinfecting of surfaces
• Wearing a mask or face covering when in public or in close proximity to others to avoid particle spread.
You may happen to work with a particularly high-risk population such as the immunocompromised or elderly. You may be in a high-risk category. The question to ask is, can you resume face-to-face services safely and within the safety guidelines?
Some state and local governments have quite strict guidelines and penalties for violation of them. You need to know what your area requires of you as a business owner or practitioner.
The other risk to consider is liability. There has been considerable discussion of just what liability a business may face if a person is exposed to COVID in one’s place of business. There are no hard rules at this time but it is advised that you discuss your re-opening and your planned risk management plans with your malpractice insurance provider.
New Policies and Procedures
Choosing to offer in-person services during this time means new ways of doing things. You, your staff and your clients need to have a clear understanding of what’s expected and the new procedures they may encounter.
• Informed Consent – Your client needs to know the risks of in-person therapy during this time as well as the policies and procedures you will be implementing. Obtain a new informed consent in writing from your client. Your consent should include things like the risk of exposure, changes in existing policy and procedures and the risk management practices you have in place.
• Staff Policies – If you have staff in your office, you need to have procedures for maintaining safety and minimizing exposure. These may include temperature checks, wearing masks, pre-arranged seating, flexible scheduling and sick policies or other procedures that minimize exposure. What is required in your area may vary so check with your state and local health officials. The CDC has also issued safety guidelines for healthcare settings that may be helpful. You can access that information here:
• Office Procedures – Offering in-person services requires a change in your physical office environment. Some of the most common changes will include the way clients are scheduled and seated, how the office is cleaned and how they check in and out. The American Psychological Association (APA) recently issued some recommendations for managing the office setting safely. These recommendations include:
o Arranging office seating to encourage physical distancing. Consider removing chairs in the waiting room or positioning them far apart.
o If feasible, open windows or take other steps to increase ventilation.
o Wear a mask and ask your patients to do the same. Keep a few in the office for those who may not have one.
o Schedule appointments at intervals to minimize having too many people in the waiting room.
o Ask patients to come into the office five minutes before their appointment time, not earlier.
o Keep hand sanitizers that contain at least 60% alcohol in the office, the waiting room and check-in counter.
o Post notices encouraging people to wash their hands and to avoid touching their face.
o Tell patients and office staff to stay home if they have a fever, shortness of breath or a cough, or have been exposed to someone who shows signs of COVID-19.
o Avoid hugging or handshaking.
o If you use a credit card station, sanitize it after each use. If staff runs the credit cards, they should wear gloves.
While there is no one perfect practice solution, there are ways to minimize risk and still provide the much-needed therapeutic services your clients need. The most important thing is to make all of your practice decisions from the stance of safety first. We will get through this and we will get through this together.