As the COVID-19 pandemic began sweeping across the globe, CVT’s clinical teams took immediate steps to care for clients using safer, remote methods. In the United States, this transition affected all four CVT clinics: in Atlanta, Georgia, and in St. Cloud and St. Paul, Minnesota. By the middle of March 2020, all U.S. programs had shifted to extending care to clients via telehealth, a term for use of virtual communication technologies to provide healthcare services when the provider and the client are not physically together.
The CVT Research team also adapted to the change in modalities, and began watching the results coming in from their ongoing monitoring and evaluation assessments with an eye for changes resulting from the new telehealth operations. Sabrina Roowala, MPH, program evaluation specialist, and Jennifer Esala, Ph.D., research associate, compared clinical outcome measures, documenting results from before the move to telehealth and then after the pandemic began. Andrea Northwood, Ph.D., client service director, provided insight on how findings translated in the clinical setting.
They made some interesting discoveries.
As part of their analysis, the researchers noted that because of the nature of the times and the pandemic itself, there were a number of factors that could have contributed to outcomes: for example, the social distancing, isolation and loss of employment so many clients experienced during the pandemic affected all aspects of their lives. In addition, a number of critical social situations, including ongoing violence by police and related uprisings, the U.S. elections, and anxiety around the COVID-19 virus, impacted clients in many different ways. These factors may have affected the results in ways that are not yet apparent simply from the numbers.
Nevertheless, the team was pleased to see positive outcomes for CVT clients during telehealth, acknowledging that there was a small percent of clients as it was more difficult to conduct measures. But importantly, clients’ anxiety, depression, post-traumatic stress disorder (PTSD) and somatic symptoms improved at the same rates when they were meeting remotely as they did when meeting with therapists in person.
In addition, there was an increase in the number of sessions conducted with clients in two disciplines: therapy sessions and social work case management. This is consistent with other clinics’ telehealth experiences: clients are more able to attend appointments virtually, without certain barriers such as transportation or feeling too depressed to leave the house. Overall, clients had more sessions with therapists once they were meeting remotely; however, these sessions tended to be shorter in duration.
In the area of social functioning, clients did not show statistically significant improvement once CVT transitioned to telehealth. This was new. Before going remote, CVT typically saw large improvements in social functioning. However, social functioning measures include many factors that were impacted by the changes caused by COVID – things like safety, stabilization, social connection, employment and other indicators of how well one is managing in the community and society. This year of the pandemic has been a time that was very hard on people socially.
Sixty-one percent of clients reported that they liked the telehealth sessions very much. Many people appreciated that they no longer had to travel to meet with therapists – a real benefit in Minnesota winters as well as in the wide-spread urban environment of the Atlanta region. However, there were factors such as technology and connection issues, and having a quiet private space to meet, that clinicians worked to optimize for clients.
Despite the challenges inherent to telehealth and, more broadly in the social and political environment, these data points illustrate how CVT was able to provide continuity of care to our clients.