COVID-19 Update and Plan
Return to Community Integration with an Abundance of Caution
We are committed to continuing to provide high-quality care to our clients while keeping them as safe as possible from transmission of the virus. The model we use for psychiatric treatment at Ellenhorn is consistent with the best ways to respond to public health crises: a model that balances significant long-term plans with the understanding that crises always generate unforeseen effects, and that teams must be ready to respond with ad hoc innovations. Our staff and leadership meet daily to develop creative and proactive ways to serve our clients while we all adapt to new ways of doing things that help keep our clients and our larger communities and neighborhoods safe. The current crisis calls for significant organizational agility, and Ellenhorn is well-prepared for that challenge.
As a community-based model serving most of our clients outside office settings, and one designed for individualized care, we are built, in many ways, for this kind of crisis, and especially for social distancing. While we do have two residential programs in the Boston area that serve a maximum of 15 clients, the majority of our clients live in their own homes. This gives them the opportunity to control their social distancing and to self-quarantine if necessary. In addition, we do not depend on therapeutic groups as our main mode of treatment at Ellenhorn, instead focusing clinical care on individual interactions between our teams and our clients. We are thus able to suspend group treatment or move it to virtual platforms without a significantly detrimental effect on clinical care.
Since March, we’ve taken an “abundance of caution” approach, moving almost all our contacts with our clients to virtual meetings, while continuing in-person interactions when absolutely necessary. Because we work with individuals enduring complex psychiatric and psychosocial experiences, identifying our program as a “hospital without walls” that serves individuals typically deemed as needing care within residential or hospital settings, the move to virtual care took significant effort and thought. We set our sights during this time on psychiatric and health safety, while appropriately scaling back our usual goals of integrating clients into their communities and supporting them in recovering a sense of purpose.
We are gratified to say that our success in keeping people safe has met and exceeded our expectations, with minimal psychiatric emergencies and no significant health symptoms. Our plan all along has been to keep an even keel in our care, while preparing to hit the ground running in terms of greater therapeutic change once states began to open up.
Of course, as we’ve learned more about the pandemic, “running” is likely the wrong word for a return: We’ll hit the ground in a jog or a walk. In two of the states in which we operate, the time for doing so is now.
A State-by-State Plan for Returning to Community Work
Ellenhorn operates in three states: Massachusetts, North Carolina and New York. Each state is following its own plans for re-opening, and our policies are influenced by these individual plans and our own study of epidemiological data. Given the considerable governmental pressure for businesses to open up, despite warnings of a dangerous spike in infections if they do, and often in defiance of CDC guidelines, our plans remain guided by an abundance of caution, and are typically at least one step more conservative than state policies.
Fidelity to our evidence-based model of care (called PACT) is based partly on one important metric: Up to 70 percent of our therapeutic contacts occur outside the office, in the community. Our end goal is to reach that percentage again, when it’s safe to do so. We have a four-phase plan to get there, the shift to each phase dependent on public policies and our own study of the epidemic. Here is how we are implementing this phased plan in each state:
Our Massachusetts team is in Phase One. Phase One outlines the minimum level of restriction we require our staff to abide by. This means that while each individual client and family may decide to maintain a higher level of restriction, it is up to our clinical teams to decide to lighten restrictions if clinically indicated. What follows is a list of Phase One’s minimum level of restrictions:
Each client can be seen face to face by one clinician only, preferably their primary clinician. All other appointments will continue to be virtual. We will continue to restrict people from coming to the office, and face-to-face appointments will be conducted outdoors, or if not possible due to weather, in the client’s home with extra PPE. Clinicians will not make physical contact and will maintain a six-foot distance. If a clinician or client shows any signs or symptoms of illness, we will not meet face to face. The clinician and client will complete a screening, which includes a temperature reading, before a face-to-face meeting can occur.
All group meetings will continue to be virtual. All staff meetings will remain virtual.
The Brackett House and Annex. The Brackett House and Annex are our residential options in the Boston area. We have created three quarantine suites for these residential programs and are now offering the suites to new clients until they are found to be clear of the virus. Clients in the quarantine suites will have contact with staff at least twice daily, will have meals delivered, and will reside in a building that is staffed 24 hours a day, if necessary. We are directly admitting clients into our residences from programs or hospitals with strict protocols regarding testing at discharge.
Now that North Carolina’s governor has lifted restrictions, the Ellenhorn program is shifting from Phase One to Phase Two. Each client can be seen in person by their primary clinician, and by members of the team who conduct psychosocial work in the community. Therapy and psychopharmacology appointments will mostly be done virtually.
All group meetings will continue to be virtual. All meeting between staff will remain virtual
Supported Apartments. Our North Carolina program has developed a relationship with the Revisn apartment building in downtown Raleigh. Working with the Revisn, we help our clients and families rent fully furnished apartments, managing all the details. Besides our PACT team’s regular daily contacts, clients at Revisn receive extra support twice a day, including weekends. These Supportive Residential Care visits include a check-in regarding clients’ psychiatric well-being; help with daily living issues, such as shopping, cooking, cleaning and organizing; and companions to help them engage in the community in a safe manner. These supportive visits will follow the same safety protocols describe for the Boston residential options.
Based on current information, we are not changing our practices in the New York area just yet. That means that most of our contacts with clients are conducted virtually. We are having remarkable success in this mode and are currently accepting clients in New York whom we believe can benefit from our whole-person approach through virtual means.