April 15, 2020
How COVID-19 Has Changed the Daily Lives of Virginia Social Workers
Interviews with Heather Stone, PhD, LCSW & David Lewis, LCSW
The transformation took just one business week, but it was a frantic five days as Heather Stone, PhD, LCSW, moved the patient caseload and operations of Central Virginia Health Services (CVHS) in Petersburg to a completely virtual environment.
As director of behavioral health services, Dr. Stone and her team of 16 behavioral health clinicians and staff found that—like so many social workers across the state—their daily work habits turned upside down when COVID-19 creeped into Virginia, creating unprecedented anxiety and fear while simultaneously interrupting mental health care and turning even toilet paper into a stressor.
Although telehealth is touted for its convenience and increased physical safety, social workers are finding that it also has drawbacks both expected (i.e., internet access issues) and surprising (i.e., a potentially exhausting fast, relentless pace).
David Lewis, LCSW, a trauma therapist at ReadyKids with a private practice in Crozet, Va., finds it “much more difficult to feel I am meeting the needs of my clients effectively.” Some of his patients, for instance, respond only occasionally to phone or email contact.
Recently honored as NASWVA Social Worker of the Year, Lewis also finds that teletherapy makes assessing client needs more difficult, as well as responding to crises and starting services.
“Some clients are so caught up in their families' struggle to meet basic needs—financial, as well as health and/or social/emotional--that follow-through is minimal,” he says. “At the same time, the needs of my clients overall are greater. The pandemic has been very hard for many of my clients who were already very isolated.”
Loss of structure for clients, upheaval around a new way of working, and fear about physical safety for themselves and loved ones are additional COVID-19 challenges for social workers in every specialty.
However, Lewis and Stone see silver linings, too. Lewis notes that some clients are requesting telehealth even post-pandemic, and consistency of care has been “reassuring with pediatric patients,” who have enjoyed introducing clinicians their rooms and meaningful items. In addition, some patients whom Lewis considers generally withdrawn and anxious “seem to be doing okay,” calmer in the safety of their familiar home. Both social workers also expressed deep gratitude for the collaboration, commitment, and innovation they see around them.
To showcase the many critical roles “essential” social workers are playing in the state’s pandemic response, NASW Virginia asked Stone and Lewis to share their experiences and observed trends as part of a new storytelling series. If you would like to share your own experiences, please contact firstname.lastname@example.org.
NASW Virginia: How is the pandemic affecting your daily duties and workload as a social work professional?
STONE: “Clinically, my personal patient caseload has stayed fairly consistent. I have had contact with most of my patients either via a telehealth platform or by phone. But the work is somewhat more laborious, since I am communicating with my patients by phone, text, and email to set up sessions and then coaching people in how to use telehealth technology….
“With regards to our ‘integrated care’ with behavioral health, medical, and dental services, we are still working together but differently…. [We] can’t just pop by each other’s offices. Rather we are calling, texting, messaging in the electronic medical record, or emailing. And our office base opioid treatment program seems to be having three-way calls (medical, behavioral health, and patient) every few days.
“Administratively, it was really stressful and a lot of work when the pandemic first broke out because I was so concerned about the safety of CVHS clinicians and patients, as well as needing to operate within federal and state regulations. As soon as it seemed feasible, my team learned a new telehealth platform, made directions about telehealth, and arranged for all patient care to be virtual in just one week.”
LEWIS: “At ReadyKids and in my private practice, clients are suddenly without the safe support systems and resources they had relied on. Many kids and adults who've experienced trauma rely on the support they get in therapy just to make it through a typical day.
“Some children really struggle without the daily structure that felt safe to them, and others no longer get to visit with their own families due to the isolation. I find that most children respond to the increased stress of adult family members, the social media they are seeing, and the messages of safety and reassurance from adults. The options and social outlets for kids are suddenly much more limited.
“We have posted many resources and options for families on our website, though it is hard to do more than share these options for supporting kids: https://readykidscville.org/readykids-preparing-for-coronavirus-in-charlottesville/. I’m especially concerned about children and families in high-risk situations such as homes with histories of domestic violence, discrimination, or self-harm when there is increased stress.
“Most medical and therapeutic services have been put on hold. My co-workers, other social workers, and medical providers are trying to stay home to keep themselves and other safe. This makes it even harder to get support in a crisis. My clients who are transgender or gender-expansive rely on supportive adults and medical help that is suddenly not available, which is often increasing their distress or dysphoria.
“Many clients have had their support groups stopped, found themselves isolated without support, and had surgeries put on hold. Some adults I work with through our Virginia Victim Assistance Network support group have unexpectedly lost the only nurturing connection they had: https://vanetwork.org/.”
Are you offering teletherapy or holding meetings online, and if so, how have they been received?
STONE: “All of our behavioral health providers started telehealth services March 23. We were fortunate in that we had started with a small telehealth practice in December 2019. Prior to March 23, we had just one clinician seeing about five patients a week by telehealth. While limited, that experience allowed us to gain familiarity and initial success in how to do it. I believe that allowed us to be able to get all behavioral health clinicians and staff seeing most of our established patients [within] one week.”
“We have not received a huge increase in requests for services, but I don’t think that is an accurate indication of the need. CVHS sites are seeing half as many patients. Most new patients tend to come from medical and dental provider referrals, and CVHS has not yet made our telehealth capability known for patients outside of CVHS. While our services went virtual fast, the CVHS registration process has not yet. We are having to mail registration packets or ask patients to come to a CVHS office. Hopefully, this will be remedied in the next few weeks.
“The main thing that our patients seem to want to know about has been the stimulus. We have been trying to stay on top of the best information to share with them.”
LEWIS: “Yes, I offer teletherapy both at ReadyKids and through my private practice. We have weekly meetings and training online, and they are going well now that we're learning more advanced technical skills!
“[However], many clients do not want to participate in such sensitive therapy online. Although I have many clients that need to be seen in person, I don't want to risk their physical safety by seeing them in person.
“I do offer confidential (HIPPA-compliant) digital communication, but my support group for adult survivors (loss of a family member to murder) has temporarily shut down. We are organizing an online support group and other online connections to continue support through the Virginia Victim Assistance Network.”
What trends are you seeing among those you serve?
STONE: “The main issue we are seeing is disparity in who can adequately engage in telehealth. There are many rural areas with poor broadband services and poor cellular service. Some patients don’t have smartphones or the smartphones they have do not have enough capacity for video communication. Patients who struggle with technology generally feel like they have less access to care. Before even trying to use our platform, some will say, ‘I can’t do that!’ Many of our patients who are seniors are not participating in telehealth.
“There is a lot of appreciation from established patients for being able to have continued care…. [and] a lot of fear about the health of patients or family members who are ‘essential’ workers and whether ‘essential’ workers are adequately protected. There also is a lot of grieving about deaths of loved ones and not being able to be present or have a funeral. There are many political concerns as well.”
LEWIS: “For those with limited personal resources, health issues, financial resources, single-parent families, and barriers to privilege, there is a significant increase in stress and risk of illness. So many of my clients have family whom they are worried about [or] family members who are at high risk, and [they] suddenly need to focus only on basic needs.
“I've also seen a trend of increased anxiety related to the social media coverage that they are seeing. My clients find the news and social media confusing, scary, and divisive, which intensifies the anxiety they regularly feel. Many of my families are also facing real struggles from the impact of social distancing--specifically, the effects of job losses, food insecurity, and partners and children who have to be home in abusive situations.”
How are you feeling individually about your efforts to serve and support others in light of the additional stress of the pandemic?
STONE: “My main feelings now are gratitude and concern. I am very thankful for technical capability to serve our patients virtually. I am relieved that my organization allowed us to move fast to innovate. I have been thankful for the large number of patients we’ve served virtually in just one month.
“I am thankful Virginia expanded Medicaid benefits so patients can more easily access services, and then rapidly accommodated telehealth. This has provided CVHS with a financial cushion absent for FQHCs in states that never expanded Medicaid. I’m also grateful for having a network of other FQHC behavioral health directors to reach out to and share information.
“I am thankful for federal grants coming in to provide more and better care. I am most grateful that I haven’t been asked to cut my department back in any way.
“But I remain very concerned about patients that we can’t reach now. I haven’t yet had a patient begin care because of losses incurred by the pandemic. I’m not sure what that [will] be like. I want behavioral health services to be available for these people, but virtual registration is not here yet.
“I also am concerned about patients that don’t want us to see what is happening in their lives and may disappear from care, or never show up for care. We know that increased stress, isolation, and unemployment can be factors in increased substance use, domestic violence, child abuse, and suicide. As always, those are dangerous shameful issues people hide.”
LEWIS: “At times, it is very challenging to work in isolation, provide online support that is effective, and juggle the basic needs of my own family. It's certainly been interesting learning how to homeschool children and create a completely new routine for our family! We have both elderly adults and a frontline medical provider in our home, so physical safety has been a daily focus.
“That said, I feel a tremendous amount of gratitude for the safety and privilege that I have in my life. I also feel that it is necessary as a social worker to help others in our community … with safe health practice, seeking equity when possible, sharing our resources with those in greatest need, being patient with high levels of stress (our own and others), and practicing compassion for those who are isolated or grieving.”