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Getting back to the office after sheltering from home involves a number of important decisions. In the short post below, Telehealth.org offers you a checklist of questions to consider as you prepare to re-enter your workplace when the time comes.
An essential part of the planning process is to create a workable plan, one that highlights the things that are important to you, your work and the people who trust you with their care. A workable plan getting back to the office focuses on ideas that are practical and that build on one another. Setting yourself up for success with incremental steps to take between now and then will help support a smooth transition back into your physical workplace.
Practical Checklist for Getting Back to the Office
At the forefront of most people’s minds during the COVID pandemic is safety. How do you plan to keep yourself safe? How do you plan to keep your clients and patients safe from you, as well as other people in your office or your building?
Considerations for getting back to the office are grouped below for your convenience. Please feel free to add more in the comment section at the bottom of this page if other thoughts occur to you. Telehealth.org will keep this post online for you to check every now and then for more ideas if you like.
When considering all-around safety issues fore getting back to the office, here is a checklist of questions that you may want to ask yourself:
FOLLOWING THE RULES
Do I know the most up-to-date CDC guidelines for safety? Here is the link to the CDC guidelines.
Do I know the most up-to-date orders from my state’s Governor? (In addition to the Governor, consider your county’s or city’s Department of Health recommendations and meet or exceed those standards as they may differ from those for other parts of your state.)
How will I keep my office clean? How often will I clean high-touch areas like doorknobs, chair arms, light switches, etc.?
How will I manage the discussion around wearing masks, especially if my client/patient does not want to wear one?
Is my office set up to allow for social distancing?
Some therapists are ordering plexiglass shields to wear, install around their chairs, or to put on their desks after rearranging their office furniture to protect everyone involved. What are the pros and cons of taking such measures with the people whom I serve?
DEVELOPING PRACTICAL PROCEDURES WHEN GETTING BACK TO THE OFFICE
Will I adjust my schedule to allow for breaks in between sessions to prevent having more than one client at a time in the office?
How and where will I document my safety procedures?
Do I need to re-evaluate my required paperwork to include a signed waiver, release of liability, and assumption of risk agreement from each person, including signatures by parents or legal guardians on behalf of children?
Who can I contact in my local professional community to get a sense of local norms?
ARRANGING YOUR OFFICE SETUP
How do I arrange my office to maintain social distancing?
Will I take everyone’s temperature? Do I have the proper equipment? Where would I take this reading?
What do I say to people in my office who are disregarding social distancing requests and potentially put others in harm’s way?
MANAGING CHILDREN WHEN GETING BACK TO THE OFFICE
How will I address questions about bringing children to sessions if my policy has previously been not to allow children to be left alone in the waiting room?
How shall I best intervene if children are not complying with parental limits when parents are in session with me and the children are waiting?
ADVANCING AND RETREATING GRACEFULLY FROM TELEHEALTH
If I move forward and later decide it was ill-advised, how will I retreat to telehealth? Should I offer a week or two of in-office contact to see how I feel about it before offering a full return to in-person care?
If I retreat from in-person care after a few weeks, have I said disparaging things about telehealth? If yes, how can I then reasonably return to telehealth if needed?
What can I say or do to foster trust in my decision-making as I figure this out?
Regardless of how you answer these questions and manage your responses to them, it is important to have direct conversations with your clients prior to getting back to the office so that you are all prepared for the changes in the environment, both physically and emotionally. It is important to encourage open communication as issues arise around having to navigate through unfamiliar circumstances. By encouraging open communication, you are providing a safe space to address creative ways to manage change and potentially challenging experiences.
Self Care When Getting Back to the Office
While it is important to manage change and potentially challenging experiences for your clients, it is equally important to ensure that you are taking care of yourself, not only during this time but also throughout your clinical work. A consistent focus on self-care supports your ability to present your best self to your client and to yourself. There are many examples of self-care that are as diverse as each individual. It is important to find something that you enjoy and that allows you to disconnect from technology in some way. Some people like to read, journal, take walks, bake, or do puzzles. Others like to run, take pictures of nature, scrapbook, or play board games. Do whatever gives you joy and peace.
Telehealth After Getting Back to the Office?
Consider your experiences with using telehealth so far. If you are enjoying using telehealth in your practice, you may want to consider using that modality as you move forward with your work. Maintaining a positive attitude about your telehealth options will not only help you become increasingly comfortable with the use of technology in your work, but also help your clients to become open to creative options in their work with you. Please reach out to us for more ideas on how to do use telehealth as the primary modality for your clinical work.
Introduction to Telehealth Theory & Practice
Enjoy a fast-moving overview of telebehavioral and telemental health. Understand the key points related to telehealth clinical, legal, ethical, technology, reimbursement, social media and other pivotal issues.
My biggest concern returning to my office is the lack of ventilation. While I have huge floor to ceiling windows, they are old
and unable to be opened. MY air-conditioner is also old and inadequate. I am working on all of this with my landlord.
While this may not be applicable to other’s situation, should checking adequate ventilation and air circulation in the office be
added to the list.
Mindy, Indeed, ventilation is a big issue, especially when you sit in the same room hour after hour. It just isn’t safe for anyone. Waiting rooms are also difficult to ventilate in some buildings. The lack of easily sterilized surfaces is another concern that I hear a lot these days. Most therapists work in cushy-type offices, with fabrics that cannot be easily cleaned after every client or patient.
When you do play therapy or sandplay therapy you also have “things” that have to be cleaned. I have a sandroom full of miniatures. Someone said to me if a person were to cough in there I would have to clean everything or leave it sit empty for 3-5 days. If folks where a mask does that take care of the concern?
I would refer you to the Center for Disease Control website, where proper procedures are outlined. To my limited knowledge, I would imagine that a mask will not prevent someone from spreading the virus through their hands when touching your sand play objects. Perhaps it would be wise to make sure your clients or patients wash their hands carefully whenever you decide to resume in-person services? And do you have a regular routine for how and when you clean your toys?
Does anyone else have any ideas for Barbara?
Thank you for this post. It’s very helpful as I contemplate how I want to respond to reopening my in-person practice. I have found that telemental health suites me very well for many reasons. I am seriously considering not doing in-person sessions anymore, but worry if it will work post-pandemic. Until now, I would never have thought that this would be a direction for me to go in. Is it realistic to have a full-time telehealth practice from home, not have an in-person office? I have taken CEs from Person Centered Tech and Star Telehealth and am in the process of taking the NBCC test to get board certified in telemental health. I would like to take some of your courses as well, as you seem to have a more provider sensitive approach plus a depth of experience and focus on direct to client issues. I could use some grounded, realistic encouragement. Portland, OR
Thank you for your kind words. To see how we are different from other training groups, you may want to look at TBHI’s FAQ for a question that explains several key points of differentiation. In short we offer quite a bit more in many directions.
In response to your question about providing services from home, yes, absolutely that is possible. Actually, most telehealth professionals traditionally work from their homes for one reason: they can. The only thing stopping more professionals from doing so is if they work for an employer who mandates otherwise. We developed a webinar a few years back that gives details of why working from home is both legal and ethical. It is called Telepractice from Home.
Can you please elaborate on the complexities of providing in home psychotherapy to children and families safely, that is, when you cannot modify the environment as you do for outpatient. Any experiences, helpful hints shared by other providers of in home psychotherapy?
Thank you for this important question. Indeed, there are many telehealth resources to work with children and some also include adolescents, and they can be adapted to work with children at home. I haven’t seen any published since COVID but they might be out there… Meanwhile, I’d encourage you to get the full articles listed below through a free PubMed account, which will get you into the National Library of Medicine. If you are not an academic, you can access using a Google login: https://pubmed.ncbi.nlm.nih.gov/28930496/
Once inside, you will see these options:
Myers K, Nelson EL, Rabinowitz T, et al. American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents. Telemed J E Health. 2017;23(10):779‐804. doi:10.1089/tmj.2017.0177
American Telemedicine Association Operating Procedures for Pediatric Telehealth.
McSwain SD, Bernard J, Burke BL Jr, Cole SL, Dharmar M, Hall-Barrow J, Herendeen N, Herendeen P, Krupinski EA, Martin A, McCafferty D, Mulligan DA, North S, Ruschman J, Waller M, Webster K, Williams S, Yamamoto S, Yeager B.
Telemed J E Health. 2017 Sep;23(9):699-706. doi: 10.1089/tmj.2017.0176. Epub 2017 Aug 22.
PMID: 28829680 No abstract available.
Mental health services for children and youth: a survey of physicians’ knowledge, attitudes and use of telehealth services.
Cloutier P, Cappelli M, Glennie JE, Keresztes C.
J Telemed Telecare. 2008;14(2):98-101. doi: 10.1258/jtt.2007.070815.
PMID: 18348757 Clinical Trial.
Telemental health: a new collaboration for pediatricians and child psychiatrists.
Goldstein F, Myers K.
Pediatr Ann. 2014 Feb;43(2):79-84. doi: 10.3928/00904481-20140127-12.
PMID: 24512157 No abstract available.
The effectiveness of telemental health: a 2013 review.
Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM.
Telemed J E Health. 2013 Jun;19(6):444-54. doi: 10.1089/tmj.2013.0075.
PMID: 23697504 Free PMC article. Review.
A Review of Pediatric Telemental Health.
Nelson EL, Sharp S.
Pediatr Clin North Am. 2016 Oct;63(5):913-31. doi: 10.1016/j.pcl.2016.06.011.
PMID: 27565368 Review.
Carol, Although engaging parents has its own challenges during COVID, they sometimes can be engaged to help you set up the room with not only toys and such, but multiple cameras in the form of cell phones, tablets such as pads. They also might use a laptop and/or a desktop computer to give you multiple viewing angles at being and working with a child. The issue is that a healthy child is not likely to sit and look into a camera for a full session.
What you can do is send your video link to the parent, who opens that link with multiple devices, then sets up each of those different devices (assuming they have multiple devices in their home), and point the device in different strategic angles to allow you to more fully see the child as they move around a room. Only one microphone can be enabled along with only one speaker, or horrible feedback may frighten the child. You may want to practice this set up ahead of time to get it down right, but if you let yourself think outside the box, many things are possible. Engage them in creative thinking if you can.
Of course, if multiple devices are not available, if the parents cannot control and work with their own technology, if they can’t grasp the concept of multiple cameras, if the room is too big for a child’s voice to carry to a single microphone, and if you cannot practice the setup ahead of time for whatever reason, it probably won’t work. Telehealth cannot remedy all COVID problems. We have to pick and choose where to go and how to approach such complex situations.
Does anyone else have an idea for Carol?
Excellent, very thorough resource for transitioning back to the office! I will share this with my colleagues.
Your comment is appreciated, Poonam.