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Taking care of clients during “Stay at Home” order

Over the past couple of weeks, I have been receiving a number of inquiries from interventionists, clinicians and recovery specialists about whether or not to see clients and/or travel when asked to do an intervention or a companionship. I have put together a brief response and hope that it will be helpful.

We have to consider:

  • Two levels of providers:
    • Level I: If you are a licensed physician, nurse or emergency or frontline service provider, or
    • Level II: Non-frontline nonessential level services (interventionists, addiction counselors, counselors, recovery specialists, etc.) and these are the majority of the queries I’m receiving, so this is the group I’m going to focus on:
  • Level I: For the first group there’s very little choice because, typically, the answers are very clear according to workplace and responsibility level. This group is generally working for healthcare services and would need to negotiate with their employers if they themselves are at high risk and should not be on the frontline.
  • Level II: For those at level II, the first question to ask is whether the service can be provided virtually. If it can, then follow the quarantine ruling of your state. Do not cross state lines unless it’s absolutely essential. This is a time for humility and creative service. Forget about competition and how good you are, and that no one else can do as well as you or your favorite program across the country. Start compiling a list of local clinicians, interventionists and programs. I have done many virtual interventions, not meeting my client and family until they are settled into treatment and sometimes only after discharge. We all have the training and skills to provide our best services online.  We can  coach the family through some of the activities that we would typically do live, as we continue to support them and our Person of Concern (POC) through this challenging time. Over the years, I have found both my immediate and long-term results to be the same, whether the service was provided in person or online.

Decision Steps:

  • 1st rule of thumb: Safety for all. If at all possible, stay home, safe and quarantined, so you can serve many other people in the future while keeping yourself, your family, your clients and their families safe. You will also be contributing to the decrease in spread of this potentially lethal virus.
  • Before agreeing to travel: 
    • Assess acuity: If extremely acute, refer to their local emergency room and have the client and POC sign a release of information (ROI) for the emergency room personnel to be in direct contact with you.
    • Check locality: If not acute, is it possible to provide the service on HIPAA- compliant video conference? If yes, go ahead and provide the service online with all your usual skills and paperwork. If admission is needed, refer to a local facility and collaborate with them as usual. Honor the first rule of thumb: Safety for you, your family, your client and their family.
    • If the client refuses virtual assistance or signing an ROI and is not acute, I personally would not agree to work with them, and would refer elsewhere. If the POC is reluctant to work (or join the group) virtually, use your engagement skills and coach the client and other members of the support system to invite the POC as you would if this were live. Remember that you have the skills, and this is just applying them through a different delivery system.
  • Providing service on-site:
    • If you are already providing on-site service as a live-in companion, the best way to protect everyone is to stay right there. If you need a break, try first to arrange it on-site. Find a quiet space. If your client can safely be alone for several hours at a time, this is a lot easier. If you are in a family situation, is there a family member, or other member of the support system, who could be trusted with your client and would be prepared to provide you with a regular 2-4 hour break? If you are alternating with another companion (something I would not recommend at this stage of the pandemic), careful consideration will have to be given as to how both of you will maintain quarantine and safety during switchovers. The risk in a situation like this is potentially to three families (yours, the other companion’s, and your client’s family) who in turn are at their own risk. A changeover would exponentially escalate everyone’s risks.
    • If you are providing in-home therapy, counseling or coaching, switch to a virtual mode.
  • If you are asked to provide a new on-site service, your decision-making has to be very deliberate. You are being asked to put yourself at risk at a time when people are being asked, very firmly and with convincing rationale, to stay at home. Do you have a family? How many people will you be putting at risk? Given the current lack of testing, do you know whether you have the virus and might be putting the clients at risk? Again, if you choose to put yourself in this situation, please be aware of the risks. If you have any underlying condition that puts you or your immune system at risk, I would not recommend your taking this risk. If the situation in which you are being asked to serve is truly “life and death,” there are facilities that are staying open for service with residential or in-patient programs. They are effective and safe and will not put you and your loved ones at risk.
  • Providing virtual services safely and effectively: There are several HIPAA-compliant services that are designed to meet all our confidentiality needs so we can practice virtually.

Please stay safe and healthy and maintain all your connections to loved ones, friends and colleagues. We have put several resources for you on our Facebook page. I hope these are helpful. I am also including a useful link for decision-making. This was developed by Al Jonsen, PHD Former Chair of Medical History and Ethics at University of Washington, a four-box model for decision-making that I have found very useful over the years.  The link to a PDF is below as a citation here.

Sala Gahle (stay well),
Judith

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