Patients, Doctors Adjust to Telehealth Amid Social Distancing

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Dvora Entin sitting on a couch
Dvora Entin: “I tell my clients, we’re switching spaces today. I get to sit on the couch.” (Courtesy of Dvora Entin)

Telehealth is nothing new to Dvora Entin.

Entin is a nationally recognized specialist in maternal mental health, based in Bala Cynywd, who focuses on women experiencing infertility, postpartum mood and anxiety disorders, complications in the aftermath of pregnancy loss and other challenges related to pregnancy and childbirth. Her services are sought after to the degree that prior to the outbreak of COVID-19, which has prevented her from being able to see clients in person, she was already videoconferencing or even calling 75% of her clients, many of whom contact Entin from out of state.

Even so, for clients newly introduced to telehealth, it can be a bit jarring if they’re not used to it. Entin addresses the issue with humor.

“I tell my clients, ‘We’re switching spaces today. I get to sit on the couch,’” she said with a laugh.

Entin, like many mental health professionals today, is adjusting to the new obstacles in providing care to her patients during this period of social distancing. It works now, in part, because certain HIPAA regulations relating to privacy have been temporarily eased.

“I think that every one of us are trying to just really meet the clients’ needs in a very chaotic time,” Entin said.

Before the crisis, according to Robin Axelrod Sabag, assistant director of counseling and therapeutic services at Jewish Family and Children’s Service, JFCS mental health professionals were serving about 140 individuals in the Greater Philadelphia area. Programs included counseling for individuals 60 and under, another program for those 60 and above and a third program for suicide prevention and intervention.

“With this new reality that we’re focusing on,” said David Rosenberg, JFCS senior vice president of programs and strategy, “we’re looking to do more remote counseling with our clients.”

Staff who are typically assigned to other areas are being trained to direct new clients to the appropriate services, and JFCS will post daily videos with meditation tips and anxiety reduction methods, recorded from different staff members’ homes.

Like Entin, JFCS is navigating the new telehealth landscape created by the loosening of HIPAA restrictions. According to Sabag, there are typically constraints on which videoconference methods can be used for telehealth, due to privacy concerns.

But now, with the inaccessibility of in-person sessions, “any non-public facing audio or video platform may be used to provide telehealth services such as FaceTime, Facebook Messenger video chat, Google Hangouts and Skype” are all fair game, she said.

JFCS staff is opting for Zoom. It’s not exactly the same as face-to-face interaction, according to those interviewed, but it’s the best option available.

Speaking of face-to-face: Those who use Zoom or a similar application, according to Entin, will be looking at a small inset of their own face at the same time they are speaking to their client. Such close study of her own face mid-session, Entin said, has given her insight into how she might better shape her facial reactions to her clients’ needs.

Davida Vogel is a third-year student in Widener University’s graduate clinical psychology program, pursuing a combined doctor of psychology degree and an MBA. Over the past year, she’s been doing psychoeducational testing at a high school in Media. On Widener’s campus, she’s seen clients for therapy sessions and executive leadership coaching.

The former has stopped completely. But the latter continues, via remote, secure video platforms.

“It is a little odd,” Vogel said, “but for the clients with whom I had already been able to develop a rapport, moving to online is a little less weird than for clients that I’m just about to start with.”

One worry for Vogel is that some clients may not be able to find a quiet, secluded place for a telehealth session in their newly crowded homes. She’s heard of professionals who have directed their child clients to go and sit in the family car, for privacy.

Though Zoom and other videoconferencing apps can’t create a perfect facsimile of the therapist’s office, connecting clients to their therapists is an important way to keep anxious individuals close to their old routines, Entin said.

“Even if it’s not in-person, face-to-face interaction,” Rosenberg said, “that telehealth allows us to check in with people and keep them connected and let people know that we’re here and we care about them.”

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