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Child / Adolescent - Externalizing

Creative solutions for virtual implementation of an evidence-based treatment modality during the COVID-19 pandemic

(PS4-A22) Creative Solutions for Virtual Implementation of an Evidence-based Treatment Modality During the COVID-19 Pandemic

Friday, November 17, 2023
1:00 PM – 2:00 PM PST
Location: Regency Ballroom, Level 7
Across the country, the COVID-19 pandemic prompted a rapid shift towards the use of virtual therapeutic practices. Although not new, prior to the pandemic, only about 21% of psychologists used teletherapy in their clinical practice. Michigan has been utilizing TFCO to build public mental health treatment options that bridge community-based care with inpatient and congregate care settings. This program serves youth from diverse backgrounds with severe social, emotional, and behavioral difficulties. TFCO is an empirically supported evidence-based practice that utilizes therapeutic foster homes as treatment settings for mental health interventions delivered by a well-coordinated clinical team. Accordingly, it was of great importance to maintain the operation of this program in order to prevent increased hospitalizations of high-risk youth, especially at a time when hospitals were over-taxed due to COVID-19. The adaptation of TFCO to a virtual format (utilizing teletherapy) was challenging because of the intensity of the service and the importance to adhere to program fidelity requirements. Adaptations included utilizing phone calls for verbal de-escalation during emergencies, and planned video calls during office hours in place of face-to-face crisis visits. The program engaged apps, web-based services, and online charts in place of paper reward charts/stickers to stay connected with Therapeutic Homes. Creative solutions such as “screen sharing” and virtual drawing pads to share information and illustrate concepts, create engaging online psychoeducational materials, review homework assignments and complete worksheets in session were included. For skill building, online videos and games and virtual museum visits were utilized, which allowed for modeling online engagement with safe and effective use of social media for youth. Interactive online video games also offered an opportunity for the therapist to model pro-social behavior with the youth while they interacted with other people within the game. The therapists used a graduated approach to engage in these virtual experiences to maximize potential for success, and to reinforce self-esteem and the likelihood of those behaviors generalizing to future contexts. Techniques taught during parent training sessions included engaging youth on video calls and creating videos to share with the youth, with specialized coaching for parents on how to demonstrate parenting skills virtually (e.g. modeling appropriate behavior over video chat). Overall, therapists interacted with Therapeutic Homes more frequently across multiple platforms than before the pandemic. We have anecdotally observed that increased frequency in communication and connectivity with Therapeutic Homes mitigated feelings of isolation and Therapeutic Home attrition, which was a concern during the pandemic. This paper outlines clinical adaptations, based on cognitive behavioral principles, which allowed for virtual treatment continuity that was both safe and effective during the COVID-19 pandemic.