Onward Transitions Chief Clinician Darrell Fraize, M.Ed., LCPC, LADC spoke last week on a Zoom Conference Call coordinated by Embark Behavioral Health with over 200 professionals, on the steps for continuing services to clients by implementing Telemental Health Services (TMHS.) Fraize spoke on the model’s evidenced-based effectiveness for some clients and highlighted briefly that for others, TMHS may not be as helpful.

“Parents are faced with an even bigger dilemma right now when trying to help their children living with mental health challenges,” Fraize stated in a follow-up question and answer session. “We are beginning to see them fall into one of two ‘camps,’ if you will, that at their heart are about safety. Camp A is that for whatever valid reason, the parent believes that sending their child to residential treatment or a supported apartment program is the safest thing for them to do. Camp B is, again for whatever valid reason, the parent believes that keeping their child home is the safest thing for them to do. But even for those in Camp A, who are in residential treatment, the likelihood for utilizing TMHS is going to increase as programs insulate their campuses by keeping only essential staff on the premises.”

For families and clients looking to join Camp B, Fraize points to a number of recent studies that advocate for the early adoption of TMHS upon returning home from a program or college. “We know that the recommendations for those living with mental health challenges is that now is not the time to stop treatment¹. Additionally, keeping up routines and staying connected to supports – and specifically peer supports – is critical. Synchronous, online communities can provide a safe alternative for the face-to-face interactions clients are going to need²,” he continues. “And obviously getting ahead of a relapse back into old, negative behavioral patterns by staying engaged in treatment is optimal.³”

“At Onward, we are providing HIPAA-compliant individual, group and family therapy in our G-Suite, and our overall community attendance is up. What our members seem to really enjoy is the structured day that our 50+ hours of synchronous online coaching and social programming provides for them. Keeping young people engaged is critical, and we and other online programs are designed for Group B. Providing a forum for like-minded peers to congregate and drop into is a great tool. Whether it’s a young adult stepping down from a higher level of treatment, looking to continue in a therapeutic milieu, or a college student who has returned home seeking out a supportive network, TMHS can help.”

Fraize suggested that parents seeking residential treatment perform the role of collaborator and consultant while their children are out of their home. The program staff perform roles that control and direct the treatment of primary acute or chronic, moderate to severe mental health issues with controlled accountability in their physical environments. By contrast he sees parents investigating TMHS as “space-givers” and stand-by supporters with their at-home children. The staff in online programs guide primary or continuing care for individuals with mild to moderate mental health issues, and encourage accountability through structured programming and support. “The lack of social connection is mitigated in both camps; however Camp B still retains the ability to opt-in or out of sub-cohorts or the group altogether when they need a break, or to connect with any of their pre-existing social networks” he adds. “This way, Camp B supports maintaining the prosocial connections that young people have and would worry about losing.”

“Some parents are surprised by the amount of services beyond therapy that can be delivered online, like living space consults, wellness consults, educational coaching, vocational coaching, meal planning, and social forums from discussion groups, to virtual dinners, to hosted trivia events and jackbox games. They want their children home with them, or in their own apartment, and they don’t want them to get lonely or for their symptoms to get worse.” Fraize adds.

“Each camp is going to benefit a particular type of client, with some overlap,” Fraize adds. “For young people with acute symptoms and major mental illness, getting into residential treatment is likely the best option for mitigating their moderate to severe symptoms. For those who have more of a lingering, sub-acute or moderately chronic form of depression, anxiety or PTSD,^{4, 5} TMHS has been shown to be effective.” Fraize recommends families seek out TMHS including online intensive outpatient communities should they and their child choose to shelter-at-home while seeking mental health treatment.

References:

1. https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
2. https://www.nami.org/getattachment/Press-Media/Press-Releases/2020/COVID-19-and-Mental-Illness-NAMI-Releases-Importan/COVID-19-Updated-Guide-1.pdf
3. https://www.apa.org/news/apa/2020/03/covid-19-research-findings
4. https://www.unmc.edu/bhecn/_documents/evidence-based-telemental-health-with-cover.pdf
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723163

About Onward Transitions

Onward Transitions (OT) in Portland, ME is a small, independent, owner-operated program for bright, motivated, emerging adults in the final stages of learning to live on their own. OT supports actual sustainable independent living and autonomy from two city locations. Participants (members) ages 18-29 never live with us; they live in their own apartments, scattered throughout the city. Members’ challenges include anxiety, depression and executive functioning.