COVID-19 Response

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Steady State Response

Too Long, Didn’t Read

- The State of Utah is beginning a “Steady State” as of March 31st, 2022, which means that many parts of Utah will be opening.

- In response, ERC has decided to hire two new practitioners, use evidence to support the continuation of telehealth work, and consistently evaluate the safety of our community alongside the preferences of clients.

- ERC is concerned about “long COVID” and its potential impact on our practitioners, as we have seen many small practices close because of severe/long COVID illnesses.

- ERC will remain a telehealth-only practice for the foreseeable future.

- Our plan is to continue having discussions in consideration of all the moving parts related to physical safety and COVID-19.

The Full Version

Dear Clients, Colleagues, and Community Members,

ERC’s staff felt it critical to discuss the upcoming change in the State of Utah to “Steady State,” as it goes into effect on March 31st, 2022.

To Our Understanding

What the Utah Steady State means is two-fold:

1. This is not the “end” of the pandemic. The State of Utah is keeping an eye on the COVID numbers with readiness to “ramp back up,” if necessary.

2. Because Utah has “made great strides in fighting the pandemic,” the State of Utah states that we can manage the virus through at-home testing, improving vaccinations, and re-establishing the use of the ICU and hospitals, as COVID-19 numbers continue to decrease.

The State of Utah and ERC acknowledge that in the past two years, the State of Utah has:

- announced an additional 917,000+ cases

- processed more than 9.1 million tests

- administered more than 4.9 million doses of COVID-19 vaccines

- closed schools, and safely re-opened them

The State of Utah reports that “all of the key metrics are moving in the right direction.” Meaning that:

- Vaccines are widely available and hopefully soon everyone older than six months will be eligible to receive the vaccine.

- Treatments are more widely available, and supplies are improving every week.

- Testing is available in the comfort of your own home.

You can find coronavirus information from the State of Utah at coronavirus.utah.gov and health.utah.gov.

What This Means for ERC

ERC continues to operate as a small business that is held to the hospital-level standard of cleaning through the Utah Department of Human Services. Unlike larger businesses that are held to this standard, the cost of cleaning products and personal protective equipment (PPE) creates a specific impact on ERC. The way in which we have managed this, to date, has been to utilize telehealth services, keeping only staff on-site with hospital-level protocols that meet the Utah Department of Human Services’ standard of cleaning.

An additional consideration is that we are facing a national hiring shortage (of therapists) that is impacting our ability to grow as we had over the years before COVID-19. Although the demand for therapeutic services is increasing significantly, the number of therapists we have nationally isn’t meeting the current need by a large margin. With our growth being impeded by the national hiring shortage, it is very difficult to offset the costs of cleaning products and PPE.

Considering that, we are hopeful to find two practitioners who are the right fit for ERC and who can immediately support the growing mental health treatment needs within our community.

What This Means for Clients of ERC

ERC will remain a telehealth-only practice for the foreseeable future.

There is a team within the ERC Team that meets to discuss ongoing COVID-19 concerns and evaluate the safety of returning to face-to-face work. As of the Steady State announcement, this team has asked each of the practitioners to start evaluating the nature of their caseload and preferences of treatment form (telehealth or face-to-face) to inform our collective thoughts.

Each practitioner is in the process of gathering feedback from each of their current clients. To date, it appears that about 1/3 of the ERC caseload would like to return to face-to-face work in the current climate of COVID-19.

ERC recognizes this preference but is currently relying on evidence to support the safety of our staff, clients, colleagues, and larger community. According to several sources, including the American Psychological Association, “telehealth is essentially just as effective as face-to-face psychotherapy—and retention rates are higher.” Retention rates are likely higher due to two pieces:

1. People are at home more frequently, now.

2. Being at home allows practitioners to remind clients that they have an appointment and within minutes, the client can connect with the practitioner. (This would not be the case if clients were commuting).

If you are a current client of ERC, please make your treatment preference (telehealth or face-to-face) known to your practitioner.

ERC is considering physical safety first, and has continued, specific concerns about the nature of what is now being called, “long COVID,” as we have seen many small practices close due to the nature of practitioners contracting COVID-19 in one of its more severe forms.

In Summary

ERC is currently in consideration of the Utah Steady State announcement and what the impact will be, as things continue to open. Ideally, we will keep our staff, clients, colleagues, and community members safe via the pieces that are within our control. For now, the efficacy of telehealth is just as strong as the efficacy of face-to-face sessions, which helps us to stay safe for the longer term. We are still here, though on the other side of a phone or screen, and our intention is to remain here as you need us.

Resources

https://governor.utah.gov/2022/02/22/what-you-need-to-know-about-utahs-new-steady-state-covid-19-response/

https://www.apa.org/monitor/2020/07/cover-telepsychology

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387833/#:~:text=Research%20into%20telemental%20health%20provided%20to%20children%2C%20young,in-person%20treatment%20and%20superior%20to%20treatment%20as%20usual

ERC'S COVID-19 RESPONSE

Updated November 24, 2020

We continue to prioritize the health and wellbeing of our clients and staff. As a result, we will continue to provide telehealth services exclusively until it is determined face-to-face sessions are safe.

We try to stay apprised of changes to insurance coverage for telehealth including cost sharing (copayments, coinsurance and deductibles). Every insurance is different and there have been many changes. Some insurance carriers were covering copayments until September, and others will continue to do so until the end of the year. We strongly encourage you to contact your insurance carrier to verify details and monitor their website for updates.

We will continue to monitor developments related to COVID-19 and provide you updates as applicable (no later than April 2021).

Resources

CDC Mental Health & Coping During COVID-19

NAMI (National Alliance on Mental Illness)

COVID-19 Managing Stress

7 tips for managing coronavirus anxiety and stress

How the Stress of the COVID-19 Pandemic Scrambles Your Brain

What's the Best Mindset to Ward Off COVID-19 Stress?

ERC'S COVID-19 RESPONSE (August 31, 2020)

Effective today, we are extending our plan to provide telehealth services exclusively. We cannot offer in-office sessions at this time. We understand for many of you in-office sessions are preferred, and telehealth is not the same experience. A lot went into this decision and we want to share some of those factors with you. With school starting, there is an increased risk of transmitting COVID-19. It seems prudent to first monitor the rate of infection for the first quarter of school. When we return to the office, we are required to follow strict guidelines for disinfecting our space. This will significantly increase our expenses and significantly decrease the number of clients we can see in a day. As a result, the frequency in which you are seeing your therapist would be negatively impacted. Since we are able to meet virtually, it makes more sense to focus on providing the best possible quality of care via telehealth.

Information on the pandemic is constantly evolving and we will continue to monitor and evaluate new information as it comes in. Similarly, we will do our best to track and keep you apprised of insurance carrier changes to COVID-related policies and procedures. Due to the number of insurance plans and policies, we strongly encourage you to carefully read any updates you get from your insurance company and reach out to them if you have questions about coverage (including telehealth coverage). We will update our continuity plan no later than December 1, 2020.

How to Change Your Mind During Tough Times

Amanda Gonzalez, MSW, LCSW: July 30, 2020

Four Months of Shifts

Since March, the ERC Team has been witnessing, discussing, writing, and vlogging about the COVID pandemic. We have certainly noticed over the last four months that the nature of our work has shifted, which means that the lives of each of you have shifted, too.

We’d like to honor our human experiences, here. And we would also like to offer support with the challenges held during this unique time in history.

Haas, M.D., suggests that “[t]he current [COVID] pandemic . . . is new territory in terms of its nature and scale, at least in modern times.” New territory; this is certainly true.

When we are in new territory, how do we respond?

With cautiousness?

With fear?

With frustration?

Among this new territory, we may find ourselves facing tough decisions and many of them in real time.

Tough Decisions

With summer coming to an end and the timing for a typical school year to start up again, we may be facing tough decisions. Some of these decisions may be impacting us sooner than others and common thoughts may look like:

What will I do about child-care with as many as half of programs closing due to COVID?

What is the safest decision regarding my children returning to school?

What do I do about job changes?

How do I manage job loss?

How do I manage changes with insurance and keep my family healthy?

First of all, we deserve a whole sheet of gold stars! Secondly, we are likely doing better in our decision-making than we think. Meaning: it is likely that during this time, our brains have assisted us with coping by unconsciously changing our perspectives.

Change Your Perspective!

From our friends over at Salty Counseling: “changing [our] perspective is key.” We agree, so . . . how do we do this? Often, intentionally changing perspective is more complicated than we hope, even if we are unconsciously practicing this. So, let’s break it down!

See ya on the flip side!

For many humans, altering perspective and landing on the flip side means thinking something just slightly more helpful. As a result, we become less ego-centered.

When we center ourselves around something larger than our own egos, we begin to have a compassionate understanding of others and the world around us, which in turn, makes us more compassionate to ourselves. Read that again…

Translation? If we loosen our ego grip, we may find ourselves being more compassionate and kind to ourselves. How’s that for a win-win?

So . . . how do we loosen the grip we have on the ego to trick our minds into a perspective shift? Using something called a “perspective lever” (PL), we can “train [our] brain[s] to be less sensitive to negative situations (7 Tactics. . .)” and thus, less ego-centered. The two PLs we will want to know are: time and thinking.

PL: Time

“We humans are remarkably skilled at mental time travel[,]” meaning that we are able to hold thoughts in the present while being aware of the past and the future. In times of great stress, it may be helpful to us to “generate experiences that are, in [our] mind[s], more distant[,] either in the future or the past (7 Tactics. . .).”

An example from Psychology Compass: We have an opportunity to write to our future selves, describing the situation now, as if it has already happened. To make this affective, “rate the anxiety [of the current situation] on a 0-10 scale, describe what is causing you stress, and include how you think the stressors will change in the future.

PL: Thinking

Utilize concrete thinking to assist with reducing anxiety. Concrete thinking is literal thinking that is focused on the physical world and opposes abstract thinking, which can look like thinking about objects, principles, and ideas that are not physically present (Abstract Thinking).

An example from Psychology Compass utilizing concrete thinking:

“List the means of an action (NOT the ends).” Think… intention versus impact.

How: Think about what you did yesterday to complete a specific task. What exact steps did you take to get there? Get specific and “lean in” to really notice what you did.

More on “The How”

“The hills [may not be] alive” in the same way with COVID clouding “the sound of music” right now, but we can still take a cue from the script. Remember the part of the play/movie when Liesel is going through a breakup and she asks her new mother for advice? Julie Andrews’ character offers this, “Well, you cry a little, and then you wait for the sun to come out. It always does.”

Do you see what she did, there? She focused on something concrete and consistent – she used the ‘thinking PL’ to change the way in which she directed her attention.

According to Psychology Compass, “[c]hanging perspective [to redirect our attention] means rewiring the medial frontal gyrus part of the brain. . . the set of the self. It means altering our behaviors and cognition to separate our sense of self from stress. This becomes an effective method for coping with different sources of anxiety.”

Remind me – which button do I push to rewire the medial frontal gyrus part of the brain? Kidding. Let’s explore further.

Rewiring the Medial Frontal Gyrus

Alice Boyes Ph.D. suggests that if we impact the medial frontal gyrus by practicing cognitive restructuring (like using PLs), we may effectively combat common problems like depression, anxiety disorders, and binge eating. She suggests that we:

· Practice noticing when we’re having a cognitive distortion [(thinking error)]

· Evaluate the evidence for/against your thought

· Try [m]indfulness meditation

· Practice self-compassion

Practice noticing when you’re having a cognitive distortion or “thinking error” by calling out unhelpful thoughts. Notice the thought and ask: are there other ways I could be thinking about this?

Evaluate the evidence for/against your thought by asking: is this thought 100% true?

Try a [m]indfulness meditation like “Loving Kindness.” Link here: https://youtu.be/ra8199F1Vfc

Practice self-compassion by offering compassion to others and to the world around you.

Bonus! The Loving Kindness is a mindfulness meditation that is centered around compassion.

Let’s Review

Thoughts: On-Point - Medial Frontal Gyrus Isn’t Acting Up

· When my cognition is on-point, am I doing something differently?

· Like… Using PLs?

· What is my focus like?

· Compassion for a person, pet, or plant?

· What’s my language like?

· “I am okay right now.”

Thoughts: Challenged - Medial Frontal Gyrus Needs a Rewire

· When my cognition is challenged, am I doing something differently?

· Like… Focusing on problems as they are?

· What is my focus like?

· Lacking compassion or kindness?

· What’s my language like?

· “Things are going to suck forever.” Be careful with this one… am/are tells the brain that the thought is permanent. Think: when I introduce myself, I say, “I am [my name]” as opposed to saying, “I feel like [my name].”

Let’s keep our language permanent for more positive ideas like:

· I am one of a kind.

· I am doing my absolute best.

· I am enough.

Deal?

A Tip: Add the language “for now” or “right now” to further combat thinking errors.

Wrapping it Up

Times are as challenging as they feel right now.

We are facing many tough decisions in real time while lacking enough information to make these decisions. Typically, many of us would be spending this last bit of summer by soaking up the Utah heat near a body of water or in the mountains, where the hills come alive with seasonal flowers and local wildlife. This year is different, fears load our ordinary decisions and what was once mindless, even spontaneous, is now ovesrhadowed by risk and benefit analyses.

Over the last four months, we have likely changed. In some ways, our coping skills have been stifled, while in others, we have become increasingly creative, more compassionate, and have found ways to place meaning. Wherever we feel we are at this point in time is okay because we are only there right now, in real time. We hope that we can maintain focus on healthy perspectives, rewiring our medial frontal gyrus (as needed), and being as kind to ourselves and others as is possible. If the kindness isn’t there, reach out.

We are here when you need us: 385.800.3272.

References

1. Abstract Thinking (n.d.) Abstract Thinking [Good Therapy Article Online]. Retrieved from: https://www.goodtherapy.org/blog/psychpedia/abstract-thinking

2. Boyes, Ph.D. (2013, January 21). Cognitive Restructuring: Six Ways to do cognitive restructuring. [Psychology Today Article Online]. Retrieved from:

https://www.psychologytoday.com/us/blog/in-practice/201301/cognitive-restructuring

3. Haas M.D., S.B. (2020, March 11). Covid-19: How to Keep a Healthy Perspective: To beat this pandemic, we need to change how we respond to our fears [Psychology Today Article Online]. Retrieved from: https://www.psychologytoday.com/us/blog/prescriptions-life/202003/covid-19-how-keep-healthy-perspective

4. Wilding, Melody. (2016, April 15). Forget Positive Thinking: This Is How To Actually Change Negative Thoughts For Success. [ForbesWomen Article Online]. Retrieved from: https://www.forbes.com/sites/melodywilding/2016/08/15/forget-positive-thinking-this-is-how-you-actually-change-negative-thoughts/#28a4ceb76c46

5. 7 tactics for overcoming anxiety, by putting things into perspective. (n.d.) 7 tactics for overcoming anxiety, by putting things into perspective [Psychology Compass Article Online]. Retrieved from: https://psychologycompass.com/blog/overcoming-anxiety/

ERC'S COVID-19 RESPONSE (June, 2020)

June 17, 2020

Dear Clients,

We are writing to provide you an update on Empowering Relief Counseling’s (ERC) response to the COVID-19 pandemic. We appreciate your patience with us and recognize COVID-19 continues to negatively impact the health and wellbeing of our community. Our top priority is to provide you appropriate care while attending to the health and safety of our clients and staff.

Unfortunately, the number of cases in Utah continue to grow and, most recently, we have seen a two-week spike in cases. It is important for us to heed the advice and direction of the scientists, epidemiologists, and physicians working to combat COVID-19.

Effective today, we are extending our plan to exclusively provide telehealth services and cannot offer in-office sessions at this time. Information on the pandemic is constantly evolving and we will continue to monitor and evaluate new information as it comes in. We will update our continuity plan no later than September 1.

We are working hard to track insurance carrier changes to COVID-related policies and procedures. Many have extended their telehealth expansion, and some are waiving client cost share. We will do our best to keep you apprised of any changes to reimbursement policies. Due to the number of insurance plans and policies, we strongly encourage you to carefully read any updates you get from your insurance company and reach out to them if you have questions about coverage (including telehealth coverage).

We invite you to reach out to your therapist or anyone on our team if you have questions or concerns. We care and we want to be as supportive as possible even while we are unable to see you face-to-face. We’re here when you need us.

Warmly,

ERC

a word of caution

Through an online discussion with Mayor Jenny Wilson and Blake Thomas, Economic Development Director, Salt Lake County, this morning, we learned some unfortunate news: there are people taking advantage of vulnerable populations, especially aging persons, via scams related to the COVID-19 pandemic. We are disheartened to learn this and are anticipating that our clientele and community will need to express increased caution.

HERE IS WHAT WE NEED TO KNOW

General:

· Be aware of financial scamming (including email scams and contests related to COVID-19 – they are likely scams, too)

· Be aware that most people don’t have to do anything additional to get their stimulus check or their tax return after they have filed taxes; a call for more information is likely a scam

WHAT TO DO

· Stay calm and try to collect information from any potential in-person scammer

· Call your local non-emergency line and speak to a police officer, if you believe that you have been victimized by a scammer

WHAT NOT TO DO

Email:

· Do not click on links that you aren’t familiar with – you can “hover” over the link with your mouse to find out the source; if it is not a trusted source, do not click on it

· Do not open attachments from anyone you do not know

· Do not give personal information to anyone you do not know

Physical Health:

· Do not buy cures, vaccines, or COVID-19 treatments right now

· As approved treatments become available, medical teams will present them to the general public and there will be news coverage confirming approved treatments.

Phone:

· Scammers are also contacting people to report that their friends or family members are unable to pay for COVID-19 treatments; this is not true; do not give any personal information or money to the person on the phone

Home Visits:

· A person may come to your door, stating that they are with the CDC

· They may offer you COVID-19-related surveillance and attempt to step inside your home

· Do not give any personal information or money to the person at your door and do not allow them to come into your home

It is our hope at ERC that our community bands together at this time. Many vulnerable and marginalized populations are at risk simply because of an overexposure to COVID-19 symptoms, paired with a lack of access to personal protective equipment (PPE). Sharing information at this time is a potentially protective measure. If you are in the Murray area, we have listed the Murray City Police Department's Non-Emergency Line below. Please continue to practice safe measures.

We are here when you need us.

*Please note: the list above is compiled by an ERC Mental Health Specialist based on their interpretation of the meeting referenced above and not provided directly by the meeting organizers.*

Murray City Police Department's Non-Emergency Line:

801.264.2673

ERC'S COVID-19 RESPONSE (May, 2020)

May 1, 2020

Dear Clients,

Thank you for your continued support through this difficult time. We care about you and value the opportunity we have to work together. As we transition from crisis to stability, we want you to know we are working hard to make educated and informed decisions about safely moving forward. Our highest priority is to keep our staff and clients safe and healthy.

We are writing to provide you an update on ERC’s response to the COVID-19 pandemic.

Fortunately, through the use of telehealth we have been able to minimize interruption in our services. Effective today, we are extending our plan to exclusively provide telehealth services until June 29. We are unable to offer in-office sessions at this time.

ERC’s staff will work diligently throughout May and June to develop a plan to secure appropriate cleaning supplies and personal protective equipment to safely transition back to in-office work. We will continue to rely on medical expertise in our decision-making process and evaluate and update our continuity plan prior to June 29.

Some clients have expressed concern about returning to the office. ERC’s telehealth services are HIPAA-compliant, were available prior to the pandemic and will continue to be an option for anyone interested after we transition back to face-to-face sessions.

During the pandemic, most insurance companies have amended their policies and procedures to cover telehealth sessions. We will do our best to keep apprised of any changes to reimbursement policies and pass that information on to you. Due to the number of insurance plans and policies, we strongly encourage you to carefully read any updates you get from your insurance company and reach out to them if you have questions about coverage (including telehealth coverage).

Thank you again for choosing ERC. As always, we are committed to providing quality care and want to be of support to you and your loved ones. Please do not hesitate to reach out with questions or concerns. We’re here when you need us.