SAE Issue Brief: Operational Considerations during the Coronavirus Pandemic

With the urgency in care for vulnerable populations during this current pandemic, SAE understands providers are looking for answers and solutions to continue and possibly grow services to meet the needs of overall population outcome during COVID-19. It is clear that, as providers of care for vulnerable populations, this is not the time to step back. However, the implementation of services and collaboration with new partners must still be critically aligned to your agency’s mission and strengths. At SAE, with prior experiences in emergency management and response to national and local emergencies, our consulting team has implemented direct operational responses to continue and build services. As with all organizational planning and the reshaping of products, there are key components that must be addressed. The following are elements that are forward-leaning to implement services and care during COVID-19. Each element addresses core organizational planning and requires critical clinical and risk management decisions. Communication, structuring, and performing constant reviews of moving parts due to increasing risks and policy changes are necessary. Providers are urged to consider addressing the following critical issues which SAE will discuss over the course of our podcast series concerning the behavioral health system’s adaptation to the Coronavirus pandemic.

  • Leadership — management preparation for service changes to help identify organizational areas of challenges, identify service specific continuation during COVID-19 pandemic, identify new collaborations with external partners to increase or offer internal resources, and resolve decisions/protocol for organizational risk mitigation. Develop workflow for decision-making and roles/responsibilities. Identify an emergency management team with leads for: operational security, health and safety, communication, data integrity and breach security, and employee wellness. Develop action plans, goals, and benchmarks for each emergency management team lead. Assist the team to organize and synthesize internal and external responsiveness for change/accountability with a roadmap for team implementation.
  • Triaging New Services and Business Activities — identify new services and activities responsive to COVID-19 and appoint personnel for leadership with accountability for oversight and management reporting. For example, if new services include teleservices, develop a crosswalk of current to new activities, ensure staffing capability fits with state requirements for the new services, communicate with health plans / payor to ensure fiscal responsibility, and identify quality management indicators for risks to new service implementation. This may include guidance on management reports for quality oversight across operational, administrative, clinical, personal, and revenue elements.
  • Screening and Protocol Development — clinically focused to adapt current internal clinical services to COVID-19 guidance and state requirements. Identifies the protocols for service activity changes (such as teleservices, care coordination of members who are discharged after COVID-19 treatment, and support services like training/voc programs). Activities must also identify clinical concerns such as minimizing trauma for those recovering from COVID-19, physical/health requirements and guidance for the care/referral for individuals with reported symptoms and providing support/wraparound services (such as providing food, medicine, and transportation) for families of those identified with COVID-19. It must address clinical vulnerability issues such as elevated suicide risk, increasing depression/anxiety symptoms, and substance abuse issues or access to buprenorphine. Clinical vulnerabilities would also identify the most impacted population with guided profiling of weighted risk, based on known chronic diseases, general population health indicators, and communities at risk geographically.
  • Communication — development of internal and external messaging on how the organization is addressing COVID-19. Messaging is important as it speaks to awareness, leadership, knowledge, and support. Developing action plans on messaging and identifying internal key personnel is important. The messaging must be consistent and coming from members in the leadership group, as well as possibly from the service community. A key internal statement must be developed for this messaging. A key external statement must be developed as well.
    • The internal messaging must be prioritize:
      • improving staff competency to give them the skill sets to meet health, security and training challenges,
      • providing structure and daily goals,
      • organizing tele-huddles to give support, supervision and decrease sense of isolation while working,
      • giving continued updates on how leadership is addressing risk and security for staff and the organization, etc.
    • Internal messaging has to be determined in terms of pathways of communication and scheduling. It is important to offer emotional support and develop messaging on coping and self-care for staff, particularly with the organization’s Employee Assistance Program (EAP).
    • The external messaging includes continuation of services to clients, other providers, the state/county, and any potential collaborations. This must be developed in alignment with existing vision and presence in the community of service.
      • The client population must be messaged consistently about new service activities, risk characteristics, adaptive behaviors to lower risk, coping skills. They should also be notified of wraparound services and/or offerings of new platform services (such as nutrition while in isolation, re-fresher on first aid at home, guided mediation/ relaxation for biofeedback, narrative journaling, etc.).
      • Coaching may include giving guidance on the use of current media, identifying goals for each activity, and usings new media with assistance on procurement issues.
  • Education and Training — assist identifying and/or developing responsive training for new services/activities (decontamination and safety hygiene, implementing teleservices in secured environment, care coordination of COVID-19 recovering patients, symptom assessment of COVID-19 risk, referral procedure for suspected COVID-19 infection, documentation of services, risks in data breach with hacking or ransomware, changes to HIPPA and information exchange for COVID-19, etc.). Identify and ensure training roll-out of Evidence-Based Practices (stress reduction using CBT, reducing risk for self-harm with EMDR, sleep hygiene assessment, etc.) and federal guidance on services (state-specific implementation of the 1135 waiver) during the COVID-19 pandemic. Identify appropriate separate training rollouts for different levels of contact and duties to each organizational staff member (supervisors, clinical staff, peers, support clerical/administrative staff, IT, etc.). Tracking and management reports for training should be developed for quality oversight and risk mitigation.
  • Data Integration and Security with New Technology Launch — with new or responsive services identified for the COVID-19 pandemic, assist providers to develop a roadmap for new tech-supported functions (patient portals for direct messaging and journaling, teleservice products, cloud storage and secure VPN access, group chat capabilities for staff in-checks and supervisions and huddles, etc.) to track, implement, report, and safely store data with existing or new products. Align organizational IT capabilities with state-specific requirements (store and forward function for teleservices, data integration and CMS billing updated for COVID-19, user security and authentication for remote access to data/cloud server, etc.) and a roadmap for implementation to lessen user burden, in addition to ensuring management oversight and data security.

SAE will continue to provide updates, insights, and tools to respond to the needs of your agency during this pandemic.