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Present at a Distance

CCFH continues all family services via telehealth during COVID-19 crisis

A first-time mom needs to talk about how hard it is to recover from her difficult delivery. A mother of six is dealing with depression, interpersonal violence, and an infant child with a medical condition that causes developmental delay. A nine-year-old who lost her grandma – her primary caregiver – now lives in the uncertainty between a temporary foster home and placement with a distant relative.

CCFH’s mission is to be present with children and families in the midst of such adversities, promoting resilience and restoring health through trauma-informed clinical care and in-home support. In the midst of the COVID-19 crisis, though, we have had to learn how to be present at a distance.

On March 16, CCFH – like so many organizations – moved all its staff to remote work arrangements. This meant discontinuing all in-person client services. Before this transition, though, each program team had begun working on how to provide care and support for families virtually. Within a week, the Urbaniak Clinic and Family Connects Durham were conducting treatment sessions and nurse home visits via telehealth. By the second week, Healthy Families Durham and Durham Early Head Start had also re-established regular contact with most client families. As a result, none of CCFH’s clinical and community-based programs have discontinued services as a result of the coronavirus outbreak.

“There’s no roadmap for doing our treatment models via telehealth,” says Kelly Sullivan, director of mental health services at CCFH, “but we are figuring out how to adapt them as we go along, and our clinicians are doing amazing work.”

As an example, she points to the weekly treatment census, which dropped from 58 to 46 scheduled sessions in the first week of remote working, then jumped to 66 sessions the following week. She also notes that clinic staff have converted all intake documents and trauma assessment tools to online versions, and Spanish translations are underway. As a result, the clinic will soon be able enroll new clients, a capacity that was in doubt at the beginning of the crisis.

Sharon Crews, a home visitor in the Healthy Families Durham program, was one of the first CCFH staff to enroll a new family for services remotely: the mother of six mentioned above. Following a domestic violence report made to social services in December, she and her spouse are still living together and coping with their infant child’s serious medical condition. In their first call, Sharon could hear how desperate the mother was, struggling with morbid thoughts and unhealthy coping strategies. She stayed on the phone with her for two hours.

“That would have been a tough one in person, but especially so by phone,” Sharon says. “We’re connected now, though, and she is so glad for the support.”

The greatest concern for CCFH home visitors like Sharon is the economic insecurity they are seeing in so many families. As businesses have closed or reduced their operations, parents who earn hourly wages are experiencing an immediate loss of revenue. Many who are working are in jobs that cannot be done remotely. Overcrowding in low-income housing makes effective social distancing difficult, if not impossible. Loss of transportation is a reality for those who rely on friends and neighbors or who are nervous about using public transportation, and this affects access to essentials like groceries. All of these factors heighten the stresses families are enduring, which in combination with increased isolation raises the likelihood of child abuse, domestic violence, and other traumas.

CCFH therapists and staff are also coping with their own stress and isolation. For some, the only people they see during the day are their clients. And they all carry heightened concern for the children and families in their care, knowing a child may be seen by no one else outside the family or that they are a family’s only supportive contact.

Despite these concerns and stresses, though, CCFH staff are still able to find the thread of hope running through their work. This comes in part from the fact that programs have continued weekly team meetings for case review and peer support, while recognizing that this new way of working requires them to be more intentional about being in touch for supportive conversation. “We don’t have the informal interactions in passing that we had in the office,” says Sharon Crews, “but the feeling of camaraderie still remains.”

They are also heartened by the way families are responding to virtual sessions and visits. “This has actually strengthened the relationship with some of our clients,” says Anna Pabon, coordinator of the Durham Early Head Start home-based program. “One mother had not responded to us for a month and was on the verge of dropping out, but she had an amazing home visit by phone this week.”

“Parents see now that we’re not going away and they find it so reassuring,” says Sharon Crews. “They have all told me how much it means to them just that I call to ask how they are doing.”

Posted on April 27, 2020