When director Ekta Kumar and her staff returned to work in January after the winter holidays, Cal Lutheran's Community Counseling Services had no experience with telehealth technology. No online system was in place at the clinics in Oxnard and Westlake Village. But the team of licensed therapists and supervised graduate students had plenty of experience with caring for the hundreds of clients of all ages who came to them to deal with depression, grief, trauma, partner problems and parenting challenges.
As a novel coronavirus spread across the globe and, in March, became a local news story everywhere in the United States, the counseling team's capacity to put caring into action was tested. Public schools in one district and then another were closing. Restaurants and bars shuttered. Doctor and dentist offices were open only for emergencies. Would Cal Lutheran’s low-cost, community-focused, bilingual mental health services have to scale back or shut down at the worst possible time?
"In such a turbulent time, it was critical that our clients continue to receive the care they needed and deserved," recalled Kumar, who has a doctorate in psychology. "We had to have things in place to ensure this."
On March 19, the same day that Gov. Gavin Newsom issued a statewide stay-at-home order, the community counseling centers made the bold and decisive move to provide all services via telehealth video and phone sessions. Clients who were seeing therapists would no longer meet with them in person. Some clients had already stopped coming in, whether out of fear of contracting COVID-19 or due to confusion about what they should do.
"It's a big transition," observed assistant clinical director Patti Yabu. "Many people are reluctant and cautious. Some people feel anxiety about telehealth. Is this the best platform for them? It is hard for people to try it out. Some clients don't even have the technology."
There's also the question of protecting privacy. "We have to ask clients whether they have a space to be able to do sessions privately," Yabu explained. "If you live in a home with a lot of people, it may be difficult to find a private area. Our clients need to feel safe and comfortable while they share their innermost concerns with us."
"So we're trying to make it a little more accessible," she continued. "We have evening hours. I suggested to a mother of three that when her husband comes home in the evening, she can do a session with us while he’s with the children."
To make their own transition, Kumar and her team sought help early in March from Cal Lutheran's Information Technology Services. They embarked on a crash course in everything from synchronous videoconferencing to telehealth-related HIPPA compliance, researched the benefits and learning curves of various online platforms, met with vendors, and set up workspaces.
All that time, the clinics were operating as usual. They finally closed for a week so the graduate student therapists could be trained on the selected telehealth system, working from a comprehensive package of written and video training materials that Kumar produced almost singlehandedly.
"Transitioning the clinics to a telehealth delivery system has been pretty overwhelming and stressful for everyone involved," Kumar admitted in April.
Early on, the team had an overload of information to consider when determining what impact the pandemic might have on the clinics and how they could adapt to protect patients and staff alike. At one point, the Centers for Disease Control recommended social distancing for in-person therapy. Both Cal Lutheran clinics brought in all hands to rearrange dozens of tables, desks and chairs so everyone could stay at least six feet apart during private therapy sessions.
"We were still working on that," Yabu said, "when the news started talking about a lockdown in one place and then another." Lockdowns, of course, meant that no one would be using those tables or chairs.
Against all odds, with less than three weeks to prepare, the counseling clinics found a new way to deliver their full range of services. In the weeks since, the telehealth services have been a lifeline to clients grappling with the escalating impacts of the coronavirus, from sickness to job losses to the loss of loved ones to the illness.
"How people react to stressful situations is specific to them, unique to their life experiences," said Sunayana Kaviya, a licensed marriage and family counselor at CCS. "The client's subjective experience is going to vary from person to person. That's how trauma works. We have to be sensitive to that."
"During this lockdown, people are isolated. And this can intensify a lot of pain," she continued. "We are there for people who feel anxious or sad, because isolation often exacerbates the whole experience. People are apart, we'll acknowledge, but our message is they're not alone. We encourage them to find creative new ways to stay connected."
To make an appointment with Cal Lutheran's Community Counseling Services, call the Westlake Village clinic at 805-493-3390 or the Oxnard clinic at 805-493-3059. Visit CLUCounseling.org to learn more.