The clinic opened last summer to help children and families dealing with medical trauma. Then a global pandemic happened.
Two years ago, clinicians from Texas Tech University and the UMC Children's Hospital teamed up to start a clinic that could help children and their families dealing with the psychological effects of a medical trauma. Because many of the patients they hoped to help were from outside Lubbock, they made a plan to add in teletherapy once the face-to-face clinic was up and running.
They couldn't know it at the time, but a global pandemic would soon make that plan essential to providing services to patients in Lubbock as well.
As a Level I Trauma Center, UMC Children's Hospital wanted to improve its abilities to assess and prevent post-traumatic stress disorder (PTSD) among pediatric trauma patients. To that end, UMC reached out to Texas Tech's Couple, Marriage and Family Therapy program and Department of Psychological Sciences.
"We get a lot of children who come from regional areas," said Dr. Brian Payne, chief medical officer for UMC Children's Hospital. "We've seen that these families have a significant, increased risk of getting PTSD and acute stress disorder. And as clinicians, we wanted to see if there were some ways we could address that."
Family therapy and psychology doctoral students have been working in the hospital to conduct initial screenings and psychoeducation, and offer services to families of children hospitalized due to medical trauma. But they soon realized that, in order to really prevent PTSD, they needed to offer interventions following discharge.
"We were exploring ways to provide services to the families after they left the hospital," said Dr. Douglas Smith, a Licensed Marriage and Family Therapist (LMFT) and associate professor in couple, marriage and family therapy. "Dr. Payne worked with UMC, and they donated space to us in the Medical Office Plaza to start a clinic, the purpose of which was to provide ongoing treatment to the pediatric trauma patients and their families."
The clinic also would be open to referrals from the medical community, so any child or family dealing with medical issues, or who had been referred by a doctor, could get help there.
"'Medical trauma' has a broad definition so we can meet the needs of a variety of families facing circumstances that may be common or less common," said Dr. Nicole Piland, LMFT and an associate professor of practice in couple, marriage and family therapy.
The traumas addressed through the clinic were originally envisioned in two ways. The first was more external, where an outside force causes trauma, such as vehicular or other types of accidents that result in serious injuries and emergency care. The second was more internal to a family's functioning, Piland said, such as the trauma resulting from abuse, neglect or a family member's suicide attempt.
The Children's Behavioral Health Clinic officially opened in July 2019, offering face-to-face therapy beginning in August. To address the needs of those trauma patients who lived outside of Lubbock, the clinic planned to add teletherapy services later, once the in-clinic operations were well established.
After emerging in China in late December, COVID-19 spread around the world, coming ever closer to Lubbock. In March, the Texas Tech campus closed in response to the global pandemic, along with businesses deemed nonessential. Communities across the country implemented stay-at-home orders.
Piland said it presented a type of medical trauma they'd never considered. On top of the stress and uncertainty many people are experiencing is the deeply personal impact for the family members of people infected with COVID-19. This is just as true for parents afraid for their immunocompromised child and for children dealing with a caregiver or an older family member's illness.
"This could definitely create some traumatic experiences for families," Piland said. "In cases where the patient is not able to overcome the effects of the virus and ultimately dies, the families can be greatly affected. It could be a parental figure that dies as a result of this virus, and the loved ones are not able to even be bedside and supporting them. Or, if they are, it's going to be through a virtual means, like a cell phone or an iPad, to have their final goodbyes. That in itself can be another layer to the traumatic death they're experiencing of their loved one."
In response to these anticipated mental health needs, Piland, Smith and the other clinicians behind the Children's Behavioral Health Clinic decided to make teletherapy their priority.
"We actually had just finished getting some teletherapy capability in place in the clinic itself, but with COVID-19, we've had to totally change our delivery model," Smith said.
"We really had to scramble to completely transition to a telehealth service delivery. Now all the services we're offering are done by telehealth – they're done not from the physical clinic space at all, but from our therapists' homes. Our therapists are reaching out using privacy law-compliant telemedicine platforms to provide services from their homes to the clients' homes."
The clinic has hit a few snags by transitioning to teletherapy so rapidly, but its leaders didn't let those issues get in the way of fulfilling its vital role.
"We're still working out challenges around how we process payments and things like that, but honestly, we decided to move forward," Smith said. "Right now, we're not charging anyone anything until we get the payment system worked out. We decided it was better to maintain client care and not worry about the financial aspect of it."
Making a difference
The Children's Behavioral Health Clinic's administrative operations previously were handled through the Family Therapy Clinic, part of the Couple, Marriage and Family Therapy graduate degree program. Since they're both now fully online, they are, effectively, one clinic. As such, all graduate-level clinicians are available to help clients – and they're going all in to help anyone they can.
"Prior to this, we would work with any family that has a child who could potentially be affected, but we've even relaxed that," Smith said. "At this point, we're just providing services. So even if someone who didn't have a child needed help or there was an issue that wasn't child-related, we're not going to turn anyone away at this point in time. The only exception is serious safety or mental-health issues that would require inpatient treatment."
Once payments are available online, fees will be on a sliding scale based on each family's income. But Smith notes that they understand families may be struggling with the economic impacts of COVID-19 on top of everything else.
"We won't turn people away," he said. "If someone could legitimately only pay a small fee, we would work with them. We won't deny people services based on financial issues."
The clinic has decided to continue offering free services for one particular group being hit hardest by COVID-19.
"We plan to offer free services to health care providers who are directly affected by the experiences of the coronavirus outbreak and pandemic," Piland said. "We will prioritize our services to meet their needs because they are giving to the community during such a critical time."
The mental-health impacts of COVID-19 vary by individual and situation, but people already suffering from mental-health problems may be at greater risk now.
"There's a general level of anxiety and stress everyone's experiencing, faced with a new situation where the parameters are kind of unclear, no one's sure how long this is going to take and what exactly it's going to look like," Smith said. "For people who are already suffering from anxiety or depression, that raised stress level can make it harder to cope with the depression or anxiety."
Relationship conflicts and issues with children acting out may become more likely as families spend more time together without relief. Domestic violence also is likely to increase.
"And then, of course, there'll be the direct effects as cases increase and people start to be directly affected, either knowing people or having family members who are affected by COVID-19," Smith said. "There will be increasing stress with that and issues with grief, loss and bereavement related to deaths associated with COVID-19 as well."
Smith noted that many of COVID-19's mental-health impacts are not yet apparent in this area – but they will be in the coming weeks and months.
"We're sort of in the beginning stages of things," he explained. "Even though it's been stressful, it's only been a few weeks. I would anticipate we'll start to see more challenges related to emergent mental-health issues as this progresses.
"The longer the stay-at-home orders and things are in place, the more demand we'll start seeing for mental-health services."
'Blessing in disguise'
While it may sound like only dark times are ahead, the timely creation of the Children's Behavioral Health Clinic presented an opportunity that otherwise wouldn't exist now, when it's so badly needed.
And COVID-19, while obviously not a situation anyone would have hoped for, presented an opportunity to improve the clinic's offerings for the future.
"In some ways, it's quite the blessing in disguise, if there can be one under these conditions," Piland said. "We had this global idea of not only working from face-to-face to doing teleservices, and because we've been under stay-at-home orders, we've actually been able to place all of our energies into getting our teleservices up and implemented."
The clinic will resume face-to-face therapy sessions after stay-at-home orders are lifted, but Smith called its transition to telemedicine the "silver lining" of a very dark cloud.
"COVID-19 forced us to transition to telemedicine faster than we had intended, which will improve our ability to reach more people even once this is all over," Smith said. "That capacity won't go away, we'll still have it, so that will definitely improve our ability to provide services to people from greater geographic distance."
For more information about the Children's Behavioral Health Clinic or its services, call the clinic at (806) 742-3074.