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COVID-19 in Primary Care: Behavioral
Health Cases and Discussions
July 8, 2020
CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.
2
COVID-19 in Primary Care: Behavioral
Health Cases and Discussions
www.healthywilliamsoncounty.org
COVID-19 in the U.S.
2,983,961 cases on 7/7/20 –
131,268 deaths https://coronavirus.jhu.edu/map.html
Upward trend in cases
June
COVID-19 in the U.S.
2,983,961 cases on 7/7/20 –
131,268 deaths https://coronavirus.jhu.edu/map.html
Upward trend in cases
Upward trend in testing positivity
News updates
• USA to pull out of the WHO?
– July 6, 2021
• Brazilian president – Bolsonaro
tests positive
• “Can’t completely rule out”
[aerosol spread]
Dr. Anthony Fauci
News updates
• Dr. Fauci (7/6 interview NBC news):
–“Simple things”
• Masking
• Physical distancing
• Washing hands
• Closing bars
– Vaccine candidates entering clinical trials: End of July,
August, Sept
– Vaccine manufacture starting: Large number of doses
ready by Winter 2020; early 2021
Resources
• Nuvance
health:https://spark.adobe.com/page/qrH7iY0Gi0hU9/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/
COVID-19 in Primary Care: Behavioral
Health Cases and Discussions
Tim Kearney, PhD
Chief Behavioral Health Officer, CHC, Inc.
Jessica Welt, PsyD
CEO/Clinical Director, Child Guidance Center of Southern CT
Shari Fanelli, MS, LPC, ATR
Intake Director, Child Guidance of Southern CT
• Four months ago COVID crept into the Northeast and we
soon spiked in NYC and New England
• CHCI has been delivering remote BH by video and phone
since early March 2020
• As people have acclimated to the changes brought about
by the virus, the themes and issues in treatment have
changed.
– In the Northeast, the emergency feel has decreased - now
about how to deal with life in the new reality
• For some, new situations have improved BH issues; for
others - exacerbated them
10
Setting the Stage
Setting the Stage
• BH issues are affecting both people with and
without pre-existing mental illness
• BH needs are moving to the forefront due to
the heightened level of arousal; we anticipate
BH challenges continuing well after the
pandemic subsides
• We invite you to discuss BH care that you
provide, raise questions, and share insights
11
Pediatric Case # 1
• 15 year old client
• TFCBT treatment due to victimization of a sexual
assault
• Heavy parental involvement
• Family is now in narrative component; however, just
prior to moving to this component experienced the
rapid death of her godmother due to COVID
• Treatment focus shifted for a few sessions to grief
work, and processing things that were in family’s
control verses areas out of control
12
Pediatric Case # 1
• This client had experienced 2 major losses in her life,
so in tying the TFCBT model back in treatment, she was
able to continue to explore themes of loss and how
losses impact client/parent functioning.
• Last week, while clinician was with client for session
mom got a call that her work was shutting down and
she would be unemployed.
• Took a session to shift out of the model and focus on
managing anxiety that comes with the job loss due to
COVID.
13
Adult Case #1
• 31 year old female
• Entered care early March 2020; dx of Adjustment
Disorder with Mixed Anxiety and Depressed
Mood
• 15-year history of being caregiver for mother who
has been in nursing home due to dementia for 2
years
• Anxious re mother and her ability to care for her,
lack of support from family, increasing self doubt
and depression
14
Adult Case #1
• Late March: Nursing home closes to visitors. Despite
phone calls, mother insists daughter is not reaching out.
• Early April: COVID outbreak at facility, mother has fever.
Client feels information is not being shared honestly.
– Intervention: self care, thought stopping, radical acceptance
• Mid-April: Mother diagnosed with COVID. Client decides
to go back to work and asks for and get support from
family. Brings up funeral plans “just in case” with siblings
after processing it in therapy.
• One week later (Mid-April): Mother in coma in the
hospital - emotional exhaustion. Anxiety interferes with
eating and sleeping, Therapist supports emotional
expression, self care.
15
Adult Case #1
• Early May: Mother died this week. Client insisted upon and
was allowed to be with her in the hospital. Has recurring
intrusive memories of her heavy breathing and struggling
for air. Placed on 2-week unpaid quarantine by work.
• Currently: Back to work, wakes up at nights with
nightmares, intense fears of not being there for mother,
then remembering.
• Therapist working with client on cultural myths of death vs
reality, stress reduction, redirecting thoughts, focusing on
other activities, self care, grounding in present, reaching
out to friends, and self talk.
16
Pediatric Case # 2
• 17 year old female completed TFCBT
• Would have been ready to discharge in a non-
COVID world; however, 3 weeks into telehealth
completed TFCBT and continued work to
manage increase in anxiety and depression that
was triggered by quarantine
• Themes focused on managing increase in family
conflict while home in quarantine
17
Pediatric Case # 2
• Understanding triggers that COVID is having on
anxiety and understanding how decline in
socialization and stopping of work impacted
client’s mood.
• Treatment has worked in supporting client
advocate for herself within school as she
struggled with distance learning, managing
increased stress, and building insight of the
impact of external factors on symptoms.
18
Adult Case #2
• 61 year old male, 7 years as medical patient, entered
CHCI BH care April 2020 (had previous BH care outside
of CHCI).
• Initially diagnosed provisionally as PTSD, but upon
further evaluation changed to Adjustment Disorder with
Mixed Disturbance of Emotion and Conduct and Alcohol
Use Disorder, mild, abuse.
• Precipitant: impending death of best friend from cancer
and intrusive traumatic memories triggered by
combination of loss and grief and pandemic factors.
• Could not visit friend, hospital closed. When he died no
physical gathering at funeral (virtual only). “It is just
wrong” and runs parallel to feelings of being abused as a
child, “even though that makes no logical sense.”
19
Adult Case #2
• History of one or two day periods of drinking when
under stress, and had one episode prior to
treatment. COVID worked in his favor here- no
alcohol in the house and unwilling to risk infection
to go to the store and get any.
• Therapy was a place to sort through feelings,
especially with social distancing. Focus on
understanding how one trauma triggered memories
of another, coping skills, expectations re death and
grief and the reconciliation of his expectations with
his reality.
20
21 * This initiative is supported by 21
Thank You!
www.weitzmaninstitute.org/coronavirus
22

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Weitzman ECHO COVID-19 in Primary Care: Behavioral Health Cases & Discussions

  • 1. COVID-19 in Primary Care: Behavioral Health Cases and Discussions July 8, 2020
  • 2. CME Credit • Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to sponsor continuing medical education for physicians. The Bridgeport Hospital Yale New Haven Health designates this live activity for a maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only credits commensurate with the extent of their participation in the various activities. • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to provide continuing medical education for physicians. • The content of this activity is not related to products or services of an ACCME- defined commercial interest; therefore, no one in control of content has a relevant financial relationship to disclose and there is no potential for conflicts of interest. 2
  • 3. COVID-19 in Primary Care: Behavioral Health Cases and Discussions www.healthywilliamsoncounty.org
  • 4. COVID-19 in the U.S. 2,983,961 cases on 7/7/20 – 131,268 deaths https://coronavirus.jhu.edu/map.html Upward trend in cases June
  • 5. COVID-19 in the U.S. 2,983,961 cases on 7/7/20 – 131,268 deaths https://coronavirus.jhu.edu/map.html Upward trend in cases Upward trend in testing positivity
  • 6. News updates • USA to pull out of the WHO? – July 6, 2021 • Brazilian president – Bolsonaro tests positive • “Can’t completely rule out” [aerosol spread] Dr. Anthony Fauci
  • 7. News updates • Dr. Fauci (7/6 interview NBC news): –“Simple things” • Masking • Physical distancing • Washing hands • Closing bars – Vaccine candidates entering clinical trials: End of July, August, Sept – Vaccine manufacture starting: Large number of doses ready by Winter 2020; early 2021
  • 8. Resources • Nuvance health:https://spark.adobe.com/page/qrH7iY0Gi0hU9/ • CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html https://emergency.cdc.gov/coca/calls/2020/ • WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 • Johns Hopkins: https://coronavirus.jhu.edu/map.html • Others https://www.thelancet.com/coronavirus https://covidactnow.org/
  • 9. COVID-19 in Primary Care: Behavioral Health Cases and Discussions Tim Kearney, PhD Chief Behavioral Health Officer, CHC, Inc. Jessica Welt, PsyD CEO/Clinical Director, Child Guidance Center of Southern CT Shari Fanelli, MS, LPC, ATR Intake Director, Child Guidance of Southern CT
  • 10. • Four months ago COVID crept into the Northeast and we soon spiked in NYC and New England • CHCI has been delivering remote BH by video and phone since early March 2020 • As people have acclimated to the changes brought about by the virus, the themes and issues in treatment have changed. – In the Northeast, the emergency feel has decreased - now about how to deal with life in the new reality • For some, new situations have improved BH issues; for others - exacerbated them 10 Setting the Stage
  • 11. Setting the Stage • BH issues are affecting both people with and without pre-existing mental illness • BH needs are moving to the forefront due to the heightened level of arousal; we anticipate BH challenges continuing well after the pandemic subsides • We invite you to discuss BH care that you provide, raise questions, and share insights 11
  • 12. Pediatric Case # 1 • 15 year old client • TFCBT treatment due to victimization of a sexual assault • Heavy parental involvement • Family is now in narrative component; however, just prior to moving to this component experienced the rapid death of her godmother due to COVID • Treatment focus shifted for a few sessions to grief work, and processing things that were in family’s control verses areas out of control 12
  • 13. Pediatric Case # 1 • This client had experienced 2 major losses in her life, so in tying the TFCBT model back in treatment, she was able to continue to explore themes of loss and how losses impact client/parent functioning. • Last week, while clinician was with client for session mom got a call that her work was shutting down and she would be unemployed. • Took a session to shift out of the model and focus on managing anxiety that comes with the job loss due to COVID. 13
  • 14. Adult Case #1 • 31 year old female • Entered care early March 2020; dx of Adjustment Disorder with Mixed Anxiety and Depressed Mood • 15-year history of being caregiver for mother who has been in nursing home due to dementia for 2 years • Anxious re mother and her ability to care for her, lack of support from family, increasing self doubt and depression 14
  • 15. Adult Case #1 • Late March: Nursing home closes to visitors. Despite phone calls, mother insists daughter is not reaching out. • Early April: COVID outbreak at facility, mother has fever. Client feels information is not being shared honestly. – Intervention: self care, thought stopping, radical acceptance • Mid-April: Mother diagnosed with COVID. Client decides to go back to work and asks for and get support from family. Brings up funeral plans “just in case” with siblings after processing it in therapy. • One week later (Mid-April): Mother in coma in the hospital - emotional exhaustion. Anxiety interferes with eating and sleeping, Therapist supports emotional expression, self care. 15
  • 16. Adult Case #1 • Early May: Mother died this week. Client insisted upon and was allowed to be with her in the hospital. Has recurring intrusive memories of her heavy breathing and struggling for air. Placed on 2-week unpaid quarantine by work. • Currently: Back to work, wakes up at nights with nightmares, intense fears of not being there for mother, then remembering. • Therapist working with client on cultural myths of death vs reality, stress reduction, redirecting thoughts, focusing on other activities, self care, grounding in present, reaching out to friends, and self talk. 16
  • 17. Pediatric Case # 2 • 17 year old female completed TFCBT • Would have been ready to discharge in a non- COVID world; however, 3 weeks into telehealth completed TFCBT and continued work to manage increase in anxiety and depression that was triggered by quarantine • Themes focused on managing increase in family conflict while home in quarantine 17
  • 18. Pediatric Case # 2 • Understanding triggers that COVID is having on anxiety and understanding how decline in socialization and stopping of work impacted client’s mood. • Treatment has worked in supporting client advocate for herself within school as she struggled with distance learning, managing increased stress, and building insight of the impact of external factors on symptoms. 18
  • 19. Adult Case #2 • 61 year old male, 7 years as medical patient, entered CHCI BH care April 2020 (had previous BH care outside of CHCI). • Initially diagnosed provisionally as PTSD, but upon further evaluation changed to Adjustment Disorder with Mixed Disturbance of Emotion and Conduct and Alcohol Use Disorder, mild, abuse. • Precipitant: impending death of best friend from cancer and intrusive traumatic memories triggered by combination of loss and grief and pandemic factors. • Could not visit friend, hospital closed. When he died no physical gathering at funeral (virtual only). “It is just wrong” and runs parallel to feelings of being abused as a child, “even though that makes no logical sense.” 19
  • 20. Adult Case #2 • History of one or two day periods of drinking when under stress, and had one episode prior to treatment. COVID worked in his favor here- no alcohol in the house and unwilling to risk infection to go to the store and get any. • Therapy was a place to sort through feelings, especially with social distancing. Focus on understanding how one trauma triggered memories of another, coping skills, expectations re death and grief and the reconciliation of his expectations with his reality. 20
  • 21. 21 * This initiative is supported by 21