This document summarizes a webinar on providing crisis counseling during the COVID-19 pandemic. It discusses normal crisis reactions, elements of crisis counseling including education and developing coping skills, and strategies for 20-minute counseling sessions. It also addresses supporting behavioral health staff who may experience secondary traumatic stress and providing preventative resources and acknowledgment. The webinar aims to help primary care providers counsel patients and staff during this difficult time.

1. Weitzman ECHO on COVID-19
Crisis Counseling and
Caring for Your Staff & Yourself
April 15, 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.

3. Weitzman ECHO on COVID-19
A Primary Care Perspective cont’d
Stephen J Scholand, MD
Infectious Disease Consultant
15 April, 2020

4. Objectives
- Update on epidemiology (2019-nCoV, SARS-CoV-2)
- Review any good news?
- Continue the good fight!

5. COVID-19 in the United States
589,048 cases 4/14/20 – up from 368,533 cases last week (4/7/20) -
https://coronavirus.jhu.edu/map.html

6. Any good news?
• Remdesivir data starting to appear
– NEJM for severe patients (n= 53)
• 68% improved oxygenation
• 57% extubated
• New York showing early signs of improvement

7. Health Care Workers = Heroes
• These are trying times
– Emotional and physical exhaustion
• Patients and patient families
– Dying alone
• Support is appreciated!

8. Stay safe -- Stay up to date
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• https://www.who.int/emergencies/diseases/novel-
coronavirus-2019
• https://covidactnow.org/
• https://coronavirus.jhu.edu/map.html

9. Jessica Welt, PsyD
Timothy Kearney, PhD
Crisis Counseling and
Caring for Your Staff & Yourself

10. • Global Pandemic vs. Past Potentially Traumatic Events
• Impact of COVID-19: Population Exposure Model
• Shelter-in-Place Orders
• Individual Variables
• Normal Reactions to Abnormal Circumstances
• Emotional
• Cognitive
• Behavioral
• Physiological/Physical
Crisis Response in the Midst of a Potentially
Traumatic Event

11. Maslow’s Hierarchy of Needs
Source: Simply Psychology

12. Step 1:
Assessing the Situation
• Listen and ask questions
• Define the problem
• Determine what client
needs to cope effectively
with the crisis
• Ensure client’s safety
Elements of Crisis Counseling
Step 2:
Education
• Psychoeducation about
crisis reactions
• Normalize reactions
• Help client understand
reactions are often
temporary

13. Step 4:
Developing Coping Skills
• Explore different solutions
to the problem
• Identify potential triggers
• Practice stress reduction
techniques
• Encourage positive thinking
• Help devise plan to utilize
strategies independently
Elements of Crisis Counseling
Step 3:
Offering Support
• Active listening
• Provide acceptance
and reassurance

14. • Structuring the session
• Keep focus on the here and now
• Set the frame with the first contact
• Crisis Counseling DOs
• Ask about status since last visit
• Assess safety every session
• Practice coping strategies
• Plan for the time between visits
• Crisis Counseling DON’Ts
• Focus on the past/history
• Attempt to resolve long-standing
problems
Strategies for a 20-minute Session

15. • Ongoing safety and risk assessment
• Increased risk of domestic violence
• Increased risk of child abuse
• Increased risk of suicidality
• Increased risk of substance abuse
• Develop safety plans with limited resources available
• Physical safety
• Psychological safety
COVID-19 Era Increased Risk Factors

16. Supporting Your Behavioral Health Team
Provide necessary support to assist BH team members in their
goal to provide compassionate, efficient, and effective care to
clients in the midst of a pandemic while balancing their own
needs and those of their families and love ones.
Staff members move through phases:
 Is my job secure?
 How do I care for my current clients and surging demand?
 I can do a sprint – wait, is it a marathon?
 How much longer can I do this?
 Burn out.

17. “secondary traumatic stress is emotional distress that results when an individual hears about
first hand traumatic experiences of others”. NCTSN web page
Secondary Traumatic Stress
• Irritability
• Hopelessness
• Guilt
• Inability to
concentrate
• Social withdrawal
• Exhaustion
• Physical ailments
• Emotional
detachment
• Sleep problems
• Intrusive thoughts
• Decreased self care
• Hyperaware
• Lack of predictability
• Sense of chaos
• Loss of control
• Heavy case load
• “Dose exposure”
• Feeling unprepared
Indicators: Contributing factors:

18. Opportunities to Provide Support
SAMHSA’s Trauma Informed Care:
• Realize you don’t see what you don’t know is there
• Recognize need in your own staff
• Respond balancing the multiple imperatives you face
Preventive:
• Training
• Good Mental
Health habits
• Up to date
information
In the moment:
• Administrative Support
• Clinical consultation
(client services)
• Listening to feedback
(transparency)
Restorative:
• EAP and other
resources
• Boundary discussion
• Acknowledge the
tension
• Future orientation

19. 19
Free COVID-19 eConsults
• Web-based portal
• Free to all Safety Net Primary Care Practices
– FQHC, FQHC-look alike, Migrant Clinicians, Healthcare for the
Homeless, Free Clinics
• No Protected Health Information (PHI)
• Consults Addressed by:
– Infectious Disease Specialists
– Public Health Nurses
* This initiative is supported by

20. 20 * This initiative is supported by

21. Thank You!
www.weitzmaninstitute.org/coronavirus