Healthcare leaders in Klickitat County address mental health needs, impacts during pandemic

Columbia Gorge News spoke with Dr. Jodi Daly, CEO of Comprehensive Healthcare, and Kyle Cardwell, manager of Comprehensive Healthcare in White Salmon, to learn more about how COVID-19 and the shutdown has affected their organization and the services they provide to Klickitat County residents.

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What has changed in the months since the shutdown?

Daly: We have had to adjust, like how to really make sure our staff stays safe and continue wanting to work in an environment that frankly creates a lot of anxiety and concern, because more often than not they are dealing with a lot of high-risk individuals. And there certainly is a risk factor for them, being concerned about bringing COVID-19 back to their families. From a high level incident command span, we do all those reserves. In the middle of that as well, we are designing what is called the COVID-19 Resource Manual so that we memorialize all of our different discussions and innovations during this time because they’ll most probably be used during some other disaster or change in our environment. Outside of reviewing, we’re advocating in different forms for some of the things that we’re recognizing are imperative as it relates to our clients, telehealth. There were these teleheath waivers that allowed us to provide services to clients from their homes so they didn’t have to come into a facility; there’s regulations around that. That was lightened up. As well, Medicare didn’t allow telehealth and they are right now to ensure access. We want to take that and say these measures are really imperative in the future. When COVID-19 is hopefully done, this is the way clients want to access services. The majority of them find being able to be in their home and access us is a benefit to them. And then there are some waivers around telephone conversations. We’re finding that beneficial. On that level, we’re also advocating to the state to develop legislation to ensure that those waivers stay in place.

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Have you experienced any challenges in this transition?

Cardwell: Some of our patients live in pretty remote parts of the county, where either they don’t have internet access or their internet access is pretty slow, so that prohibits them from doing (online appointments). That’s why the waiver for telephone has probably been really been beneficial for us in the Gorge because just depending on where someone lives, it’s a challenge ... Patients living 30-40 minutes away from (the office) to have to come in for an appointment when they could do telehealth or phone, not only do they get to stay home and save time, gas and resources, but they are able to access the resources without exposing themselves or staff to potential COVID exposure. We have found that, for some patients, they actually enjoy it more. For some of our patients, they have found it easier to open up ... Covid has presented us with some challenges but I think some the good things that come out of this, it’s a way that we can really deal with folks who may be too afraid to come in for an appointment.

Daly: On the staff side, we’re also finding a push to reconsider a remote workplace opportunity. We have staff who are considering split shifts to take care of families, we have a lot of essential workers that are mothers and fathers and we need to meet them halfway to ensure that they have jobs and they can service the clients we have and take care of their families. This has given us an opportunity to consider a new model of, do therapists need to come in and necessarily be in the office? I think not only are the clients liking it, but we have some staff that are liking it. And when they like it, the staff, they’re given variable hours. We’re starting to see things where therapists are. They’re being innovative right now in this disruption and I think its something we need to pay attention to and it’s something that we need to continue to think about as we move forward.

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Has expanding telehealth services meant an increase in access to mental health services by Klickitat County residents?

Cardwell: In the larger system, we are seeing a decrease in no-show rates and a decrease in cancellations. I think people are liking the access we can give them so they don’t have to come into the office. We are seeing some data that supports the use of telehealth and definitely we need to take that opportunity to move forward and avail that technology to ourselves and our clients. One of our barriers of concerns is that some of our clients, particularly in the rural areas, are met with a technological ceiling. There are people we can’t serve, they really don’t have adequate technology. We can’t assume telehealth is going to be the go-to that serves everybody.

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Are there any services you are unable to offer at this time?

Cardwell: We have a medication provider, we have a physician assistant who is able to offer telehealth services, we are still providing our substance abuse services, we are doing individual psychotherapy. If it’s a appropriate, we can also do telehealth crisis response to our hospitals. If the ER is very busy, our hospitals have machines which they can roll into a patient's room for us to perform telehalth services. The only service we are still trying to figure and work on is group therapy. We have plans to expand that. We’re looking at sharing resources between our different sites to share staff, to make sure we can increase services. It forces us to think outside the box and be better stewards of our resources. 

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What should readers know about mental health in Klickitat County?

Daly: I hope they know Comprehensive Healthcare is open, willing and accessible. If someone is in need, please call us. We’re going to demonstrate that you can trust us, you can count on us, we will link you to the appropriate resources.

Cardwell: For Klickitat County specifically, one of the things we are trying to do specifically ... even though other organizations are seeing furloughs, we are actually hiring more staff down here in Klickitat County. Not only are we here, we have capacity to meet with folks, we don’t have a waitlist. Doing teleheath, if a patient has to cancel or no-show, we’re able to call (other patients) and conduct services ahead of schedule. It’s harder to do that with face-to-face therapy because people have to drive in. Another thing I want people to know is we definitely work with our community partners. We have a large continuum of care. It’s hard to find programs that offer such a broad continuum of care. Yes, Klickitat County is rural, and we might be small in population, but we can still offer good quality care and get folks what they need. We’re open 8-5, Mon-Fri. We have a crisis line that gets answered 24/7. Our organization is the one that responds to emergency rooms if folks are in crisis. 

I would also encourage people to take time for yourself. With kids being home and all the extra pressures that we have in our life, sometimes we need to address some stuff. There are people here in White Salmon and Goldendale can talk with folks and meet with needs.