Virtual Chat Session Archive
Virtual Chat Session Archive:
- 21st Century Cures Act (Part 2): Managing the Confidentiality of the Adolescent and Young Adult Within the Electronic Health Record – Wednesday, December 16, 2020 – view summary/shared resources
- Meeting the Needs of Adolescent and Young Adult Rising Rates of Mental Illness and Suicidality: The Role of Adolescent Medicine Professionals – view summary/shared resources
- Youth Engagement in Programs, Services and Research – September 14, 2020 – view summary/shared resources
- Caring for Adolescents with Eating Disorders during the COVID-19 Pandemic, a continued discussion – June 19, 2020 – view summary/shared resources
- Advocacy Priorities for Adolescent Health During COVID-19: A Conversation with SAHM and AAP Advocates – May 28, 2020 – view summary/shared resources
- Caring for Adolescents with Eating Disorders during the COVID-19 Pandemic – Friday, May 15 – view summary/shared resources
- Planning for Recovery of Clinical, Research, and Educational Efforts after the COVID-19 Surge – May 8, 2020 – view summary/shared resources
- Telemedicine – April 16, 2020 – view summary/shared resources
- SAHM Virtual Chat – April 8, 2020 – view summary/shared resources
Meeting the Needs of Adolescent and Young Adult Rising Rates of Mental Illness and Suicidality: The Role of Adolescent Medicine Professionals
November 17, 2020
View SAHM’s position paper on Improving Integration of Behavioral Health Into Primary Care for Adolescents and Young Adults.
The Columbia Lighthouse Project
The PHQ-9 Item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)−9 Item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS)
Peter J. Na, Satyanarayana R. Yaramala, Jihoon A. Kim, Hyelee Kim, Fernando S. Goes, Peter P. Zandi, Jennifer L. Vande Voort, Bruce Sutor, Paul Croarkin, William V. Bobo
Journal of Affective Disorders; Volume 232, May 2018, Pages 34-40
Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents
Dillon J. Etter, M.P.H., Allison McCord, R.N., Fangqian Ouyang, M.S., Wanzhu Tu, Ph.D., Stephen M. Downs, M.D., M.S., Matthew C. Aalsma, Ph.D.
Journal of Adolescent Health; Volume 62, Issue 2, p. 191-197, February 01, 2018
Teens in Covid Isolation: ‘I Felt Like I Was Suffocating’
The New York Times, Published Nov. 12, 2020 Updated Nov. 13, 2020
Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020
Weekly / November 13, 2020 / 69(45);1675–1680
Rebecca T. Leeb, PhD; Rebecca H. Bitsko, PhD; Lakshmi Radhakrishnan, MPH; Pedro Martinez, MPH; Rashid Njai, PhD; Kristin M. Holland, PhD
Teens in Quarantine: Mental Health, Screen Time, and Family Connection 2020
Institute for Family Studies; The Wheatley Institution
The American Board of Pediatrics Foundation: Behavioral and Mental Health
National Institute of Mental Health: Ask Suicide-Screening Questions (ASQ) Toolkit
Youth Engagement in Programs, Services and Research
September 14, 2020
Introduction: The future of health will entail the following: 1) Patient/client-centered care where youth are engaged using innovative forms of communication; 2) Team-based interdisciplinary approaches that include youth as stakeholders to identify the root causes of and viable solutions to adolescent health problems; and 3) Value-based outcomes where youth populations exercise their fundamental right to attain healthy youth development and impact their lived environments in timely and relevant ways. To inform SAHM’s effort to create a structure for youth engagement within the organization, the main objective for the chat was to share experiences and explore models of youth engagement in programs, services and research.
About 60 participants attended the session and all (except the facilitators) were randomly assigned to one of 4 breakout sessions.
Before the breakout session, the whole group was asked:
What are your expectations for today’s chat?
About youth engagement (insights, recruitment, strategies, incentives, physician role)
About SAHM’s plan and resources for engaging young people
To share models of successful youth engagement
To foster networks of others who engage youth meaningfully
Question 1: What are your greatest desires//vision for YE in adolescent health programs, services & research?
Youth-led efforts; youth taking part in all levels of projects from early decision-making process to dissemination
More published research on youth engagement processes/outcomes
Paying youth for their time
Youth at the table to design & conduct research (i.e. access, enablers, & barriers to care)
Use of global models of youth engagement (e.g. Australia)
Being creative to understand what youth value
Seeking genuine relationship with young people
Build capacity for SAHM members to include YE in their work
Monitoring intersection between global and local YE work
Creating relevance/resonance to appeal to youth
Finding ways to get youth to participate in research
Access to resources for youth to be engaged in their health
Question 2: What are your greatest fears/challenges or perceived barriers to youth engagement?
Youth-led groups avoiding adult/professional input
Lack of cultural diversity in youth advisory boards)
Racial bias affecting motivations behind reproductive health practices
Finding balance between supporting project and supporting youth broadly
Creating structures that are amendable to youth
Disseminating process data
Avoiding tokenism, staying relevant to the youth
Need for resources to engage youth
Affect of COVID on accessing school systems
Disparate internet connections
Youth personalities (introverts vs extroverts) communicating virtually
Perception ongoing programs provide more group
Ensuring positive experience for youth
Recruitment, reaching ‘hard to reach’ youth for research
International relevance and appropriateness
Legal liabilities of involving minors
Lack of institutional support to engage youth
Creating YE models to fit different disciplines
Lack of incentives for reaching and keeping youth engaged
Question 3: What are some success stories you can share about engaging youth/young adults in your programs/research?
Utilizing in-school models for youth referrals; teaching seniors knowledge & skills
Giving youth space and ability to take leadership roles without assigning them
Asking youth what incentives matter to them, if any
Working youth incentives into grants, balancing needs with desires
Providing menu of options for feedback and compensation
Creating youth advisory councils as part of health clinics
Providing community service hours as incentives
After the breakout sessions, the whole group was asked:
What are some of your takeaways from today’s chat?
General tips on YE
There is a need for youth engagement
YE is dynamic and flexibility is necessary
Sensitize youth before engagement
Make it meaningful
Meet youth where they are for recruitment
Incentives should be youth-informed, relevant, contextual, seen as a added advantage not the main focus.
Initiate youth conversations
Involvement does not always mean engagement
Consider community service hours as an incentive vs stipends
Potential benefit of virtual climate for youth engagement
Others have challenges of shifting from in-person to virtual engagement
Getting culturally diverse youth
Caring for Adolescents with Eating Disorders during the COVID-19 Pandemi
Friday, June 19
Eating Disorders and COVID-19: What Healthcare Providers Need to Know – The National Center of Excellence for Eating Disorders (NCEED) partnered with researchers at the University of North Carolina at Chapel Hill and Leiden University Medical Center to examine the impact of COVID-19 on individuals with eating disorders.
Eating Disorders and COVID-19: What Individuals and Families/Caregivers Need to Know – The National Center of Excellence for Eating Disorders (NCEED) partnered with researchers at the University of North Carolina at Chapel Hill and Leiden University Medical Center to understand how COVID-19 is affecting individuals with eating disorders.
www.nceedus.org – National Center of Excellence for Eating Disorders
www.aedweb.org – Academy for Eating Disorders
Advocacy Priorities for Adolescent Health During COVID-19: A Conversation with SAHM and AAP Advocates
Discussion of current challenges and strategies related to advocacy:
Juvenile justice issues – cases in juvenile justice centers, staff refusal to wear masks, release versus continued detention, solitary confinement
Putting procedures in place quickly – decreasing census, virtual court, increasing time that kids can talk with families, education of youth and staff, PPE, separate floor for COVID-positive or those under investigation, working with officials, ramping up testing. AAP policy statement has been published. SAHM working on statement.
Runaway and homeless youth – concerns for transmission
Writing a document to support homeless youth; sheltering in place, rapid testing in shelters.
Clinical Care of Homeless, Runaway and Refugee Youth, Intervention Approaches, Education and Research Directions, Editors: Curren Warf MD, MSEd, FSAHM, FAAP, FCPS and Grant Charles PhD.
Runaway Youth: Caring for the Nation’s Largest Segment of Missing Children Thresia B. Gambon, Janna R. Gewirtz O’brien, Committee On Psychosocial Aspects Of Child And Family Health, Council On Community Pediatrics Feb 2020, 145 (2) e20193752; DOI: 10.1542/peds.2019-3752
Chatterjee A, So M, Dunleavy S, Oken E. Quality Health Care for Homeless Children: Achieving the AAP Recommendations for Care of Homeless Children and Youth. J Health Care Poor Underserved. 2017;28(4):1376-1392. doi:10.1353/hpu.2017.0121
Access to reproductive health services and family planning:
Telehealth – what services can be provided, and how can they be provided? For example, Mifepristone prescription. This and other meds are under REMs which the FDA had waived for other meds but has not waived in-person prescription for Mifepristone. ACOG sued FDA – AAP and SAHM will likely be asked to support that effort.
AAP, SAHM and many other organizations filed amicus briefs and issued statements regarding states’ restrictions on abortion services in response to COVID19.
ACA – what will Supreme Court decide when they hear the case and what this will mean for adolescents?
Supreme Court has agreed to hear the challenge to the ACA. Continued advocacy will be important. AAP Federal Affairs is monitoring the situation and will provide updates.
Health insurance – state Medicaid programs have been receiving many requests due to unemployment. If states do not receive federal funds, they will respond with cuts. Generally, states moving into increasingly difficult positions. Almost all states have mandatory budget balancing provisions, but what that actually means differs across states.
Need funding to shore up funding for Medicaid. Next coronavirus bill would provide state support. Current status of COVID19 bill- passed US House of Representatives, stalled in US Senate.
Additionally, there are concerns about ongoing payment for telehealth services.
Health promotion targeting adolescents – Why should I as an adolescent practice mask wearing and social distancing? Is there enough information on how Covid affects adolescents?
Few campaigns directed toward adolescents re: practicing PPE and social distancing. Should be done in collaboration with adolescents. More likely to be asymptomatic carriers. How could SAHM be involved? Anisha Abraham has shared materials with us. Chinwe Efuribe has noted that youth engagement SIG could be involved. Has OAH thought about doing a campaign? Re-inviting families back to preventative care: https://www.youtube.com/watch?v=B7U7iddiR9c
Resources for youth:
Why talking helps – (reachout.com)
What happens when I call a helpline? – (reachout.com)
How to call a helpline – (reachout.com)
Coping during coronavirus (COVID-19) – (reachout.com)
Does #SocialDistancing have you feeling isolated? – (youtube.com)
Mental health concerns
Virtual visits have been a silver lining. Now have better access to Telehealth.
But there are concerns about mental health effects of disruption of routines, social isolation, lack of peer interactions, school interruption, and sleep disruptions.
Sports PEs not required this year – concerns that this will decrease well visits
Some states, health systems and insurers have said that the AAP recommended delaying pre-participation visits. In fact, the AAP has issued no such guidance but has issued guidance on care:
Substance use disorder management – increased use
Some programs have gone virtual.
Decreases in vaccination rates
Provision of health to AYA in rural areas
Discussed challenges, especially hesitancy of payers to reimburse for telehealth services. Jesse Barondeau (South Dakota) is interested in networking with other rural providers.
Advising colleges, schools – risk of transmission (including chorus and band)
How to return to campus safely
How to enforce public health measures for campus students
Impact on local resources, infrastructure, and health systems
Some colleges may ask students not to leave campus from beginning of school until Thanksgiving which may pose challenges. Strategy of screening/testing students when they come back to campus, as students are returning from all over. Is the public health system ready for this?
Second wave affecting more young people
Should we then be thinking what should be the mitigation public health approaches that should be adapted. Is this something the SIG could do to guide institutions? Need statements and educational materials from SAHM and AAP that we can use for local advocacy
Youth in essential jobs (MAs, grocery stores, etc.) and youth in the military
Need for messages for these groups. Sara Kinsman interested in working with us on these groups. They may be at greatest risk for not having health insurance, etc. Important to focus on these groups in addition to college kids. In January 2020, of the 2,670,000 people working in grocery stores, 329,000 were ages 16-19 (12.32%) and 412,000 (15.43%) were ages 20-24.
Immigrant youth and in detention centers
Adolescent-led families are experiencing a period of destabilization with lack of access to childcare while trying to do online schooling for themselves, in addition to financial constraints, lack of support structure, and limited access to medical care. Many experience structural barriers including transportation and lack a full understanding of the medical system leaving them more vulnerable.
Caring for Adolescents with Eating Disorders during the COVID-19 PandemicMay 15, 2020
Dr. Jean Doak shared her own observations from her eating disorder outpatient clinic that was closed as of mid-March and transitioned to Telemedicine. Within 2 weeks, they transitioned to Epic video visits.
Saw a drop-off of referrals of college students, but an uptick in referrals for new visits
Initial challenges with the pandemic around food
Stockpiling food became an issue for some patients – have had to find the balance between the desire to stockpile food and what ability they had to regulate that
Food deficits impacted meal plans, so had to call in dieticians to provide a plan B, plan C, etc.
Food insecurity – some patients who receive meals through school districts, and not all had the resources to deliver meals to people’s homes
Discussion of Ongoing Challenges and Strategies:
Lack of supervision leading to restriction and hyperexercising
(conversely, perhaps new ED patients are being identified sooner with parents/family/home sheltering)
Guided decision-making, mindfulness may be helpful
Crises re-ignite EDs
The Hurried Child
The Hurried Teenager
Less structure and waking up late
Working on daily schedules with patients
Some do less well with structure because they are trying to get away from rigidity – strategy of putting things in a hat and pulling them out
Repertoire of strategies has decreased because there is less flexibility around what one can do outside
Building a different repertoire
Increased availability of exercise routines online (also can be a challenge!)
New hobbies (e.g. needlepoint) for distraction
Some patients with OCD tendencies are into mask-making
Babbel (with a fee, unlimited language training for life)
Just finished listening to a webinar on Art, Creativity, and the Brain. It emphasized how developing creativity helps with decision making, self regulation, problem resolution , resilience, etc. Creating art, experiencing arts to include visual art, writing, all modalities of the arts which is very wide ranging. Particularly pertinent for everyone and the patients we are discussing.
Increased availability of exercise routines
On-line resources for distraction – e.g. museum tours on line
Your Teen Magazine
Not able to tolerate visit because they can’t tolerate seeing themselves on the screen
Teach them how to minimize the image. This might even be a good technique for the visit – increasing the amount of time or size of the image
Caring for COVID positive teens with ED – facilities refusing to take them
Difficult to make these decisions about how to care for them in the outpatient setting
ED patients not wanting to be hospitalized or not wanting to come in for vital sign checks
Indicate that EDs are an essential service
Provide information about the safety measures in place
Fitbits and apple smartwatches for HR checks
Utilizing local providers for VS checks
Families doing the VS blinded or non-blinded; maybe it is not a caregiver; give parents guidance on how to get the weight (e.g. blinded, after urination, etc.)
pdf document we send to parents doing blind weights etc. at home
Telehealth strategies – what is working, what do patients think of telehealth i.e. mobile apps, video chat with providers etc.
Obtaining blind weights from other visits (e.g. dietician)
Telehealth visit for the assessment and RN visit for VS/labs etc (with one nurse) to minimize touch – multiple programs are using this method of a virtual visit and brief in-person if needed
Maudsley Method could be taught remotely
Next stage considering 4 patients in person and 4 on-line, and then switching the next day
Refusing to turn video camera on seems to be associated with the patient doing worse and needing an in person visit
Telehealth especially beneficial for rural patients or others who travel far to the visit
Groups and meal support have been virtual
Planning to continue virtual groups; this is especially helpful for programs that care for patients who live far from the program
Masks make sensitive discussions more difficult
Start online without a mask vs. in person with a mask to build rapport
Re: effects of malnutrition on the immune system, do you discuss it with families? If so, how do you communicate with families on this topic?
Mentioning that malnutrition can affect the immune system, and that this is a time when we have to be vigilant about maintaining health and nutrition
May want to also supplement vitamin D if low
What are the data? We don’t know much about risk of viral infection, but nutrition probably important
Brain function likely even more impacted and recommendation to focus on that
William R. Beisel – Nutrition and Immune Function: Overview
Gibson D, Mehler PS – Anorexia Nervosa and the Immune System – A Narrative Review
Virtual care not working as well, and patients not thriving
May need to bring these patients in
Because patients often eat or are observed together, COVID test all incoming patients nd they are allowed only one, consistent visitor and both patient and visitor must be masked during visits
Others are working with limits on visits as well. Compromises may need to be made to maximize safety while providing the family support and training that is needed.
Challenges keeping masks on all day
Made an exception for the pediatric patients in one program not to use masks due to the challenges
Experience of virtual IOP and PHP – effectiveness, engagement of patients, concern about them seeing themselves on screen
Some kids seem to be used to the online interface so perhaps not as odd to them; moving forward, talking about a virtual platform for those who have nothing else
Planning for Recovery of Clinical, Research, and Educational Efforts after the COVID-19 Surge
At UW, Central command centers have been very helpful. Deputized to make decisions and communicate out. These have shifted to “Business Rassumption Centers” to drive the recovery. The major question is how we are going to do things differently moving forward.
How are others managing the recovery?
UCSF: cognitive-based specialties that have been able to provide Telehealth may have been less affected than others. In the recovery phase, it will be important to incorporate Telehealth to improve access. Division is back to full operation and seeing 5-10% more patients than a year ago with no change in staff. Inpatient service is unchanged. Educationally, everything is done through Zoom. Will not resume classes until July 2021. All salaries frozen until 2021 and there is a hiring freeze.
UW: Telehealth is now 80% of visits. Psychiatry is the only service that has been able to transition fully to Telehealth. All children who enter facility are tested. UW will soon provide serology testing to all employees, after testing everyone working with COVID-19 patients. Trying to align across the organization in terms of testing/screening etc. Still many questions about resuming research.
IU: Riley Children’s is part of IU Health; incident command centers have been working well together. Able to leverage supply chain resources because part of a state-wide incidence. Testing those who have symptoms only; in the adult practices, testing before elective surgeries. Expanding testing sites in the next week or two. Adolescent Medicine took the lead in terms of Telehealth visits. This month they will incorporate residents; medical students still not incorporated. Salary freeze and hiring freeze except for clinical providers. Inpatient services have been transitioned so they are taking care of some of the hospitalist patients so that hospitalists can take care of COVID-19 patients.
At UW, med student rotations will be reduced from 6 to 4 weeks.
How do we ensure virtual learning in adolescent medicine? Kate Greenberg is leading an effort to create additional on-line learning opportunities for residents, to complement the SAHM resident curriculum.
How can we extend our reach in terms of adolescent medicine training? Consider amplifying online learning by providing online access to a broader audience, which is more feasible now that we are using more virtual learning methods. Consider online journal clubs.
Incorporating equitable access to Telehealth when not everyone has the technology.
Advocacy for reimbursement; Steve North and Abigail English will be working on an advocacy effort as an outcome of the virtual chat on Telehealth; contact them if you are interested.
Telehealth for out of state patients – many states have loosened requirements for Telehealth. Guidelines and reciprocal agreements are state by state.
Continue to see college students but have had no new patient referrals for them x6-8 weeks since campus services were closed.
Advocating for Telehealth when there is resistance at our institutions. May be helpful to get patients’ and parents’ feedback about the convenience and demonstrating who you are able to reach. At UAB, had to use academic staff to take over Telehealth scheduling.
Zoom-health has been a good platform for to run virtual clinics – it allows faculty, fellows, residents and other team members to move in and out of breakout rooms with the patients in them, and patients stay in the room.
Don’t think patients will let us walk away from telehealth now that they’ve experienced it, and the time savings.
COVID-19 related research – one topic might be the link between adolescent population’s use of vaping products and COVID-19 illness. There are a great deal of opportunities available.
Phased plan for ramp-up of research at Cincinnati Children’s – being ramped up phase by phase, the timing of which is driven by the epidemiology of COVID-19 in the hospital and in the community.
Social distancing will be a key factor in bringing researchers back
Extension of reappointment and tenure clocks
Could be a great time to write at this time
What will be different moving forward – what do we need to think about and plan for?
The ability to expand access through Telehealth
Disruptions to medical education – how will we attract learners to our field if they have less exposure to us?
Virtual recruitment and ensuring diversity when we cannot bring people in for visits. With fellows, will be bringing fellows for interviews for different disciplines virtually – there will be group interviews. Working on a virtual tours. Maybe first phase is a virtual tour and second one in person. On some levels, it’s easier for us to participate in interviews outside of our department, on other levels, it’s much more difficult to anticipate the person beyond the camera.
What visits need to be in person; finding a balance between in-person and Telehealth visits.
Funding streams for research; research on the mental health aspects of Telehealth
Challenges in terms of academic productivity while children are at home and online schooling
Continuing to communicate through SAHM about innovations occurring across the country and learn from each other
April 16, 2020
Most people on the call are rapidly ramping up Telehealth but others are still in the queue or have access to audio but not video telehealth
Enthusiasm expressed about the opportunity to start Telehealth, but would prefer it wasn’t on such a rapid timeline
Challenges and Strategies:
Ask parent to step out of the room when discussing confidential topics
Ask patient to step outside the house when discussing confidential topics
Ask patient to use headphones
Call back at another time when it is more feasible to have a confidential visit
Ask yes/no questions if they don’t have privacy
Catch them when they are on their way to and from work (unless they are driving)
Create MyChart accounts for those younger than 18 years, if possible
Ask yes/no questions if they don’t have privacy
For reaching marginalized populations, using Doxy.me can be helpful (free)
Conducting video visits through the EMR (e.g. in Epic)
Some have used Epic, but may be advantageous to use another platform because it can take so long to make changes through Epic and the portal enrollment is challenging
Using a system in which a link can be sent to the patient is very helpful
Conducting well visits
AAP came out with guidance yesterday
Billing regulations are state by state – Center for Connected Health Policy
Some are seeing patients for urgent issue by Telehealth and doing the physical component at a later date
Some practices are doing drive-through vaccinations after doing a virtual well visit, and scheduling the actual physical exam for later
Person receiving the vaccine cannot be the driver (given possibility of syncope or allergic reactions)
Others are creating vaccine clinics – well visit done virtually, then bring them in for a nurse-only visit
Doing screenings virtually
Only use the tool when you have the opportunity to intervene; if you do a GAD7 or PHQ9 through a portal and don’t see the results for 24 hours, it can be unsafe
MA or LPN can administer the forms via the Telehealth platform
Some read the questions out loud to patients
Some are emailing the forms or sending through MyChart – asking them not to fill out until the day of the visit
One more resource for managing suicide risk (question that came up earlier): Essentially, confirm contact info for “Patient support person”/safety person if suicidality arises – Practice Guidelines for Video-Based Online Mental Health Services
Incorporating learners into Telehealth
Use a platform that allows for multiple providers: InTouch, Google duo (works for live time watching a resident do the interview and precepting, and interfaces with visual both android and iphone), Microsoft Teams, Zoom
Involveming multiple providers
As above; for example, there are platforms such as Zoom in which there can be warm handoffs between providers. They are in the same “virtual” room. Providers can come and go in virtual clinic and they get placed in a virtual waiting room until the next step.
Epic MyChart portal allows up to 5 people on a visit (combination of providers and family members)
Maintaining social distancing
Conduct well visits in morning, ill in the afternoon
Limit staff who are physically present in clinic
Managing suicidality screening
Make sure you know local resources
Make sure you have their contact info and address if you need to send someone (police, ambulance)
Confirm a safety plan during the visit
Conducting a physical exam by Telehealth
Ask patient to take their own pulse – there are apps to obtain a pulse, or can use data from Fitbit or apple watch
USB stethoscopes or otoscope on iPhone for patients who need them
Bring camera close to the patient
Have them take off relevant clothing if needed; e.g. to do a skin exam
To assess for acute abdomen – have them bounce up and down on the balls of their feet
Conducting new visits by Telehealth
egulations differ state by stateShould be able to do new visits, if state allows
Evaluating patients with dysuria or vaginitis
Do they have a prior hx? If yes, more likely to treat empirically (e.g. for UTI).
May be able to have patient go to test referral to drop off labs.
Shipping of STI screening tests directly to patient – however, may lead to issues around confidentiality
Routine screening questions and then drop in to provide labs
Drop off home pregnancy tests in school clinic
Self-collection of Affirm vaginitis swabs
Managing inconsistencies in what visits are being done in person or by telehealth
Provide guidance to triage nurses about who could see in person vs. telehealth – create standards across practice
Supervising residents and fellows
Assign SAHM resident education modules and go through the cases and videos
Teaching sessions virtually; virtual curriculum
3-way phone call – resident conducts visit with attending on the phone – then staffs afterwards
With Telemedicine, opportunity to be in the “room” at the same time then patient goes back to the virtual waiting room while they staff
For new eating disorder patients: resident sees the patient first then they get on “team meetings” at the same time, and resident presents the case to the team.
Conducting inpatient consultations
In some organizations, all consults done virtually – have technology in rooms to allow for more complete exams
Collecting our individual experiences so that we can advocate for adolescent telehealth
We may be able to collect data that would be useful in advocacy; e.g. improved show rates for visits
Will set up another time to discuss
If seeing patients from other states, may have to follow the regulations of the state of residence rather than the state you practice in. Some states have lifted those restrictions during this time
Resource – Listing of states waiving medical licensing requirements
SAHM Virtual Chat
April 8, 2020
Because we were unable to meet in San Diego and the COVID-19 pandemic has been disruptive and challenging, we brought SAHM members together for a SAHM virtual chat on April 8 to:
reflect on our experiences of the past few weeks
discuss major challenges and stressors
provide support for one another by being together and by sharing strategies and resources that have been helpful
discuss what resources SAHM can put into place to address challenges
Almost 60 SAHM members participated in this warm, energetic and supportive virtual chat, and below I’ve summarized for you the discussion and a description of resources that we are planning to put into place in response to the challenges raised.
We asked participants to provide one word describing how they came into the call at the beginning, and one word describing how they were leaving the call at the end. A review of some of the words offered demonstrates the powerful impact of connecting SAHM colleagues with each other:
How participants came into the call: unsure, stretched, confused, nervous, sad, frustrated, alive, disoriented, still, stressed, hopeful, anxious, helpless, unorganized, lonely, restless, zoomed-out
How participants left the call: hopeful, good, supported, optimistic, recharged, connected, uplifted, reinvigorated, interested, not alone, energized, motivated, grateful, optimistic
What are your personal reflections on the events of the past few weeks?
Widespread anxiety and fear
Priorities and perspectives are changing
Observations of solidarity and selflessness, with people coming together and connecting deeply
The seismic shift to telemedicine
What are your major challenges and stressors right now?
Concerns about colleagues and families
Concerns about family’s health
Concerns about the health of colleagues who care for adults
Managing colleagues’ concerns and emotions
Serving behind the front lines instead of on the front lines
Pressure to stay productive
Balancing work, homeschooling, housework
Concerns about patients and youth
Concerns about quality of patient care with Telehealth and not seeing patients face-to-face; that patients will not be seen who have urgent issues; youth with unmet sexual/reproductive health care needs
Increasing conflict between patients and their families now that they are in closer contact
Youth in a public university with insecure housing, food, unmet mental health needs, and families who cannot support them
Fear that youth are being blamed for transmission
Youth are missing major milestones such as graduation
Youth will miss out on employment and internships
Youth are losing parents/loved ones without being able to say goodbye
Concern that after the COVID-19 pandemic will emerge a pandemic of mental health among youth
Disparities in youth outcomes during and after the epidemic
Concerns about trainees
Education of trainees, such as residents; appreciate SAHM resident curriculum but trainees are missing face-to-face care
Other concerns about the epidemic
Anxiety that social distancing will be lifted too soon and that university administrators are not being cautious enough
Profound disappointment in U.S. lack of preparation for the pandemic
Emotional shock over the scope of the pandemic
Urgent need for policy; concern about abortion rights
How are you managing the changes that are occurring in your personal and professional life? What are the strategies and resources you have found helpful?
Presentations, webinars, and podcasts about COVID19 to community, juvenile justice center, patients/families, staff
Providing learners opportunity to do virtual visits and learn Telemedicine
Zoom health clinics with breakout rooms for individual patients and team room for fellows
Mail-in STI screening, home pregnancy tests, Sub-Q depo, home testosterone injections
Considering how to maintain Telemedicine gains – e.g. seeing patients in their homes offers a new perspective, observing patient JUULing during the visit led to an extra SBIRT session
Support for and from peers
Daily leadership huddles, weekly meetings
SAHM committee calls
Check in on peers
Provide mental health resources for peers, group coaching
Virtual happy hours and zoom calls
Exercise (running, yoga, biking) and being outside (taking work-related calls from outside)
Hobbies – photography, painting, gardening, music
Taking courses; podcasts
Disconnecting from media
Thinking of ways to help and cheer others; sidewalk appreciative messages
Humor – sharing memes and cartoons, making funny videos, lip-sync challenges
Focusing on silver linings – gift of family dinners, college kids being home
Recognizing our privilege
Recovering after COVID-19 – regaining strength, stamina
Recognizing the innate drive to be ultra-productive and that COVID-19 is asking us to be more reflective, focused and flexible
What resources can SAHM put into place to help address challenges?
Share information on annual meeting online content
Organize SIG and Committee meetings by Zoom
Schedule regular virtual support sessions – topics could include Telemedicine, creative strategies for caring for patients virtually, educational strategies (SAHM Education Committee?), ramping back up after social distancing
Here is how SAHM is planning to address the resources requested:
Virtual support sessions on telemedicine, strategies for virtual patient care, educational strategies, ramping back up after social distancing
We will be planning these sessions – stay tuned for the schedule, and let us know if you would like to facilitate one!
Annual meeting online content and virtual SIG and Committee meetings
Online content – SAHM is putting together a package of virtual content previously planned for presentation at the 2020 SAHM Annual Meeting. Additional details to be announced soon.
SIG leaders and Committee chairs will be reaching out to set up these meetings over the coming weeks if they have not already