Imagine working for a pro-bono physical therapy or communication disorder clinic when the COVID-19 pandemic hit this spring.
Not only did you face the prospect of increased demand as the economy suffered but the pandemic restrictions also meant you couldn’t meet with patients in person.
Those were significant challenges the Community Rehabilitation Clinic (CRC) and Center for Communication Disorders (CCD) — non-profit 501©(3) charitable organizations in Provo run by the Rocky Mountain University of Health Professions Foundation — faced this year.
“When COVID-19 started becoming a big issue in the US, I started hearing rumors that the universities were shutting down,” CRC director Coleby Clawson said in a teleconference last week. “I started to worry not only about our patients but because we fill such a huge need for the community here. A lot of the providers who see these patients send a lot of referrals to us, so it dropped away suddenly it would be a huge loss. I also worried about our employees and volunteers.”
He said he was thinking about what he would have to do if he had to shut the clinic down.
“That week I had two neighbors come to me and three family members call me with issues,” Clawson said. “I talked them through some things on the phone and some of the things I gave them work. I thought that while it’s not as good as getting your hands on patients, I think that a telehealth program could work. We can’t do everything but we have found ways to be creative and help patients through issues where they wouldn’t have had any help. I think overall it’s been a big success.”
Laura Harrison has faced back and feet issues, and has been working with the clinic for a few years but no one knew what was going to happen when the virus hit and everything shut down.
“I was concerned,” Harrison said. “They put me on a home program but I thought I would lose communication with the clinic and not be able to keep in touch.”
Miskin said Harrison has a chronic condition, so it is something that takes time and diligence to mend. That’s why it was important to stay on top of things with the physical therapy.
“Telehealth was very helpful during the COVID-19 situation,” Harrison said. “It was nice to be able to use video and audio to discuss with the therapist what I was going through. They were able to update my treatment plan. That was really helpful. There were limitations, such as the fact that my camera is attached to my laptop so it wasn’t easy for them to examine my feet. But we were able to work through the treatment.”
Miskin had only joined the clinic in March, just in time for things to go in an unexpected direction but she said her rodeo background prepared her for such challenging times.
“It was quite the ride,” Miskin said. “That first week we started using Google Meet, which the patient could download on their phone or use on their computer. That seems simple but the challenge became trying to make sure the patient was ready for their appointment. We had cameras pointing at the ceiling, at the floor, at the dog, you’d just never know. It required patience and creativity as we worked with the patients.”
Miskin had an advantage, she said, because during her fellowship she had a time period where she wasn’t allowed to touch patients.
“They said, ‘you are only going to look with your eyes and your’s going to see the movement dysfunction so you can start to hypothesize what is going wrong with their movement breakdown,’” Miskin said. “We had the opportunity to start doing telehealth when I was at Kaiser Permanente. We saw most of our patients in person but I had that experience with telehealth.”
She said that background made the challenges of the COVID-19 shutdown something she felt prepared to face.
“It’s really fun,” Miskin said. “I didn’t realize that my training was going to come in handy just six months later.”
She explained that some of the toughest things for a physical therapist to understand why a patient is having an issue and also getting a patient to comply with their therapy plans.
“Because we are in their home space (via telehealth), they have been a thousand times more compliant,” Miskin said. “It solved a lot of different problems. Some of our best experiences have been having people show us exactly what they are doing so we can see where the problems are coming from.”
CCD assistant clinical professor and speech language pathologist Kristen Ipson said that her staff saw some similar telehealth benefits in working with communication disorders.
“I had a school-age client and I asked her mom for some feedback,” Ipson said. “One of the things she mentioned was that she feels like her daughter was able to open up a little bit because she was in her own environment. She got to share her life with the clinician. Our student clinicians don’t normally get to see their bedrooms or get a feel for what their family lives are like. They got to peek into the home and this mom in particular felt like it helped her daughter because it was her space instead of our space. She was able to focus better in the days after our sessions as well.”
It wasn’t an easy process for any of the clinicians or the patients as they had to adapt quickly to the new way of doing things.
“There was definitely a learning curve for us as faculty members and for students because students are learning a lot of these skills for the first time,” Ipson said. “Teaching them to take the skills they have and learn new skills in a virtual setting was definitely a challenge.”
She said one of the positives was seeing students rise to the new challenges and get more creative.
“If they would use an active game that would get a child moving and running around the clinic, they had to figure out how to use the parents to maintain the child’s attention while still getting that active movement,” Ipson said. “There was a lot of creativity that had to happen. We had some hiccups for sure but it was really nice that while everything in the world was changing we could provide something to our clients that was at least something familiar to them.”
One of the most important messages that Ipson, Clawson and Miskin want people to know is that there are resources available, even during tough times.
“One of the biggest barriers in our field is that idea that asking for help means you aren’t doing something right as a parent or as an adult,” Ipson said. “Seeking extra support or resources is about helping clients function and participate in life in the way they want to. It should be seen as a partnership. It’s not about us as the experts knowing everything to do. It’s about working with clients to improve their quality of life. For us that’s helping them communicate with the people who are important in their lives.”
Clawson said there are still many who don’t know clinics like the CRC or the CCD exist.
“We would tell people to not wait, to not go without therapy if they need therapy because you can’t afford it,” Clawson said. “We want people to know we are here to help.”
Harrison urged those who need help to seek it out because it makes a difference.
“I would say to use the clinic and to be open with exactly what is going on with your problems,” Harrison said. “I would also tell them to stay on schedule with their exercises. I would also tell people to not be scared of telehealth, since they can use it to keep in touch with the CRC.”