How Service Delivery has Changed: The Effect of COVID-19 on Occupational Therapy

By Stephanie L. Blodgett, M.S., OTR, CBIS, Rehabilitation Specialists

I have been employed as an occupational therapist with Rehabilitation Specialists, a day and residential community re-entry program in Fair Lawn, New Jersey for the past 17 years, and I have held my CBIS designation since February 2006. The current pandemic and subsequent distancing efforts have changed service delivery to our clients in ways that impact and disrupt their normal routines. The management team implemented the following measures mid-to-late March 2020 to ensure the continued health and safety of all clients and staff.

For our residential clients, Functional Life Skills (FLS) staff now provide treatment in group homes that would normally have been provided at our day program/outpatient facility.Staff follow a daily health and safety protocol, including having their temperature checked at the beginning of their shift, monitoring the temperature and O2 saturation level of all clients, and following a strict routine of cleaning equipment and high-touch surfaces. Staff must wear masks and attempt to maintain social distancing while providing treatment and performing their various duties.

Clients utilize iPads provided on loan by the company to receive treatment from our licensed therapists (OT, PT, ST, and neuropsychological counseling) working from home via telehealth service delivery. Every effort has been made to provide the same schedule of services that would have been provided at the day program facility. Residential clients are limited to socialization with their housemates, who they see 24/7 and with whom they’re currently unable to participate in goal-specific community outings, such as grocery shopping and recreational activities. Visits from family and friends are currently limited to phone calls, emails, and FaceTime. We’ve also formed a therapist-facilitated “Coffee Chat” meetup several mornings per week allowing interested residential and outpatient clients to socialize and visit one another virtually.

As for our outpatient clients, they too receive services via telehealth delivery, both for cognitive and licensed therapies, whether on personal devices or on company-supplied iPads. Family members are typically available to assist with schedule reminders and technology issues.

Regarding changes to my job and adjustments I have had to make, my days are considerably longer than when I commuted. I still awaken and get ready for my day at the same time, and although my scheduled work hours are 8:30 a.m. to 4:30 p.m. Monday through Friday, I typically have been putting in 9-hour days at the desk in my home office and occasional hours on the weekends to research new treatment ideas. I am definitely sitting more and moving less, as can be attested to by my lower Fit Bit step count! I follow a weekly client schedule, with occasional “coverage” of non-scheduled client sessions.

All of my sessions are conducted via telehealth service delivery, an option my company had to explore and arrange for all licensed therapists beginning in March. This entailed learning a completely new system, as well as creating and uploading new and relevant materials. Initial evaluations have been altered out of necessity and can no longer be conducted with standardized protocols. Sessions themselves must be conducted with the understanding that family members or other clients may be present in the background and may create a distracting environment; however, for purposes of client confidentiality, permission must be obtained from all parties when another client’s family member is present during the session. Background noise in some instances has been an issue. Treatment resources are limited to what I have at home or have been able to borrow from my office, and there is no physical or “hands-on” intervention being provided. With the current structure, all clients must work on the same activity/task, as there is no way to individualize tasks within small group sessions. This makes treatment planning more challenging, as groups are not always comprised of clients on the same cognitive or functional level.

Documentation for daily encounters required learning a new, more time-consuming system. Weekly rounds and clinical meetings are conducted via Google Meet rather than in person. Communication among the therapists has increased overall, as a number of outpatient clients frequently have technical issues with connectivity that must be addressed in real time in order to conduct treatment. Therapists often communicate via group text (while adhering to confidentiality) regarding such issues. Set-up and technical issues within the group home setting occasionally require the assistance of FLS staff.

Despite the learning curve, telehealth service delivery is a solid alternative to treatment that is provided in-person and may ultimately be worth considering for times when a client is out on extended medical leave or unable to tolerate a lengthy day at rehab. Not only does telehealth benefit clients by allowing them to remain active in working towards established goals, it also provides new learning opportunities for technology training and use and, with approval for insurance reimbursement, ensures continuity of services.

All things considered, my employer has been extremely supportive of all staff throughout this transition. I feel that, as a team, we communicate our needs better and management has been both proactive and responsive in providing the tools and resources needed to keep everyone safe while still providing the best treatment possible, given the many challenges we face in these unprecedented times. Although the near future is uncertain, I look forward to the time when we can all return to our “home base” and “rehab family” for in-person, face-to-face treatment and interaction.