COVID-19 Related Changes to Fellowship - Captain James A. Lovell Federal Health Care Center
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Captain James A. Lovell Federal Health Care Center

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COVID-19 Related Changes to Fellowship

COVID-19 Related Changes to Training

 

The COVID-19 pandemic has created numerous personal and professional challenges for us all. One of these challenges has been the uncertainty of what will happen. During the initial months of the pandemic, The Captain James A. Lovell Federal Health Care Center responded quickly to ensure the safety of staff and trainees. The training program adapted to allow for trainees at all levels to telework from home when possible. We eventually returned trainees to on-site work in March 2021, continuing to prioritize safety by providing PPE, hand sanitizer, and cleaning supplies; we continue to wear face masks and practice social distancing, including when seeing patients in-person. All of our trainees are currently eligible for on-site, free COVID testing and to receive the COVID vaccine.

 

Now, over one year later, while the situation appears to be changing for the better, we will continue to closely monitor the public health situation and made adjustments as needed to the training year. The training program prides itself on its transparency, providing detailed and accurate information about our program and training opportunities. We anticipate that the 2022-2023 training year will occur on-site and in-person.

 

However, with COVID, transparency means we cannot definitively predict how specific rotations or adjunctive training opportunities may evolve if the public health situation changes. With confidence, we can say that there will likely be more utilization of telehealth and technology-based delivery platforms, as we have seen over the past year. We do not expect there to be any significant changes to the base clinical services or populations served through rotations and adjunctive experiences described in our materials. Below we have detailed some of the changes that occurred during the 2020-2021 training year. These changes may or may not continue for the 2021-2022 or 2022-2023 training years.

 

Changes to On-Boarding

We do anticipate starting internship on-time and will still require all the normal on-boarding requirements including being up-to-date on immunizations and fingerprinting.  The CDC has stated that keeping up to date on immunizations is important during this time to protect against any other illnesses that may compromise the immune system.  Thus, we view this as an additional public health safety precaution.  Our facility has ruled that finger-printing is an essential function and necessary to protect the interests of our patients.  Thus, finger-printing is also still a requirement and needs to be completed 30 days before the start of internship.  The finger-printing department at Lovell Federal Health Care Center has enacted extra safety measures including all staff wearing masks, extra sanitization, and 30-60 minutes in between appointments.  If the finger-printing office is closed at your nearest VA, please let me know so we can coordinate with our Human Resources as to what the next steps would be. 

 

Telework from Home Arrangements

Captain James A. Lovell Federal Health Care Center views all employees, including trainees, as essential healthcare workers, and are not bound by state shelter-in-place orders.  With that being said and with much consultation from local and national leadership, we may offer telework at home options depending on local conditions. Telework from home arrangements for our trainees may not be available immediately. Teleworking holds significant challenges even for seasoned clinicians and makes it harder to access needed support in standard and emergency situations.  We will need time to assess your competency level and to document this appropriately.  Additionally, some rotations do not allow for telework.  When selecting your training plan, if you feel like you have certain needs that would be more amendable to teleworking, than you should note which rotations are open to telework when selecting your clinical training plan. If there is a need for more stringent shelter-in-place orders and we still have emergency tele-supervision allowances from our national and local leadership and you are on a rotation that allows for telework and you have passed your telework competencies, you will be allowed to telework at that time. 

 

Clinics and Rotations that allowed for some or full teleworking during the 2020-2021 training year included Outpatient Mental Health, Outpatient Additions Treatment Program, Home-Based Primary Care, Women’s Health Primary Care, BRIDGE, PCMHI, Trauma Recovery Program, Behavioral Medicine and Pain Management, Administration and Leadership.

 

Due to the nature of the residential programs, trainees during the 2020-2021 training year on residential rotations primarily engaged in on-site work. New patients were quarantined for 14 days and did not have any interaction with trainees during this period; positive or presumed positive COVID cases were removed from the building and sent to quarantine in another building, which the trainees were not permitted to access; all patients and staff wore masks; all patients and staff had their temperatures checked daily (patients 2x a day) and asked screening questions; patients were not allowed to go on pass or leave campus for the duration of their admission (although if Veterans in the Homeless Program had employment, they were permitted to leave in order to work); volunteer/outside services were temporarily stopped; social distancing was enforced: groups were kept small and individuals were assigned to private rooms; trainees had a private space to complete charting.  The supervisor was on-site to assist with emergencies and on-the-fly supervision.

 

Facility Safety Procedures

Our facility has enacted a large number of safety measures to allow for as much social distancing as possible.  Facility-wide safety measures include the following: staff must wear masks at all times when on campus unless they are alone in their office; staff must have their temperatures taken; all staff must stay home if they are not feeling well and cleared by Occupational Health before returning to work if experiencing any COVID symptoms (extra days of leave are allowed under certain circumstances to encourage this); all staff and trainees can present to Occupational Health for treatment and screening if they develop any COVID symptoms at work; trainees will have access to standard surgical masks, hand sanitizer, and CAVI wipes; interns will have their own office.

 

We will continue to update our public materials as we know more about what will be in store for the 2022-2023 training year.  Please feel free to reach out to us if you have any questions. Despite the changes that have occurred or will occur, our dedication to high-quality clinical care and psychology training and our dedication to the trainees themselves has never been stronger. 

 

 

Changes to Rotations that occurred during 2020-2021 (These changes may or may not continue for the 2021-2022 or 2022-2023 training years).

 

*VVC: Telehealth System

 

Addiction Treatment Program (ATP): The training program does not have any major changes.  There is a possible involvement in outpatient VVC work but residential work is done in person.  There is no option to telework. 

 

Home-Based Primary Care: All non-essential home visits have been suspended.  VVC and phone visits are occurring.  As for the interdisciplinary aspect of the rotation, interactions with other HBPC staff, daily huddles, and weekly team meetings are occurring via Skype.  Option to telework 100% of the time.

 

Stress Disorder Treatment Unit (SDTU): The patient census has been limited during the COVID pandemic.  There is opportunity to treat both patients in the Addiction Treatment Program who present with PTSD and SDTU patients.  There is also an opportunity to provide programming to the Veterans who are quarantined via VVC.  The rotation offers part-time telework but it is limited to screenings or individual appointments who have recently discharged.

 

Neuropsychology Testing Lab: Reduced face to face hands-on testing. We are exploring use of protective measures to get back to testing (i.e., sneeze guards, clear masks for providers, primary use of verbal tasks). Telehealth for interviews and feedbacks at this point. Things that will/have remained the same but are done with social distancing in mind, include: supervision, scoring, report writing, and learning of test administration. Didactics could be completed in my office with masks and social distancing given the space.  We are providing telehealth services for interviews and feedbacks currently so part time telework is an option. Face to face testing via VVC is not an option at this time. We may consider continuing doing this to reduce face-to-face time when we are given a thumbs up to do testing in person.

 

Gero-psychology (CLC): Socially distant with PPE, students can provide face-to-face brief intervention. Trying to reduce need for physical presence on households.  Trainees will not interact with any positive COVID cases. Our CLC residents now have access to iPads on the household to participate in VVC psychotherapy remotely. We are also attending all IDT meetings through a VANTS line remotely. Roundings on households are done virtually through phone calls. Anything that needs real hands-on attention is provided on the household in proper PPE. COVID testing and fit testing is being provided to our CLC providers.  At this time, no work is being done on the short-term rehabilitation floor and no treatment is being conducted with Active Duty Service Members.  Option to telework part-time. 

 

Substance Abuse/PTSD: No major changes due to COVID.  No options for telework. 

 

Women’s Health: Main changes right now are all clinical interactions are telehealth including individual and group therapies as well as right now the physician visits.  Staff interactions are done remotely (e.g. zoom huddles) with some key staff detailed in other positions and other staff working remotely including at times the physicians.  Most committees are on hold for example whole health committee and subcommittees although others are moving forward including women’s health committee.  I was not able to offer biofeedback this rotation and this is on hold indefinitely.  I would say though most aspects of the rotation are the same but just now remote and telehealth.  We have been actually busier with increase in new patients and different kinds of referrals (e.g. anxiety treatments around needing to wear masks).  We have found ways to be creative to support the physicians for warm hand offs based on their comfort and need including skype, offering to come into the VVC visit and wellness checks following the visit.  We have also newly partnered with PCMHI mental health pharmacists for similar collaborations where appropriate. Telework options are offered and encouraged in this rotation. 

 

BRIDGE: Groups are currently on hold but will probably be operating in some capacity by the next training year.  Telework is available. 

 

PCMHI: As of right now, changes to the PCMHI rotation include decreased warm hand-off capacity in addition to telework options. Interns are still encouraged to contact patients the same day as their primary care appointment should a mental health need arise within the patient’s primary care appointment, though the referral is not coming directly from a PACT team member at this time (as it typically does). PACT team members have been co-signing the PCMHI psychologist to their notes when PCMHI services are requested, and the supervisor then makes the intern aware of the patient needs. The intern then coordinates a same day phone or VVC assessment. Interns are still asked to maintain open access hours at multiple times throughout the week, during which time they are ‘on-call’ to be able to meet this need and have the opportunity to engage in more ‘on-the-fly’ clinical work that is typically more common in PCMHI.

 

The other small addition to the PCMHI rotation at this time is to aid in providing behavioral health support to the recruits who are in quarantine at the Great Wolf Lodge in Gurnee, IL and experiencing higher levels of anticipatory anxiety. Given this novel situation with their need to quarantine for 2 weeks prior to entering bootcamp, RTC has requested that they are offered coping and resources as protective factors for their time at the hotel. This is also currently being done via phone appointments.

 

Yes, telework is an option noted more thoroughly above. As state and facility guidance becomes more clear, the preference would be for the intern to be on-site if in-person appointments are being offered within the facility in order to gain a richer training experience, though this is likely going to be unfolding decision-making process based on interns’ own level of comfort and risk factors are weighed against continued updates on the outbreak.

 

Homeless Veterans Rehabilitation Unit: As of now, there is less opportunity for exposure to therapeutic milieu and groups are being run at limited capacity. Aside from those two COVID-related changes, everything in our materials should be consistent.  There are opportunities for telework and those would be dependent upon the trainees training goals and needs.

 

Trauma Recovery Program: All patient appointments are currently being run in a virtual or phone format.  All supervisors are teleworking at the moment.  Telework is available. 

 

Behavioral Medicine and Pain Management: All clinical work (i.e., health coaching and individual therapy) shifting to VVC/phoneMost of the committee meetings have been suspended. The remaining meetings were switched from F2F to Skype. Pain University classes are suspended by the facility. Telework is available.

 

Recruit Evaluation Unit: Expanded opportunity to complete fitness for duty evaluations.  Telework is not available. 

 

Outpatient Mental Health Clinic: All patient appointments are currently being run in a virtual or phone format.  Telework is available.

 

Administration and Leadership: All the meetings are being conducted virtually.  Shadowing of supervisors is somewhat limited if it can’t be done in person but may include things like spending the day with the supervisor on the phone.  Telework is available. 

 

SARP: Groups and treatment team meetings are being run via VVC.  Telework is not offered unless the program is being run in a virtual format.