Adapting Coordinated Specialty Care in the Post-Covid-19 era: OnTrackNY provider perspectives

December 2022

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Amplify OnTrackNY project summaries provide an accessible overview of projects led by Amplify OnTrackNY, including the goals, actions taken, learnings, and next steps. 

Project overview

What are the goals of this project?

• Learn about the challenges OnTrackNY providers experienced during the Covid-19 pandemic
• Hear from OnTrackNY participants & families about the impact of the pandemic and experiences with OnTrackNY services
• Center the voices of people connected to OnTrackNY
   

What has happened so far?

The Amplify OnTrackNY team interviewed over 70 OnTrackNY participants, family members, and providers. They worked with OnTrackNY participants and family members called "Ambassadors" to help steer the process and guide conversations. The team asked questions about Ambassadors' experiences during the pandemic and changes to the way services were delivered. Now the team is going through the feedback we received and presenting the information to different groups in OnTrackNY. 

Exploring OnTrackNY provider perspectives

What is the role of each OnTrackNY provider?

• Primary Clinician (PC): The Primary Clinician (PC) is a licensed mental health professional who works closely with the participant and their family. They assess individual needs and help participants and families access services and support. PCs provide psychotherapy to help program participants make sense of their experiences, cope with challenges, build resiliency, and pursue their goals. PCs also provide education and support to family members so they can better support the young person in their recovery.
• Outreach & Recruitment Coordinator (ORC): The Outreach and Recruitment Coordinator (ORC) coordinates activities in the community to let others know about the OnTrackNY program. The goal of networking in the community is to ensure that young people who need the program, get connected to OnTrackNY as soon as possible. The ORC engages with individuals who are referred to OnTrackNY by asking them about their goals and challenges to determine if and how the program can be helpful. 
• Registered Nurse (RN) & Psychiatric Care Provider (PCP): The OnTrackNY Psychiatric Care Provider (PCP) and Registered Nurse (RN) help participants with their health and wellness goals. The PCP engages with the participant and family in discussions about their preferences related to psychiatric medications and also monitor side effects. The PCP and RN provide education on how to stay healthy, assist participants with managing their medications and help coordinate other services to address physical health needs. 
• Supported Education & Employment Specialist (SEES): A Supported Employment and Education Specialist (SEES) helps a person achieve their work and school goals. The SEES provides support by helping program participants identify opportunities to pursue and connect with schools and get jobs. They also advocate for program participants in schools and workplace settings.
• Peer Specialist: Peer Specialists are mental health professionals who have their own life experience of systems involvement, being psychiatrically labeled, and navigating complex mental health experiences. Peer Specialists bring that experience to walk alongside program participants to support their self- determination. Peer Specialists work both with program participants and their colleagues and larger community to shift perspectives on what it means to be psychiatrically labeled.

How did the Covid-19 pandemic impact each OnTrackNY provider role?

Primary Clinician (PC)

We interviewed 4 PCs from different OnTrackNY programs to learn about their experiences providing services during the pandemic. Read about the top three challenges Primary Clinicians experienced and how they adapted:

#1: Assessing participants' needs & delivering interventions

Given requirements for physical distancing, PCs often did therapy, needs assessments, and safety planning with participants by phone or online. They used more tools in therapy like videos, worksheets, and other virtual resources. PCs also partnered more with families to help keep young people safe and engaged in services.

#2: Discussing stressors & current events

PCs spent more time in therapy sessions discussing pandemic stressors and other current events with participants. This included talking about the impact of COVID-19, as well as other political and social challenges such as racial injustice.

#3: Keeping participants & families engaged

PCs helped change how special events were hosted to celebrate program participants' achievements and recovery. For holidays, they went to participants' homes and dropped off care packages, or sent participants meals home-made by the team. PCs also started having meetings with young people outdoors, like in parks, to keep people connected to OnTrack and their communities.

Outreach & Recruitment Coordinator (ORC)

We interviewed 4 ORCs from different OnTrackNY programs to learn about their experiences providing services during the pandemic. Read about the top three challenges Outreach and Recruitment Coordinators experienced and how they adapted:

#1: Networking with community providers

Due to physical distancing requirements during the pandemic, ORCs were not able to network with referring providers in the community. Their work shifted to providing online presentations to hospitals or other settings to share information about OnTrackNY services. Others reached out to community partners to let them know that OnTrackNY was still open and accepting referrals during the pandemic.

#2: Supporting connections to OnTrackNY

Due to physical distancing requirements during the pandemic, ORCs were not able to network with referring providers in the community. Their work shifted to providing online presentations to hospitals or other settings to share information about OnTrackNY services. Others reached out to community partners to let them know that OnTrackNY was still open and accepting referrals during the pandemic.

#3: Keeping participants & families engaged

ORCs used different strategies to keep new participants engaged. Some ORCs introduced new participants to other providers on the team online, while others found ways for participants to meet with the team in person as part of their welcome to the program. 

Registered Nurse (RN) & Psychiatric Care Provider (PCP)

We interviewed 4 RNs and 3 PCPs from different OnTrackNY programs to learn about their experiences providing services during the pandemic. Read about the top three challenges Registered Nurses and Psychiatric Care providers experienced and how they adapted:

#1: Helping with medications & side effects

RNs and PCPs wanted to ensure that OnTrackNY participants could continue taking their medications during the pandemic without interruption. They visited participants' homes to provide injections or gave them the option to change the form in which they took medication (injection, pills), or how often they received medication to reduce participants' having to come to the clinic.

#2: Monitoring health

RNs and PCPs monitored participants' health and wellness at a distance in creative ways. Some visited people's homes to take blood samples, and monitor blood pressure, weight, and side effects, which would normally be done at the clinic. Others gave participants scales to weigh themselves at home or blood pressure cuffs to check for any changes in their physical health.

#3: Providing tips for staying healthy

Given that OnTrackNY participants had more limited options for engaging in activities due to physical distancing during the pandemic, PCPs and RNs provided education on how to stay healthy and active. They provided education on nutrition, exercise, and maintaining wellness. They also provided information about the COVID-19 virus and vaccine. 

Supported Education & Employment Specialist (SEES)

We interviewed 4 SEES from different OnTrackNY programs to learn about their experiences providing services during the pandemic. Read about the top three challenges Supported Education and Employment Specialists experienced and how they adapted:

#1: Networking with employers & schools

Due to limits on in-person meetings and limited availability of jobs due to pandemic closures, the SEES relied on email and phone calls to maintain networks with employers and schools. They also monitored job openings more closely and found strategizing with the OnTrackNY team to be helpful in maintaining contacts with school staff or employers. 

#2: Educational services

Providing participants with support for educational goals became an even bigger focus for SEES during the pandemic. SEES supported participants more with online learning, such as troubleshooting technology issues, and were able to suggest alternatives to formal education such as online instructional courses for those worried about starting college courses during the pandemic.

#3: Employment services

When providing employment services, SEES often met with participants online (e.g., over Zoom) to help them build resumes, apply for jobs, and prepare for interviews. They also discussed the risks and benefits of having jobs that require being in person during the pandemic and participants' preferences for work. Additionally, SEES connected participants who needed financial assistance to benefits and resources like unemployment. 

Peer Specialists

We interviewed 4 Peer Specialists from different OnTrackNY programs to learn about their experiences providing services during the pandemic. Read about the top three challenges Peer Specialists experienced and how they adapted:

#1: Facilitating groups

Peer Specialists wanted participants to feel ongoing support during the COVID-19 pandemic. Groups were difficult to maintain with the switch to remote care and teams had different results with group facilitation. Peer Specialists adapted by adjusting group times and discussion topics to better meet participants' needs. They also added more social groups (walking groups) to support connection and engagement. 

#2: Building relationships & community mapping

With limits on in-person activities, Peer Specialists helped participants to stay connected and engaged by sharing online resources, such as YouTube music videos and virtual museum visits. They also created newsletters to stay in touch and share information with participants and searched online to find support groups for participants and families. 

#3: Team communication & collaboration

With the switch to remote care, Peer Specialists experienced obstacles to getting introduced to participants early on in the pandemic. They had to rely more on other team members to help connect them to new participants. To help with engagement, Peer Specialists reached out daily or weekly to check in with participants. Lastly, they supported the team themselves by creating team wellness plans, hosting Zoom games, and encouraging hangouts outside of work.
 

To learn more about this project, email amplify.otny@nyspi.columbia.edu

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