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Adapting Addiction Treatment to COVID-19: A Virtual View from Eleanor Health

By
Channah VanRegenmorter
An iPhone displaying the meeting app Zoom, with headphones and a laptop. Photo by Allie Smith for Unsplash

Eleanor Health is an addiction treatment provider in North Carolina. This blog is the first in a series highlighting innovative provider approaches to addiction treatment during COVID-19. Eleanor and Shatterproof do not have a monetary relationship.

Several weeks ago, the same day that the Centers for Medicare and Medicaid Services, the DEA, and the American Society for Addiction Medicine changed their rules to allow virtual intakes for addiction treatment, I got an email from my boss at Eleanor Health, the addictionologist and psychiatrist extraordinaire Nzinga Harrison. The email read:

"Let’s go live in one week with a new virtual intake process."

Usually, when she comes up with a wildly ambitious goal like this, I’m in the “I’m not so sure that’s possible so quickly” camp, but for this one, I said yes.

I had already been seeing the increased risk for addiction playing out during the COVID-19 pandemic: increased drinking posts on my Facebook feed from friends, and the horror stories from an emergency response friend, who said that overdoses and drunk driving were up. Pandemics are not kind to recovery, and I didn’t want the people we care about to be alone and abandoned during this stressful time.

As each barrier to virtual intake floated through my head, a solution popped up.

How would we get e-signatures for consents and treatment plans?

In my mind I immediately responded: There are several apps for that. Let’s go ahead and purchase whichever one is highly ranked, link the app to our Electronic Health Record, and sign a Business Associate Agreement (BAA) with a 42 CFR Part 2 rider to ensure we meet all privacy requirements, for HIPAA and addiction treatment specifically.  We ended up choosing Zentake and had a signed contract with a BAA less than 24 hours from the first email.

How could we do a virtual urine drug screen (UDS)?

I knew the state medical director for North Carolina, Dr. Steve North, a telemedicine guru for over a decade, could help me figure that out. Indeed, after one meeting, we had a process and workflow figured out that solved 1) virtual completion of UDS release forms, 2) delivery options for getting UDSs to our community members, and 3) a new protocol for RN care managers to collect results virtually (thank you to Zoom Camera for allowing us to take a picture of the results remotely!).

How could we get several dozen staff across a state, some of whom had never used televideo to provide care, to turn on a dime?

Daily scrum meetings & agency-wide trainings! We already were using telemedicine to help our expert addictionologist and psychiatric staff serve our members across the state. We just needed to adapt the same trainings and technologies for the platforms to be used by all of our staff at home.  

It is an extraordinarily stressful time in addiction care.

Some of the members we care for are homeless and without cell phones, and virtual care is impossible for them. We are keeping our doors open for these most vulnerable members and have transformed our group rooms into our social distancing-approved treatment rooms in order to protect our patients and our staff, while still providing treatment. Our board has been amazingly supportive of us, encouraging us to open up several free treatment groups a week that anyone can access.

We do not know what the future holds with COVID-19, but with over 100 virtual sessions completed as of writing, including several virtual intakes and virtual urine drug screens, I can state that the future does hold evidence-based addiction care that can be done completely virtually. 

 

Channah VanRegenmorter holds a Master’s in Social Work and is a certified Project Management Professional. She is the Senior Director of Clinical Operations and Quality at Eleanor Health.