Telehealth Best Practices: Caitlyn Higgins Of Recovery Centers of America at Raritan Bay On How To Best Care For Your Patients When They Are Not Physically In Front Of You

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Caitlyn Higgins.

Caitlyn Higgins, LPC, LCADC, is the director of outpatient services at Recovery Centers of America at Raritan Bay (RCA), a drug and alcohol treatment facility that serves communities in New Jersey and the New York City area. In this role, she works closely with clinical staff to develop, plan, and implement outpatient treatment strategies, both in-person and virtual, for RCA’s patients. With nearly a decade of experience in addiction treatment she began as a detox unit treatment associate before moving into other roles, including primary counselor, licensed therapist and program director. Ms. Higgins holds a Master of Arts in clinician mental health counseling from Georgian Court University and a Bachelor of Arts in psychology, with a minor in substance abuse from Ramapo College of New Jersey.

During my senior year at Ramapo College of New Jersey, I was majoring in psychology and we had to complete an internship. At the time, I lived around the corner from a non-profit corporation serving those in need of treatment for substance use disorder and other co-occurring mental health disorders. I really didn’t know what I was going to do with my degree to be honest; I thought about maybe becoming a social worker. So I applied to the non-profit and was hired as a treatment advocate intern.

I worked on the detox unit floor, completing prescreens over the phone and handling assessments of new patients at admission, which included searches of items at intake and assisting the nurses and doctors. I also helped facilitate some group sessions. At some point, I came to realize I was really in the thick of patients who were experiencing the effects of full-blown withdrawal. It was there at this internship that I felt this is where my heart is; this is what I need to do with my life.

After my internship ended I was hired full time and worked for four years in various roles, eventually becoming a primary detox counselor responsible for individual and group therapies and aftercare services. I went on to complete a master’s degree in clinical mental health counseling and was certified as a New Jersey Licensed Clinical Alcohol and Drug Counselor.

Can you share the most interesting story that happened to you since you began your career?

One of the most interesting things that happened since I began my career 10 years ago was the pandemic. Between a Friday and a Monday, COVID-19 changed everything we were offering in therapy. One Friday we weren’t doing telehealth, and on Monday we were.

In March of 2020, I was a clinical coordinator of the ambulatory detox program at a mental health and substance abuse treatment provider. We found out on Friday, March 13 that everyone would go totally virtual on Monday, March 16. Meanwhile, we had patients who were still tapering off their medication, while some were homeless and didn’t have anywhere to go. We couldn’t just abandon them.

We tried to keep the center open and still help people because we knew all this isolation was going to have a significant impact on their addiction and mental health. It was very difficult at the beginning, as no one knew what was going on. The staff started feeling really unsafe and uncomfortable coming to work in-person, so we kept the center open long enough, about two weeks, to transition the patients to a sober-living facility or back home and set them up with a plan for ongoing support and treatment. Then, for about a year, my job became fully remote. Working from home, I held a caseload as a therapist and was facilitating individual group and family therapy sessions over Zoom.

I have a passion to not only be a therapist but to oversee and support other therapists as well as to create programming, and that is when I found Recovery Centers of America at Raritan Bay. In March of 2021, I started a new job as the director of outpatient services. The widespread acceptance of telehealth during the pandemic opened up new opportunities for outpatient treatment. What we do at RCA in outpatient primarily is evidence-based group therapy and, at that time, it was totally new to everybody that we were not physically sitting in a circle in a room. But patients either really liked the virtual experience or grew to like the convenience and safety of virtual group therapy. Now the majority of our patients actually prefer the virtual treatment experience. We are saving lives, but now through a computer screen as well as in person at our treatment center. This allows us to save more lives.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

One of my favorite life lesson quotes is hanging on the wall in my office — it is the Serenity Prayer: “God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.” People who are in recovery or in Alcoholics Anonymous (AA) might know this prayer from the 12 Steps program, as it is recited at most meetings.

At RCA we utilize the 12 Step model of addiction treatment to help patients work through the chaos they are experiencing internally to find the strength necessary to rise and overcome their hardships. The Serenity Prayer is a common theme in many recovery circles, as a way to pause and allow oneself to come back to the moment and the peace that is inside of them, whether they may initially see it at that moment or not.

Regardless of what you are going through, addiction or not, the Serenity Prayer is something that is so powerful. It can be applicable to your daily life regardless of your beliefs.

The quote speaks to me about acceptance and change. Change is possible by retraining the brain with evidence-based therapies, and acceptance of past behaviors and things that cannot be changed allows us to eliminate shame.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

I don’t have one particular person, but several of my previous supervisors and professors in grad school have all molded who I am and how I operate as a leader and therapist.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them, of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

Seeing a patient in person and seeing them via Telehealth can be equally effective and studies have demonstrated this. Telehealth is more convenient and that makes treatment more accessible to some people. In addition to providing better accessibility to treatment for those who live geographically distant from the outpatient center, virtual treatment can also foster greater attendance and frequency in treatment as traveling any distance takes a lot more time than just turning on a computer. For parents, students, and those with time consuming jobs, telehealth treatment can be a game-changer.

While telehealth did provide a solution for everyone during the initial phase of the COVID pandemic, it’s not for all conditions. There are situations where in-person sessions may be more effective and appropriate.

As a director of outpatient services, I have found that having the first session with a patient in-person may help a medical professional in developing a comfort level with their patient and in the development of a therapeutic relationship. Also, if there is a concern that treatment is not progressing as expected, meeting in-person may be warranted. Also, if there are persistent technology/connectivity issues, certainly being in the same space may be necessary.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

The initial challenge I saw arise during those first days and weeks of the pandemic when we went virtual was that a lot fewer people knew how to use a computer than I expected. Both patients and treatment advocates struggled with the functionality of Zoom — they couldn’t mute themselves or turn their cameras on. Not being tech-savvy is hard in general, but to live in a world of telehealth makes it even harder. How to start a session and share your screen, how to mute yourself or someone else — those features are now so secondhand to us. I had been on one Zoom meeting before the middle of March of 2020. During that first weekend of the pandemic, my boss and I spent many hours making sure we could get onto Zoom and that the links were working. We were sending each other tests to get on camera and to make sure we can run our groups as scheduled on Monday.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ?

Based on my experience working at Recovery Centers of America which provides alcohol and drug addiction treatment, the five things we need to best care for our patients when they are not physically in front of us are:

1. Have the right equipment. Not only a laptop or a computer with a webcam that has a working microphone, but Wi-Fi access — and fast Wi-Fi. I ended up purchasing a new MacBook during the pandemic as my previous computer didn’t have the capacity to have many windows open and my screen would freeze. At RCA facilities, we have the Rally Bar video conferencing systems (a camera and a speaker in one) connected to the television. As our groups are hybrid, it creates a unique set of challenges. Rally Bar video allows our online patients to see everyone who is in person. With this next-level technology, you almost feel like you are in the same room.
2. Establish expectations right from the beginning. One of our guidelines is that your camera has to be on. A patient can also look a lot better on camera than they do in person by using filters, giving a false sense of their well-being. We want our patients to participate in group therapy; they should not be multitasking or walking around the grocery store. They are in a quiet private space to fully listen to their peers and offer support. It is still not always easy, but by reinforcing the expectation, having cameras on becomes more and more the norm. At the beginning, I would log into groups and everyone would have their camera off and it was just me talking to 17 black boxes. The expectations should always be to do what is for the patient’s benefit.
3. Create policies and make them clear to the patients. We do not have eyes on the patients who are coming to telehealth therapy, so there is a little bit more of a risk and we need policies to mitigate that. A patient can be in group one day and not the next, and we know the worst could have happened in that time. Our policy is that if a patient misses one scheduled group session, we reach out to them. If they miss again or don’t call back a second day in a row, we reach out to their emergency contact. After three days, we will call the local police department to complete a wellness check. We tell our patients we are checking up because we care.
4. Make online group therapy interactive and fun. There are tons of activities and fun things that you can still do virtually to keep patients engaged. You may need to get a little more creative with a Zoom group, but at RCA we still find a way to do art therapy. Whether it’s an icebreaker game or team-building communication games, you can create breakout rooms to work in pairs. I ask my patients, what are things you have at home and how can we use them? It takes a little bit more planning, and it’s not as on-the-fly as in-person can be. But if you’re really thinking ahead and showing that proactivity, patients will come back.
5. Maintain a drug screening policy. When all our patients were on site we would simply collect urine. But we can’t always do that since not everyone is here at the center. It is still a requirement and a really important part of treatment — not only for accountability but for compliance with insurance policies. We can either have patients come on site or we send them prescriptions to go to labs near them.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Telehealth has created opportunities and benefits for recovery by breaking down a lot of barriers patients had for getting treatment for their addiction. For example, a patient may not have a car or can’t afford transportation to get to an in-person facility. Even driving 30 minutes might be too much for someone who has transportation challenges. As a patient, you can expand your reach a little more to programs that are farther away that you might not have considered. The common excuses don’t have to be barriers either, such as “I slept late,” “I didn’t have the time,” or “I have a headache.” Now, you can just open your computer and log on to a meeting from the comfort of your home. You don’t have to come in and you can still get the same services and support. All you need is a smartphone, tablet, computer or laptop to get started. We get to be a little more flexible with telehealth because you don’t have to worry about the drive. Our patients learn how to develop strategies to reduce relapse risk, manage cravings, build supportive relationships, and establish a daily routine to support and sustain recovery.

For patients requiring a less intensive level of care, they can safely recover with an outpatient program at one of our centers or via telehealth or a hybrid combination. In most cases they don’t need to be in an inpatient treatment program first to access telehealth outpatient services. This level of treatment is effective at providing long-term, structured support and flexible scheduling as patients continue to live at home, go to work or school, and attend therapy throughout the week.

Many mental and physical health assessments can be done virtually, which enables us to admit patients 24/7. At RCA at Raritan Bay we also have a unique outpatient program for first responders and military members called RESCU. Those patients are able to come to telehealth meetings with their peers who live in counties further away. For our alumni, we have weekly hybrid meetings for patients to continue meeting on a regular basis, expanding our reach, even out of state. Telehealth doesn’t just stop once you have completed the initial treatment.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

One of the new tools that RCA has developed to help facilitate telehealth services is the Shoutout™ app (currently in development). Pioneering a new wave of addiction treatment, this digital health platform delivers the powerful combination of Clinical Mental Health Treatment & Counseling and evidence based Holistic Wellness and Life Skill tools together in one platform…bringing people the support they need, when and how they need it — regardless of where they live — whether at home, at work or at school. It benefits people in our outpatient programs and alumni as well as the broader recovery community.

As soon as a patient calls the admissions center, one of the specialists conducts a same-day assessment to determine the best level of care. If they are using our telehealth services, the Zoom link for their group or individual session is right there on the phone or browser. It’s so much easier, eliminating an extra step to find the link in an email and typing in password. It also has a ton of sobriety and educational features, exercises, mindfulness videos posted every day and a gratitude journal feature. Patients can message their therapist, receiving treatment tailored to their specific symptoms and needs, or offer support or inspiration to others in meetings and a community forum. The time our patients spend with us in our inpatient facilities or outpatient treatment programs is only the beginning of a lifelong journey. It’s important to stay connected with recovery and others who have shared similar experiences in life.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

RCA is getting close with its telehealth system for our patients. A perfect digital health system could assist patients even further by aiding the communication of mental health professionals as a team for the patient. I would like to see features that link therapists to electronic health records portals so a patient’s health team can share patient documents and notes, putting everything we do in one online place.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Certainly we do our best to walk our patients through any technical issues to get the best results when they are not in person. Where we do see the most challenges is with older adults or where there is a language barrier. We make it work and get them online. A lot of people prefer in-person treatment because it’s what they know. I think many don’t realize how effective telehealth can be and that you can get the same level of support. Sure it’s slightly different, it’s in a different format, but you are getting the same expert education, you are getting the same skills and support from your peers. It just looks a little different, but what we are doing to help people, it’s not different at all.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

It is not uncommon for people suffering from substance use disorder to also struggle with mental health conditions such as anxiety. At some of our locations, we are using a new virtual reality (VR) experience for patients who suffer from both anxiety and drug or alcohol addiction. The VR technology is a treatment enhancement service designed to address a patient’s addiction as it co-occurs with their anxiety. It is an immersive, interactive therapeutic tool used to teach ways of decreasing the anxious response and healthier ways to ease anxiety through meditation, breath work, and other evidence-based strategies. It is interesting to think about what the application could be used for in the future, as it relates to telehealth, and to help bring people together in a shared virtual space.

Is there a part of this future vision that concerns you? Can you explain?

I think that telehealth is a phenomenal addition to treatment, but in-person residential treatment and in-person outpatient treatment is still available for many patients in need. It is a lot easier to isolate and stay in your house when you are on your computer for three or even six hours a day when you are doing group therapy. It can almost encourage some level of isolation and we know addiction loves isolation. While it has been an excellent way to connect during the pandemic, and will continue to be important in providing access to treatment for many people, there has to be something else that you are doing physically to get up and be around people to supplement telehealth treatment.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?

There is still so much stigma around substance use disorder. Even among patients who are in treatment we hear things like “I’m only drinking alcohol, I’m not like you.” People say such mean things about people who struggle with addiction. They think it’s a choice and that “you did this to yourself.” It’s a lack of awareness, knowledge and education. Let’s look at mental health and instill social emotional learning programs in schools that begin from childhood addressing these issues. I would love to see more of that implemented. So many people make it to adulthood and don’t know how to deal with certain emotions, leading to substance use and mental health disorders. The pandemic for sure brought to light some of these issues. I think in society there needs to be more representation and accurate depictions of what addiction is. You are not a bad person, it’s not who you are, you have been impacted and you are trying to get it under control and move towards recovery. Just because you are suffering from a substance use disorder does not mean you are a monster. Let’s eradicate stigma and accept everyone.

“Telehealth Best Practices: Caitlyn Higgins Of Recovery Centers of America at Raritan Bay On How To Best Care For Your Patients When They Are Not Physically In Front Of You”, Luke Kervin, medium.com, https://medium.com/authority-magazine/telehealth-best-practices-caitlyn-higgins-of-recovery-centers-of-america-at-raritan-bay-on-how-to-f4bc7d8fd362