Residential treatment for children. The Supplemental Nutrition Assistance Program. Problem gambling. Peer support for substance use disorders. What’s the unexpected link connecting these?
All are facing new challenges as a result of the COVID-19 pandemic, according to social work professionals with North Carolina’s Behavioral Health Springboard (BHS), a statewide initiative based at the University of North Carolina at Chapel Hill School of Social Work (SSW). BHS team members are working with colleagues across the state to find solutions to pandemic-related problems.
Some challenges can occur when state and federal policies collide with COVID-19 restrictions, explains Tara Bohley, SSW clinical associate professor and BHS director.
For example, although schools have been closed during this pandemic, residential treatment programs that serve children must continue to offer care.
“They’re in crisis right now,” Bohley said. “They can’t shut down, they can’t go virtual — kids still need to be admitted for out-of-home treatment.”
Children live in residential treatment when their behavioral health needs cannot be met in their home or community. The residential treatment programs follow state and federal policies to provide care for these children. However, during this pandemic, BHS team members Sharon Bell and Lisa Lackmann have worked with residential providers, their managed care organizations, and state agencies to increase communication regarding the emerging guidance and temporary waivers to rules that have hit the residential treatment hard.
For example, residential treatment providers have worked to interpret guidance for a temporary suspension of visitation with families while maintaining connections between parents and their children through tele-visits and tele-therapy.
Another BHS team member, Melissa Godwin, is working with NC Department of Health and Human Services (DHHS) professionals to lift requirements around substance use disorder (SUD) assessments for persons who receive SNAP benefits, formerly known as food stamp benefits. The temporary lift would ensure that North Carolinians would still be able to feed their families, even if in-person SUD assessments are not possible during the pandemic.
BHS team members work closely with state and local agencies to find legal and functional options whenever administrative rules limit services and, as a result, people are in distress.
But administrative rules are not always a factor. Bohley said that one of the most challenging — and most hidden — problems that have increased with COVID-19 is an increase in problem gambling.
“It’s because people are on their devices so much right now,” she explained.
“The gaming people do on their phones or on their computers — [gambling sites] are capitalizing on that,” she added. “Industries can manipulate and maximize problem tendencies.”
Although COVID-19 restrictions have put a halt to many sporting activities, which are often a focus for gambling, Bohley said that gambling sites have created a new target for betting: the COVID-19 pandemic itself. Problem gamblers can place bets on anything from “what will be the next COVID-19 hot spot” to “how many COVID-19 deaths will be reported on this day.”
For years, BHS has trained therapists to help people deal with problem gambling. In partnership with DHHS and the NC Problem Gambling Program, BHS has coordinated the “Sure Bet” training series, presented at sites across North Carolina.
Through this training, mental health professionals learn about different types of gambling, the motivations of pathological gamblers, counseling theory and practice specific to problem gambling, treatment interventions and ethical issues. “Sure Bet” also includes workshops to identify and address problem gambling for special populations, including military personnel, young adults, senior citizens and family members who have been affected by the behavior of a problem gambler.
COVID-19 restrictions forced the BHS team to cancel “Sure Bet” in-person workshops scheduled in March and April, but team members responded by offering more online training opportunities.
“We’re going to have a lot of free training between now and the end of June,” Bohley said. BHS has already provided eight free webinars, and six more free webinars have been scheduled. The one-hour, topic-specific webinars are designed specifically for therapists who may work with all kinds of behavioral health problems but want to learn more about problem gambling and treatment strategies.
Problem gambling is not the only addictive behavior that can increase as a result of the situations and emotions created by COVID-19 restrictions. Persons with substance use disorders may also find that they need additional support to cope with emotional and financial challenges, such as feelings of isolation or concerns about job security.
BHS manages the North Carolina Certified Peer Support Specialist Program (PSS), a registry of persons who are in recovery from mental illness and substance use disorders and are trained to provide support for others who are new to recovery. There are more than 4,000 peer support specialists in North Carolina. Each peer support specialist must complete a 40-hour course to join the registry. To remain in the registry, the peer support specialist must complete an additional 20 hours of continuing education coursework every two years.
COVID-19 restrictions had immediate effects on registry operations, Bohley said. For nearly three months, BHS team members were limited in their ability to receive and process the application packets that potential peer support specialists had mailed to BHS offices in the Tate-Turner-Kuralt Building, which was closed along with other UNC-Chapel Hill buildings.
To continue registry operations, the peer support program director, Bernice Adjabeng, received permission to enter the building once each week to collect and scan applications that had been mailed to BHS offices.
Working from home, team members processed applications and mailed certificates to applicants, taking large batches to the post office weekly.
“We had to create an entirely new workflow,” Bohley explained. “Because we process about 500 certification and recertification applications each quarter, we had to keep things moving while we simultaneously created an entirely online application process.”
Bohley acknowledged that, while an online application process is a smart move for efficiency, there remains a need to rely on hard copy processes and the US mail: “Not everyone has a smart phone, not everyone has wireless connectivity. Lots of people in recovery who want to be peer support specialists are in that age group where they may not be that tech savvy.”
Training was also an area of concern for pandemic operations. Although some continuing education coursework for peer support specialists was available online, the initial 40-hour course was designed for in-person classroom delivery at sites around the state.
In accordance with state guidance on group meetings, individual class sites will determine when they can reschedule their 40-hour course offerings.
Peer support specialists can complete 11 hours of continuing education coursework at their own pace with online courses offered by BHS, Bohley said. Those online courses are free at this time, and topics range from Fetal Alcohol Spectrum Disorders to strategies for quitting tobacco use.
Initial training and continuing education provide each peer support specialist with knowledge and skills to help persons who want to recover from substance use and/or mental illness, and North Carolina’s 4,000 peer support specialists may be in higher demand as the COVID-19 pandemic affects behavioral and mental health.
Throughout the pandemic, BHS team members will continue to provide training and support to serve clinicians, other health care providers and DHHS.