Montefiore in the News
On the front lines of COVID-19
- July 13, 2020
By Zara Abrams | Vol. 51, No. 6 | July 13, 202
Sriya Bhattacharyya, PhD, a postdoctoral psychology fellow at Montefiore Medical Center, a hospital in the Bronx, New York
When the COVID-19 pandemic hit, the vast majority of psychologists delivering services started doing so remotely. But not all practitioners had that option. A subset of psychologists has continued to provide in-person care to front-line hospital workers, patients with COVID-19 and patients with severe mental illness or complex medical conditions who cannot easily access telehealth services.
“For some groups of individuals, such as front-line providers, being physically present is really important for accurately identifying need and effectively providing support,” says clinical psychologist Joanna Yost, PhD, an assistant professor of psychiatry and neurobehavioral sciences at the University of Virginia (UVA) School of Medicine, who has delivered in-person care to hospital staff throughout the pandemic.
These practitioners, like other front-line workers, are taking safety precautions—donning personal protective equipment such as scrubs, masks and face shields, maintaining six feet of distance from others and sanitizing their workspaces more often than usual. Though the rapid shift in circumstances has been a challenge, psychologists say they value the opportunity to contribute.
“We’re witnessing a horrifying time in history—it’s a collective trauma that all of us are part of,” says Sriya Bhattacharyya, PhD, a postdoctoral psychology fellow at Montefiore Medical Center, a hospital in the Bronx, New York. “It felt so important to me to support those who were trying to help.”
Solidarity in the trenches
Yost co-directs the UVA School of Medicine’s behavioral medicine consultation liaison service with psychologist Casey Cavanagh, PhD, where they treat patients experiencing behavioral and psychological difficulties during medical hospitalization, for instance those displaying verbal or physical aggression toward hospital staff. That work involves close collaboration with front-line health-care providers—and Yost and Cavanagh used those connections to quickly launch a support program for the UVA University Hospital’s special pathogens acute care unit and intensive care unit (ICU) when the pandemic hit the United States in March.
The program consists of daily in-person rounds on the units to provide brief consultation, support and coping strategies. Yost and her colleagues also launched psychoeducation drop-in groups and work with unit leadership on communication strategies, such as balancing the need for transparency with maintaining stability.
That support—and the in-person nature of it—has been met with enthusiasm by the front-line workers she treats. “I can say that I know some of their struggles, because they’re mine as well. I worry about bringing this home to my toddler or my husband or getting sick myself,” Yost says.
At Montefiore Medical Center, Bhattacharyya, along with a team of about 100 psychologists and psychiatrists, also mobilized to deliver a combination of virtual and on-the-ground support services when the new coronavirus struck. More than 2,200 patients and 21 staff members at Montefiore have died from COVID-19 since March.
Bhattacharyya and her colleagues rolled out four in-person support centers and relaxation rooms staffed with practitioners delivering Psychological First Aid. They also provided an emotional support phone line, psychoeducational resources and in-person group sessions for various hospital departments. “A lot of providers were incredibly emotionally distressed, angry, anxious and fearful—and on top of all that, grieving over the loss of so many patients,” she says.
In the support sessions she leads, Bhattacharyya provides psychoeducation about mental health during crisis, encourages participants to talk about their emotional challenges and pairs up workers for ongoing peer check-ins. “This is a culture that typically has this ‘we need to be heroes and help other people’ mentality, so it’s really new for them to be vulnerable together,” she says.
Bhattacharyya is one of about five psychologists at the hospital who deliver in-person care to health-care workers and other staff, including janitors and cafeteria workers.
“These providers and hospital employees don’t have the privilege to work remotely,” she says. “One of the biggest forms of solidarity just comes from being in the trenches with them.”
Treating COVID-19 consequences
Front-line workers aren’t the only group that requires on-the-ground support. Megan Hosey, PhD, a rehabilitation psychologist and assistant professor at the Johns Hopkins School of Medicine, has treated patients suffering from COVID-19 in the ICU since March. She specializes in addressing post-intensive care syndrome—which may include problems with learning and memory, depression, anxiety, post-traumatic stress disorder and physical weakness—and ICU delirium, a state of confusion that can involve inattention, disorientation, hallucinations and delusions. (See related article.)
Hosey helps normalize and explain ICU delirium to patients with COVID-19, provides strategies for managing fear and anxiety while using a ventilator and suggests meaningful activities for patients during their stay at the ICU, such as reading, listening to music or performing relaxation exercises.
“People in the ICU may be very sick, but life can still be meaningful for them,” she says. A key part of Hosey’s role during the COVID-19 pandemic is ensuring patients understand their medical condition, including their prognosis and what recovery will look like. She also facilitates video calls between patients and their loved ones, because since the pandemic began, visitors have not been permitted in the hospital. Those calls allow health-care providers to share updates with family members; they also serve as a psychological intervention for the patient. “It’s really powerful witnessing these conversations,” Hosey says. “Until it’s happening to you, it’s unimaginable to be separated from a loved one at that stage in your life.”
She says the hardest part about her work during the pandemic is seeing patients’ extreme suffering, especially the disproportionate number from vulnerable populations. Many of her patients are underinsured, for instance, and she worries they won’t get adequate care when they leave the ICU.
Ensuring access to care
Some practitioners have continued their traditional in-person practice during the pandemic because their patients’ needs can’t be met through telehealth.
Madeline Brodt, a counseling psychology doctoral candidate at the University of Massachusetts Boston, is completing her internship with the U.S. Department of Veterans Affairs (VA) in Washington state. During her second clinical rotation, she worked with veterans suffering from severe mental illness.
“A lot of these folks have delusions about technology, which makes providing care by phone or video very difficult,” she says.
Brodt continued delivering in-person psychological services, including individual sessions and group therapy, through the end of her rotation in March. Even as COVID-19 cases approached their peak in Washington, her groups remained full.
“People still wanted services, and they didn’t feel they had access to care through other means,” even though the VA also offered virtual sessions, Brodt says.
Rehabilitation psychologist Mayra Sanchez Gonzalez, PhD, based at the Johns Hopkins School of Medicine, has shifted some of the inpatients she treats to a telemedicine framework, but she continues to see others face-to-face. Following a severe stroke, for example, patients may have significant challenges with cognitive functioning that make it hard to use technology. Those in-person sessions can also be challenging, she says, because clear communication is hindered by the surgical mask, face shield and physical distance required for patient and practitioner safety.
“As psychologists, we are so used to relying on our nonverbals to connect and to communicate empathy,” Sanchez Gonzalez says. “Now, with most of our faces covered, it can feel very disconnecting.” Mana Ali, PhD, another rehabilitation psychologist, works in the spinal cord injury unit at MedStar National Rehabilitation Hospital in Washington, D.C. She has continued treating inpatients—for whom she provides supportive therapy, cognitive-behavioral therapy and other interventions—in person throughout the pandemic.
“I had a lot of anxiety initially, especially about bringing the virus home to my family,” Ali says. “The pandemic has caused a lot of uncertainty for everyone, and psychologists aren't exempt from that.”
To manage that uncertainty, Ali has prioritized her self-care and joined several subcommittees at the hospital focused on the organization’s pandemic response. She has created psychoeducation handouts for staff and patients and is helping conduct research to help understand the experiences of patients during the pandemic.
“I have had to remind myself that I’m an important player on the team and I’m helping others each day,” she says. “That has been really grounding for me.”
‘A more sustained unknown’
As the COVID-19 pandemic continues to unfold, front-line psychologists are adapting their services to address changing needs. Bhattacharyya and her team have seen an uptick in requests for in-person support groups to address the psychological toll of the past few months. “Now, we’re entering aftermath mode,” she says. “We’re seeing people pause and reflect on what just happened.”
At UVA, Yost and her colleagues conducted a needs assessment of health-care providers who have treated COVID-19 patients. They are now analyzing more than 340 responses to determine which resources have been most helpful and what hospital workers need moving forward. “This pandemic continues to evolve,” Yost says. “We’re moving out of immediate crisis and panic into a more sustained unknown.”
A cadre of heroic psychologists are providing critical in-person services for seriously ill patients and their care providers