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Youth Find Silver Lining in Child Welfare Shift to Telehealth During Pandemic

Emergency changes to state regulations during the pandemic has allowed young people in the city’s child welfare system to take advantage of remote therapy.
Emergency changes to state regulations during the pandemic has allowed young people in the city’s child welfare system to take advantage of remote therapy.
fizkes/Shutterstock

As a therapist for foster children, Milton Cephus was accustomed to cancellations.

A client might promise to come after school but never show up at Cephus’ Brooklyn office. A foster parent could have a scheduling conflict.

But since pandemic-spurred emergency regulations allowed Cephus’ practice to move from the office to the computer screen, much of that has changed.

Suddenly, Cephus’ young patients were showing up on Zoom.

While he’d previously see 20 of 30 scheduled clients in a pre-COVID-19 week, he said, now all the children in Cephus’ practice are making it to sessions — or promptly rescheduling when they miss an appointment.

“That means that more kids in foster care are getting their mental health that they so desperately need, which is a good thing,” he said. “I’m sorry about the way it came about, but I think it’s one of the bright spots of the pandemic.”

According to a new survey by the city-based Clinicians in Child Welfare (CCW), New Yorkers involved in the system “overwhelmingly reported” that telehealth made it easier to schedule appointments.

Just over 20% of the 249 survey participants, from the five boroughs and Westchester, saw an increase in services and over two-thirds polled said they were able to access additional services for the first time. Some 120 of respondents were parents/caregivers, 71 were foster parents, 51 were youth receiving services, and seven were unknown, according to CCW.

While not a replacement for in-person treatment, telemedicine presents a good option for foster families on Medicaid, said Sharmeela Mediratta, vice president for Health & Family Wellness at Graham Windham, the child-welfare nonprofit founded in the 19th century by Elizabeth Schuyler Hamilton.

“This was inequitable for at least a decade,” said Mediratta. The pandemic, she added, “has really enabled something that’s been happening in the ‘people pay for it’ world to be available for everyone.”

‘Prioritize Equity’

Children in the child welfare system are overwhelmingly Black and Latino — communities that generally are less likely to receive mental health treatment, while bearing the brunt of the health and the economic consequences of the pandemic.

The mass use of telemedicine was made possible by New York State temporarily relaxing regulations and allowing New Yorkers on Medicaid to receive primary medical services virtually or by phone from home.

Gov. Andrew Cuomo has consistently extended the flexible regulations every 30 days and pledged to expand telehealth access in the future at his recent State of the State speech.

Now, CCW is calling for the state to “prioritize equity” in making these changes permanent for children who face barriers of “technology, reliable internet coverage, and digital literacy training,” according to the survey.

“Clients and providers do not want to revert back to old care models after experiencing the benefits of telehealth during the pandemic,” the authors of the survey concluded.

Medical providers told THE CITY that teenagers now show up for therapy in numbers and with a commitment they hadn’t seen before.

“We should be ashamed, the whole field, that this didn’t dawn on us before,” said Karen Callender, senior division director at Good Shepherd Services. “Because teenagers live on these devices.... Their phone is everything and this is how a teenager responds to life.”

For one 19-year-old from Queens in the foster system, phone therapy has proved a game-changer.

“Some things you can’t tell your parents or people that are close to you without you feeling like, ‘What are they going to say?’ Like, a therapist doesn’t really have an opinion,” said the young woman, who asked to be identified by her initials, P.N.

“I don’t have to be, like, super self-conscious about what I look like when I go to therapy when I’m on the phone,” she said of teletherapy. “Because I could just answer and just talk about my day … instead of trying to rush to go to therapy every week.”

She had leaned on her therapist at the foster agency Little Flower Children and Family Services while navigating high school in New York City. But after striking out on her own to attend culinary school in Philadelphia, she said she couldn’t afford to see someone local.

Now, she’s “seeing” her long-time therapist via phone.

“It helped me by letting me know that it’s OK to feel how I feel most of the time,” she said. “It’s not the end of the world to be sad and lonely during a crisis when I’m not the only one feeling this way. It’s completely normal.”

‘Something Good Came Out of It’

Communicating by phone allows therapists to meet teenagers with trauma where they feel most comfortable. That allows them to work on deeper issues rather than deal with “putting out fires” that might arise from their commute or being triggered by walking through the foster agency office, said Dr. Melinda Konigsberg, co-chair of CCW.

“They can be at their house, they can be on the street, they can be anywhere, but they are allowing us access when before a teenager will shut you down in a minute,” said Callender.

Still, the switch from in-person to digital mental health services hasn’t been great for everyone. Despite efforts by welfare agencies and social workers to get tech into the hands of families — at times on their own dime — a lack of cell and broadband service in places like homeless shelters hinders tele-sessions.

Virtual sessions can be convenient, but families without consistent access to high-speed cell or internet service struggle.
Virtual sessions can be convenient, but families without consistent access to high-speed cell or internet service struggle.
Rushay/Shutterstock

In interviews with THE CITY, clinicians also reported difficulties treating younger children online, as well as kids with intellectual disabilities.

And while being able to see and interact with families in their own environment is often positive, clinicians say, sometimes it can make families feel watched by a system where trust has historically been in short supply.

That makes therapists like Mediratta worry that “there are definitely spots of this city that are not being served.”

CCW’s clinicians say bridging the tech divide will be key to an equitable future for the families they serve.

“I would just say that at the core of this is basic human rights” said Good Shepherd’s Program Director of Mental Health Jennifer Schultz. “Basic rights, meaning everyone has free internet, and everyone has access to a device or something. Because without that, we’re stuck.”

Cephus doesn’t mind that more clients means longer hours. For him, watching kids progress online has been a highlight of life in lockdown.

“It’s like the pandemic being lemons — It’s lemonade. Something good came out of it.”

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