Lake County ADAMHS Board official reflects on pandemic effect, impact

Jul. 31—In the days immediately following the outbreak of the novel coronavirus pandemic, prior to Gov. Mike DeWine's quarantine and subsequent health and safety orders, the Lake County Alcohol, Drug Addiction and Mental Health Services Board took action, almost was anticipating the worst.

The strategy proved prudent, as alternatives to services were quickly discussed and shifted into place to prevent an outright suspension of everything the entity provides for the community.

Initial moves

Officials swiftly advised the provider network (contracted nonprofit agencies) to limit nonessential in-reach in the Lake County Jail and hospitals, postponed, if not canceled, consumer outings, delayed training, and limited nonessential community outreach and out-of-county travel, while establishing emergency response protocol.

While addressing emerging challenges, the majority of board staff moved to remote work, per DeWine's order, though in-office presence was maintained throughout the pandemic, noted ADAMHS Board Executive Director Kimberly Fraser.

"When schools closed, the board provided advisories to all county school districts addressing COVID-related stress and anxiety signs and symptoms, and behavioral health resources," she said.

The crisis being all-encompassing, the board also reached out to local city governments asking officials to post information on websites regarding signs/symptoms and resources. Restaurants providing carry-out and grocery stores and pharmacies were also contacted with identical requests.

Community advocacy

The board also partnered with NAMI Lake County and continually posted information about wellness, self-care, mental health management, pandemic updates, and changing agency-based news.

Efforts also included the implementation of a Coronavirus Warmline — a peer-run hotline offering emotional support — and weekly virtual support groups, open to clients of the behavioral health system and the community at large, including first responders. Hand-written letters to consumers were sent out as well.

Emergency funding was provided to address the needs of the homeless population, specifically shelter options for those who could not utilize the county shelter due to health complications, Fraser noted.

Funding and guidance to residential treatment facilities to accommodate related housing challenges were also provided, along with funding for drive-thru heated tents used for virus testing.

In order to maintain relationships with clients, the board supported state advocacy to allow for telehealth options, Fraser said.

"As a result, in order to continue to provide services, our contract agencies had to quickly move to obtain technology that would be compliant," she said. "The board provided one-time funding to our system for this technology to provide services to the Lake County community."

Tech included videos and health awareness training and presentations via Zoom.

"We also outreached to nursing homes and adult care facilities and provided PPE and cleaning supplies, in addition to our provider network and community partners, which continues and has expanded to including COVID test kits," Fraser added, noting the board suspended its Request for Proposals process for fiscal year 2020. "We extended contracts and invited our provider network to submit funding requests specific to pandemic-related needs."

A 'new normal'

With virtual public board meetings becoming the "new normal," the Lake County ADAMHS Board Pandemic Policies and Procedures (updated regulations and parameters) were established, one of the first in the state, and later replicated by other bodies in Ohio.

According to Fraser, the board, as uncertainty regarding education continued, pursued Ohio's K-12 Grant, designed to address related trauma for students, teachers and staff.

"This partnership empowered local communities in their efforts to help children build resiliency and reduce risk factors that contribute to the development of behavioral health conditions," she said. "The Trauma Sensitive School district-wide initiative incorporates trauma-informed best practices training for staff, implementation guidance for administrators and trauma screening.

"The initiative incorporated the impact of COVID-19 on staff and students and the ways TSS can address the unique needs resulting from our current environment," Fraser added. "All nine Lake County school districts opted in to work with us on this."

As a community advocate, the board has ensured no disruption occurred regarding UH/Lake Health Crisis services, including peer support within the emergency department, the Opiate Recovery Transition Program, the alcohol withdrawal management program, and hospital liaisons.

Impact and effect

Recognizing the long-term impact of COVID, the board invested approximately $1 million annually in additional funding in the behavioral health network to address workforce issues. Funds are invested in the following areas:

—Better pay for entry-level positions

—Salary equity/wage creep

—Employee health insurance

—Retention bonuses

—Non-health-related benefits (for example, mental health apps and wellness programs).

Though the overall census of the provider network slightly decreased since pre-COVID levels, Fraser noted the board has seen an increase in clinical caseloads and a significant increase in acuity, particularly among youth.

"The number of consumers receiving clinical services has risen 11 percent," she said, adding six providers implemented telemedicine toward the end of FY2020, with approximately 8 percent of their clients moving to virtual platforms in the last quarter.

"In FY2021, virtual services rose to an average of 43 percent and have settled at an average of 37 percent in FY2022. In nonclinical services, consumers served declined, and stand at approximately 88 percent (compared to pre-COVID levels)."

Looking forward

According to the board, providers are aggressively outreaching to re-engage consumers/families back into non-clinical services, as factors, including technology, workforce and inflation, have increased the cost of doing business for all behavioral health providers.

"As we've emerged from the pandemic, we have seen a change in who we serve and how we provide services," Fraser said. "Telehealth — including counseling, psychiatry and group programming — is a better option for many people, and those options will continue.

"Short-term, solution-focused services for those still experiencing COVID-related stress and anxiety are available for the community at large, but, most importantly, the tools we've developed to improve communication, increase flexibility, to make data-driven decisions, and to be more responsive to the immediate needs of Lake Countians, will drive our system moving forward."