COVID Silver Linings

On a table sits a place that says "Quiet Please. Testing In Progress."

MU Adult Neuropsychology Clinic stayed steps ahead of peers in adapting to serve the community

Oct. 8, 2020

Department of Health Psychology clinics in the School of Health Professions serve well over 1,000 patients every year. In addition to clinical service and research in autism, brain injury and rehabilitation, the department’s faculty oversee an extensive psychology training program for pre-doctoral interns and postdoctoral residents.

“We are one of the most high-volume clinics in the country when you consider number of patients seen per faculty member,” says Dr. Eric Hart, associate department chair, director of adult neuropsychology, and clinical professor.

When COVID came to Columbia in March, the high-volume clinic had to pause operations. Within days, however, they developed and launched a remote telehealth model. By the end of the summer, they were back to full capacity offering modified in-person and remote services. Here’s how they did it.

Innovation

MU’s neuropsychology clinic has a long history of serving the community, but the field’s tradition of in-person assessment has been around even longer, Hart says.

“We do a lot of paper and pencil testing,” explains Dylan Seitz, who was completing an internship in neuropsychology when the pandemic began.

In mid-March, the entire service regrouped virtually – including faculty, trainees, technicians and administrative staff. Over the next 10 days, they pored over publications and seminars and listservs for information about adapting neuropsychology testing for a telehealth format. They held extensive Zoom meetings to discuss modifications that would allow them to keep serving as many patients as possible.

“We were charged with this responsibility to think strategically and ethically” Hart said. “We needed to do this in a way that was safe and effective.”

Maintaining the validity of testing was a major concern. “We delved into the literature,” Hart says. “We practiced among us for several hours looking at visual stimuli that are components of a standard neuropsychological battery viewed through Zoom settings to determine what could be used effectively. If we had concern that a specific measure would be misperceived, introduce too much error into the assessment, or misrepresent an examinee’s true ability, it was omitted and we devised an approach using alternative measures.”

A man sits at a desk behind dual monitors
Sonny Bradshaw, psychology technician, interacts with clients virtually.

Adaptation

After intense research, Dr. Hart and his team launched a telehealth clinic model on April 6. With this change, they were able to serve half the number of patients they typically see. When given permission to resume in-person services the third week of May, they made additional changes to ensure safety. Some providers continue to offer remote telehealth services.

“We created essentially an in-house telehealth format,” said Hart. “Several patients were unable to obtain the appropriate technology or wifi. So we have them come into the clinic to circumvent those challenges.”

To minimize the risk of transmission, the clinic limits family members. Providers and technicians work on site but in testing rooms separate from the patient. Trainees work from their homes.

“With this new protocol, we have been essentially back up to our normal capacity,” Hart said.

As they work toward more in-person assessment, the clinic is testing a model where patients can be in the same room as technicians. Both wear masks and are separated by plexiglass shields. Fans are placed in the windows to exhaust air, and air purifiers with UV light graded to kill COVID are used.

A woman enters information into the computer
Ellen Johnson, psychology intern, works at her desk.

Steps ahead

Although the Mizzou Adult Neuropsychology clinic is not the only clinic that adapted to provide telehealth services, Hart’s team was several steps ahead of their peers.

“It was a matter of days for us to turn things around,” Hart says.

In addition to maintaining patient service, faculty worked hard to ensure interns like Seitz could earn enough clinical hours to graduate.

“A lot of my peers and colleagues come from clinics that just stopped services completely,” says Seitz, now a post-doctoral fellow at Indiana University. “I was really happy to be at [Mizzou], where they were very flexible with how we were getting those hours and helping us do other things.”

A man wearing a mask stands in front of a large building with a sign that says Mizzou North
David Reddan, business coordinator for the Department of Health Psychology, works behind the scenes to ensure the clinics run smoothly.

Secret to success

Seitz credits strong leadership and frequent communication for Mizzou’s success. He says he appreciated weekly check-ins led by Dr. Laura Schopp, department chair and professor.

The check-ins covered “not only productivity and making sure everyone was contributing and finding ways to be useful during this time – it was also about our own well-being,” Seitz says. “No one was kept in the dark, and we could troubleshoot problems as they come up.”

Every team member was essential. Seitz says he owes a lot to David Reddan, business coordinator, who worked behind the scenes to help with technology and other details.

“It was surprisingly a seamless process for something that otherwise should have been pretty disastrous for the clinic,” Seitz says.

Hart says the department’s collaborative culture made rapid adaptation possible.

“The secret to our success even prior to COVID has been a strong working collaboration among all team members,” Hart says. “It really came into play when we were tasked with a challenge that no one has ever faced before.”

Silver linings

Since the pandemic has evolved, silver linings are beginning to emerge.

As a psychologist, Hart says one of the best ways to deal with stress is to get back into a routine. “Although we certainly had a few moments of shock and concern and fear just as everyone else did, we realized it was imperative for our own stability to get back to doing what we know,” he says.

The changes have also made it easier for some patients to access neuropsychology services. For example, patients who need pre-bariatric surgery evaluations often have mobility issues that make it hard to travel to the clinic. Since implementing telehealth, the attendance rate for these patients has improved.

“While it’s easy to focus on the negative changes and the hardships, in the long run, we are going to be able to serve even more patients because of the way we were able to adapt and refine our service,” says Seitz.

Hart is proud of what the team has been able to accomplish. The new model is strategic and rooted in science along with clinical judgment, he says. “[It] speaks to the resiliency of our service, the dedication of the providers to patients we work with, and the integrity of what we do.”

 

Dylan Seitz was finishing his neuropsychology internship at the University of Missouri when COVID-19 began to spread. Now a post-doctoral fellow at Indiana University School of Medicine, he shares how the MU Department of Health Psychology was able to shift and adapt quickly to keep serving the community.