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Resilience and Telehealth Saved This Practice When COVID-19 Hit

Dr. Martina Moore already knew quite a bit about being resilient before COVID-19 hit in early 2020. Her practice, along with thousands of other behavioral health organizations, therapists, and professional associations all had to quickly pivot to telehealth. 

This fast switch meant having a special quality that therapists often talk about with their clients - resiliency. This was a quality that Dr. Moore came by the hard way. Her father was an alcoholic. And he had a behavioral health problem.

“I grew up with a father that was an alcoholic", Dr. Moore told Raymond Barrett, CEO and founder of the Telehealth Certification Institute (TCI). “He got sober when I was in high school - in my senior year. I walked that journey with him - of recovery. My father had what we call co-occurring disorders. He had behavioral health and substance use disorders. I saw him navigate through the process of recovery with not as many options as we have now. By the grace of God, he's still sober some 30 years later.”

Her father’s journey to recovery became a calling for Dr. Moore, who is the founder and CEO of Moore Counseling & Mediation Services, Inc. Her practice is based in Ohio. She is the president-elect of the International Association of Marriage and Family Counselors (IAMFC), which is a division of the American Counseling Association (ACA). Dr. Moore is also a faculty member and the substance abuse program coordinator for the Clinical Mental Health Counseling Program at John Carroll University.

“It really motivated me. My family did what was called a family intervention. My mother, our family physician, our pastor, and I, and my siblings did an intervention with my father. He went to treatment. I remember my mother having a suitcase packed at the door and they picked it up and carried him off. And he came back a sober man.”

“As a young girl navigating through that process with my family, I realized I had a calling and a vision to help other families. There were so many resources we didn't have then. So that was really what got me into the field, and really being involved on a systemic level with families and communities,” Dr. Moore said.

“Being a minority, I also realized that there weren't conversations taking place in my community about behavioral health disorders. I had to go outside of my community and then bring the awareness back there,” she added.

“I actually started in the church because, as African-Americans, the church is really our bedrock. But the church can also be harmful to us when we have behavioral health disorders. Many times, I found that our pastors were just uninformed and really tabooing and stigmatizing behavioral health and teaching us that the church had everything we needed. We didn't need medications, and we didn't need to talk to a counselor. All we had to do was show up and pray. I was one that really came against that belief. I really challenged my pastors.”

Dr. Moore is now married to a pastor - a pastor who is well-informed about behavioral health. 

“One of the things that my husband and I did in our business was we started what's called a church assistance program,” Dr. Moore said. “It's much like an employee assistance plan (EAP) for organizations, but it's for churches. We started a program where members could come and receive services, and the churches would pay for them. We come alongside the pastors, and we provide support to their leadership as well as to their members - teaching them about behavioral health … and saying, “Yes, there is a place for the church, and there's a place for behavioral health, and we can come together to really treat people holistically.”

It takes courage to challenge your church’s pastors - and then to offer a program to help overcome taboos about mental health. Courage and resilience. 

“One of the things I say often - those of us that work in this field - we are very resilient people. I consider myself very resilient. We bounce back,” Dr. Moore said. 

Dr. Moore still remembers that Sunday in March of 2020 when Ohio Gov. Mike DeWine ® announced that the state was going into a mandatory shutdown. 

“The first thing I thought about was that my clients were coming for treatment tomorrow, there's group tomorrow, there are individual sessions, the psychiatrist is booked. It started running through my head, ‘What are we going to do?’”

“I sat there stewing. I sat there worrying, but by that next morning, my resiliency had kicked in. I said, ‘We're gonna shift, and we're gonna shift quickly.’”

“I believe that many of us who work in this field have high levels of self-efficacy,” Dr. Moore said. “We have to have high levels of self-efficacy in order to motivate other people. We've seen the depths of despair, and then we've also seen the heights. We're aware that when we see people at the death of despair - even ourselves like at a time when the pandemic hit us - we realize there is still something we can do. We've seen it before, so we let that resiliency kick in, and we begin doing what we need to do. That's exactly what we did.”

Dr. Moore was not doing any telehealth sessions when COVID-19 hit. But she quickly switched gears and ramped up telehealth.

“It saved our clients, and it saved us. That Monday, we just began doing telehealth,” Dr. Moore said.

There was still one big obstacle, but it didn’t deter Dr. Moore for long. “The biggest challenge was the lack of access to the internet for many of our clients. I reached out to the mayor of our city, and we began to work on getting internet access for everyone. 

Dr. Moore’s husband also is a city councilman. “It wasn't a second thought to me,” she said. “I'm like, ‘We have to do something about this.’”

So she reached out to the mayor and said, “How can we get our city network where everyone can have internet?”

While the city worked to improve internet service, Dr. Moore said the local library handed out free hotspots. “They were passing them through the door to people. You could come in and get a free hotspot.”

Dr. Moore sent her clients to get the hotspots so they could do telehealth.

“We went from having six groups a day in our offices to having them online. Then we went to having all of our individuals, all of our case management, and all of our psychiatry appointments online,” she said. “The only thing that we had to still have in our office was our medication-assisted treatment (MAT) because they had to come in for their doctor. But then the doctor also started seeing them online if they were stable online.”

Dr. Moore said her practitioners had more anxiety about the quick shift to telehealth than the clients did. “The clients were like, ‘You guys will figure it out let me know when

it's done.’”

The International Association of Marriage and Family Counselors helped clinicians adjust by offering free or low-cost training on best practices for telehealth with couples and families.

“They have been extremely involved in intervening because, on a systemic level, COVID-19 has really affected the family. You've got families and generations in a home together who are there who are having to work, who are having to educate right there within the same walls.”

After a few telehealth sessions, Dr. Moore’s staff was also on board with telehealth. In fact, telehealth worked out so well for Dr. Moore’s clients and staff that it remains a big part of her practice. 

“We still have about 50% of our services on telehealth. We found that it’s what many of the clients prefer now. Even our clinicians often prefer it.”

Dr. Moore said telehealth also helps break down barriers for clients, giving them easier access to services. “We don't have the barriers like transportation or child care. There are just so many doors that it's opened for our clients, and for us as practitioners.”

Dr. Moore has seen a significant decrease in client no-shows due to telehealth. 

“Prior to COVID-19, we probably had about a 60% no-show rate. We would double or triple book. Now, we're not really finding the need to have to do that because we're seeing about a 20% no-show rate.”

During the early part of the pandemic, Dr. Moore laid off staff because she didn’t know what to expect. But then, about 95% of her clients were showing up for telehealth sessions, and some wanted additional sessions.

“I had to bring the staff all back once we started telehealth because we had all these people coming in. We had all these appointments on and, I'm like, ‘Please come back, and you can stay at home. Just turn your computer on.’ It was just great how that worked out.”

Now that telehealth has caught on at her practice, Dr. Moore said she’s working to make it even better for her staff and her clients. “We are doing all types of upgrades on our infrastructure. We’re improving it.”

To learn about Dr. Moore’s practice in Ohio, go to her website.

By Amanda Barnett, LPC, EdS, NCC

Key Sources:

Moore Counseling & Mediation Services

International Association of Marriage and Family Counselors

American Counseling Association