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Copernican Clinical Services: Coronavirus-COVID-19 Plan of Action

3/9/2020

1 Comment

 
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David A. Perna, PhD
Licensed Psychologist
Lecturer in Psychology
Department of Psychiatry
Harvard Medical School

View my profile on LinkedIn
"We will be here to support you as these events unfold"
"The overriding goal of this letter is to promote hygiene and not to increase anxiety"
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CDC: "Face-masks should be worn by health professionals who have direct contact with patients" 
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"The CDC has asked that people attempt to “socially distance” themselves from others to help decrease transmission."
"We are supportive of all of our Asian and Asian-American 
​colleagues, patients, and their families who are dealing with this issue. ."

Copernican Clinical Services:
Coronavirus-COVID-19
​Plan of Action

To Our Patients
​and Their Families,
 
In my role as the president of Copernican Clinical Services, I wanted to help clarify how my staff and I are responding as a behavioral health company to the Coronavirus concerns that have recently arisen throughout the world and more recently in our home state. 
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On the whole, we will continue to provide timely and targeted support for all of our patients and their families in any way possible to help decrease anxiety or other mental health concerns related to this public health event. We will be here to support you as these events unfold. Please be aware that only an extremely small segment of the US population will have a serious impact from the virus. Many of our patients are considered to be at very low risk for a serious impact.
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Feel free to contact me directly if you have any questions about how your specific treater or any of our staff can help you through these challenging times. Our procedures are based upon Massachusetts public health procedures and federal guidelines that are distributed via the Centers for Disease Control. The overriding goal of this letter is to promote hygiene and not to increase anxiety. You can refer to the links listed at the end of this post for additional information.
 
Practical health behaviors that we have implemented to minimize transmission:
  • We have purchased touchless Purell dispensers that are placed at the entrances to both of our facilities. Please use these dispensers when you arrive for a session and when you leave a session. We hope to be able to purchase more supplies over time.
  • We have installed touchless paper towel dispensers in all of our bathrooms.
  • We have placed spray bottles of disinfectant in each bathroom which you may use as you see fit to maintain a hygienic environment for you and/or your child.
  • We ask that you accompany younger children to the bathroom to be sure that they are using proper hygiene to minimize any transmission concerns.
  • Please consider washing your hands before and after you use the bathroom. Washing beforehand will decrease the likelihood of self-infection as you use the bathroom.
  • Please let your clinician know immediately if we are out of any items such as paper towels, Purell, or disinfectant.
  • Please let your clinician open and close the door to their office before and after your session.
  • Face-masks: The CDC has clarified that face masks should be worn at all times.
 
Informing us of Risk Factors:
  • If you think that you have been exposed to someone who has had the Coronavirus, we ask that you seek medical attention and ask that you to contact your clinician via phone/email, rather than in person, and develop a plan with your clinician to address your health and mental health issues.
  • If you think that you or your child has been exposed, then we do not want you to present in person at our facility. This request is in line with CDC guidelines to minimize transmission in health-related facilities.
  • If you or your child has been exposed, please note, we will continue to support you without question via phone/telehealth sessions, whether these sessions are covered by your insurance or not (details are provided below).  Our goal is to help minimize exposure within our communities.
 
At the onset of each session:
  • Session Check-ins: CDC guidelines have been set for health providers to take an active role in asking about patient risks for recent exposure. Your clinician will ask you at the onset of each session if there are any recent concerns surrounding your health and/or the health of your family that have increased your risk of exposure to or transmission of the virus. They will also check-in with you on your anxiety level related to this event with regard to your physical and/or mental health.
 
  • Work/Financial Concerns: We also understand that many patients are concerned about their ability to address financial stress related to their job, business, or to recent swings in the global financial markets. Please feel free to speak with your clinician about these issues, while they are unable to provide you with financial counseling, they can help you manage these stressors and put together a plan to help decrease your anxieties about your finances. We believe that these work/financial issues will tax the energy of our adult patients even more so than the health implications of this crisis and as such are prepared to have a conversation with you on this topic.
Isolation Stress:
  • Social Distancing:
    • The CDC has asked that people attempt to “socially distance” themselves from others to help decrease transmission. These measures are temporary and will fade as the health scare passes. Examples of social distancing would include:
      • Staying 6-feet away from others if possible
      • Avoiding larger gatherings if possible
      • Avoiding common social formalities such as handshakes/kisses/hugs during the crisis.
    • ​Racial/Ethnic Profiling: Please be aware that the CDC has been clear that this virus impacts everyone. Asian-Americans are at no higher risk than anyone else in the US. However, Americans who have travelled to high-risk regions are a major concern. The first high risk patients in Newton consisted of students from Newton who had studied in Italy for a week. Almost all of the other cases in Massachusetts were connected to high level executives who attended a global staff meeting at the Biogen Corporation.  We are supportive of all of our Asian and Asian-American colleagues, patients, and their families who are dealing with this issue. 
  • Self-Quarantines:
    • If you are informed by your physician to “self-quarantine,” you and your family will have minimal contact with others during this 14-day period. We understand that this intense level of home-based interaction may stress your family. We encourage you to speak with your clinician about ways to make this experience an opportunity to bond with your family in a healthy way. Your clinician can check in by phone or via a telehealth interaction on an as-needed basis during a self-quarantine. Please inform them of your needs directly. Under such circumstances, we would ask that you provide your clinician with a letter from your health provider to clarify that you are ready to return to face-to-face interactions in our facility.
 
  • Emergency/Urgent Contact: You can call our emergency phone line, (617)-244-2447, to reach your clinician if you do not feel that you receive a timely response via phone/email. Please be aware that our clinicians may be managing a variety of urgent/emergency calls during this period of time. We will definitely work together as a team to help support you.
 
Grief Support:
  • If you lose a family member, friend, or loved-one as a result of a Coronavirus-related health issue, we will provide you with emotional support and any other support possible to help you through your grief. We can also advise you on how to talk with your children about these events in a developmentally appropriate manner.  
 
What if your clinician becomes ill?
  • If your clinician becomes ill, we will expect them to simply follow their doctor’s medical advice. If that advice includes time off from work due to feeling ill, caring for a family member who is ill, being subjected to a self-quarantine, or any other disruption in their ability to meet with their patients, then they will provide you with a plan to address your specific treatment plan moving forward.
  • All of our information systems are cloud-based so your clinician can fully function with relevant clinical information relating to your case from any location where they find themselves, including their homes.
  • We have been clear in our most recent staff meeting that all Copernican Clinicians should make decisions that are in the best interests of their health and the overall health of their patients.
  • Cross Coverage: If needed, we can provide cross coverage with other staff members from our practice if your clinician is unavailable.
  • Telehealth Solutions: If your clinician is unable to be present for sessions in person, or if you are unable to be present for sessions due to health concerns, and are able to engage in an online telehealth session, then you can arrange a time to meet with your clinician virtually. Your clinician will email you a link that will allow you to meet with them virtually via a HIPAA protected telehealth interface. The interface is extremely simple to use.
  • Helping Others: If you have a friend or extended family member who becomes anxious about this public health event, please feel free to offer our supports if you deem it appropriate. Once again, if they are fearful of coming into our office, we can schedule a telehealth meeting with them remotely.  
 
I thank you for taking the time to review our concerns and response to this global health event. As is always the case, the support that we provide to each other and the manner by which we work together during these trying moments will help us define who we are in these times of uncertainty. My staff and I all look forward to passing the most critical test during these times, the test of our compassion for others during times of need. Be well and remain as healthy as possible.
 
 
Sincerely,
 
         Dr. Perna

          David A. Perna, PhD
          President, Copernican Clinical Services
          Lecturer in Psychology, Department of Psychiatry
          Harvard Medical School
 
Helpful Links:
 
How to prepare for Coronavirus in your:
  • Home:
    • https://www.cdc.gov/coronavirus/2019-ncov/community/home/index.html
  • K-12 school settings:
    • https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/index.html
  • College settings:
    • https://www.cdc.gov/coronavirus/2019-ncov/community/colleges-universities.html
  • Faith-based organization/community events:
    • https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/index.html
 
 
American Psychological Association Podcast on Coronavirus and anxiety:
  • https://www.apa.org/research/action/speaking-of-psychology/coronavirus-anxiety
 
Bloomberg-How Quarantines Have Impacted Mental Health in China:
  • https://www.bloomberg.com/opinion/articles/2020-02-27/coronavirus-quarantine-raises-mental-health-concerns-for-china
 
Psychiatric Times Article-Coronavirus and its Impact on Global Mental Health:
  • https://www.psychiatrictimes.com/psychiatrists-beware-impact-coronavirus-pandemics-mental-health
 
1 Comment

Home Schooling Strategies-Mindful Parenting: Part 1 Embracing the Moment: Being with your child

3/8/2020

2 Comments

 
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Alexis Chirban, MA
​CCS-Psychology Intern
Doctoral Candidate-
William James College

View my profile on LinkedIn
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"I have often been asked: How can being mindful with a child be beneficial"        -Alexis               Chirban
Home Schooling Strategies

Mindful Parenting: Part 1
Embracing the Moment
Being with your child
Parents, 

Please apply the words that our Copernican Intern, Alexis Chirban, MA, wrote on the topic of mindfulness to being home and schooling your child. We were planning on posting this information before the current health crisis but more than ever feel that it is appropriate to help you support your child's transition to learning at home. Please check back in with us for additional posts by Alexis on how to apply these techniques over the next few weeks. 
                                                           Be healthy and be strong,
                                                                                                                         Dr. Perna

​Mindfullness Research: 
I have often been asked, “How can being mindful with a child be beneficial?”   

Research has shown mindfulness to be associated with:
  • Significant effects on improving parent-youth relationships by parents engaging with their youths in a more attuned, accepting and compassionate way (Coatsworth et al., 2015).
  • Lower levels of anxiety, worry, depression, rumination, mind-wandering and negative affect (Deng et al, 2019 & Geronimi et al., 2019).  
  • Improving executive functions of inhibition, working memory and shifting. 
    • Inhibition (inhibitory control) is the ability one has in managing behavior, attention, emotions and thoughts in response to both internal and external distractions at a given moment. 
    • Working memory is understood as the ability to store and manipulate information. 
    • Shifting is the ability to adapt to change and consider and appreciate a different viewpoint (Geronimi et al., 2019).  ​ ​
Mindfulness has received a large amount of press recently. If you gaze at magazine covers in your supermarket’s check-out isle you will notice articles that target mindful breathing, mindful coloring, and mindful eating. These writers seldom talk about what mindfulness actually means and how you can apply a mindful approach to your relationships with your children. Let’s give it whirl and see where we end up!
"Become aware of the moment"
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"Children typically  
are not judgmental"
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Mindfulness Defined: 
Simply put, mindfulness is about noticing and becoming aware of the present moment, in a non-judgmental way.   The hardest part of this process is avoiding the judgement.  We have built up so many layers of judgement in so many things that we do, we no longer notice that we are judging. Children typically do not judge; they experience life as it comes at them.  

Challenge:
Let’s try it. Right now... Take a moment to sit back. Notice what’s around you. What do you see? Hear? Smell? Touch? Taste? How do your surroundings feel to you? If you are saying, “Well I think…” Try to drop the “think” and simply finish the statement, “I feel….” whatever?

Kids are great at this first challenge. If you place food on their plate that they do not like, they will get a disgusted look on their face and comment, “Yuck, I hate it, take it off my plate.” Our tendency as parents is to become frustrated with them. Adults will attempt to discuss all of the thoughtful reasons why they should eat the food that is on their plate, such as:
  • “It is healthy for you”   
  • “You need energy for school” 
  • “You have to watch your weight”   
And as is typically the case, the foods that kids reject are commonly vegetables or whole grains. We judge their eating, based upon our thoughts of what is a “healthy diet.” They are simply enjoying the moment.  
"Reconnect
​to your childhood sensory experiences"
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"Mindful moments can spur on a dialogue with your child"
Use your Senses:
This is what your child is doing. One of the easiest ways to remind yourself what it is like to be a mindful child is to take a step back and become aware of all of your sensory input. From our earliest moments on earth, we have processed environmental experiences through our senses. To this day, we constantly scan our world, analyze it, and respond to it without our conscious awareness… even as you read the words in this article right now you are engaged in this process of sensory awareness.  

Reconnecting to our sensory experiences can help us reconnect to our environment. As a result, we can make these habitual and automatic ways of responding more available to our conscious level of being. When our automatic ways of responding become consciously known, we can then offer ourselves a chance to engage in a substantively different experience of being in the world, including our choice to be with our children in a qualitatively different way.  
​
Example: 
For example, maybe after you noticed your child’s rejection of a vegetable, you thought back to your own childhood. What did that vegetable taste like to you when you first tried it? Was it bitter? Was it fibrous? Did it smell funny? A momentary check-in offers an opportunity for you to consciously take in information about your own past sensory experiences and provides you with a new choice in how to respond to your child’s experience.

Rather than becoming frustrated with your child, you might comment to your child, “Oh I was just like you, I hated spinach when I was a kid. It tasted funny to me and I had a hard time chewing it. I can understand why you don’t like it.” This mindful moment might spur on a dialogue, perhaps a question like, “Then why do you want me to eat it?” 

The power of mindfulness is in the choice it gives you to either respond to your environment, including your child, unconsciously from habit, or engage with them and the world around you in a different way-a mindful way.  These are exactly the techniques that will allow you to help your child focus away from many of the stressful thoughts that are barraging them during this current health crisis. 
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Keep an eye out for future posts on specific applications of mindfulness activities for during the current health crisis. Be healthy and be strong. 

References:
Coatsworth, J. D., Duncan, L. G., Nix, R. L., Greenberg, M. T., Gayles, J. G., Bamberger, K. T., … Demi, M. A. (2015).  Integrating mindfulness with parent training: Effects of the mindfulness-enhanced strengthening families program. Developmental Psychology, 51(1), 26–35. doi: 10.1037/a0038212
 
Deng, Y., Zhang, B., Zheng, X., Liu, Y., Wang, X., & Zhou, C. (2019). The role of mindfulness and self-control in the relationship between mind-wandering and metacognition. Personality and Individual Differences, 141, 51–56. doi: 10.1016/j.paid.2018.12.020
 
Geronimi, E. M. C., Arellano, B., & Woodruff-Borden, J. (2019). Relating mindfulness and executive function in children. Clinical Child Psychology and Psychiatry, 135910451983373. doi: 10.1177/1359104519833737
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