Adjusting to a Post COVID-19 World
The New Normal in a Post COVID-19 World
Oct 17, 2023
North Carolina has taken a whole-person approach to addressing the COVID-19 pandemic by centering social determinants of health (SDoH) as primary risk factors for community resilience and recovery. Artiga and Hinton (2018) assert that SDoH are conditions in which people are born into that shape their lifestyle choices based on what they have readily available. These include factors such as living in neighborhood concentrated poverty, and having adequate access to housing, food, medical care, education, and recreational supports. The fields of public health and social work traditionally address SDoH through a “Recovery-Oriented System of Care (ROSC)” practice lens. This framework provides environmental strategies for individuals living in communities to build capacity and empower themselves to address their own SDoH needs (Recovery-Oriented Systems of Care (ROSC) Resource Guide, 2010, pgs. 10-11). The essential tenets of a ROSC are an emphasis on community partnerships, creating a broad service array, and focusing on peer to peer support (Recovery-Oriented Systems of Care (ROSC) Resource Guide, 2010, pg. 8).
Since the onset of the COVID-19 pandemic, North Carolina lawmakers have taken SDoH seriously. Millions of families are experiencing collective grief, social isolation, food insecurity, job loss, and greater behavioral health needs. “According to CDC data collected June 24–30, 2020, from a total of 5,412 adults from across the US who completed a web-based survey, 40% reported struggling with mental health or substance use. Among the respondents, 31% reported symptoms of anxiety and depression, and 26% reported trauma related disorder” (NCDHHS, 2020, pg. 2). In addition, another CDC study reported that a fear of COVID-19 exposure and/or restrictions have discouraged many individuals from seeking medical or mental healthcare, or leaving violent domestic partnerships (NCDHHS, 2020, pg. 3).
However, through this struggle, there have been efforts to build capacity and expand mental health services to ensure that more North Carolinians have resilience. The Department of Health and Human Services (DHHS) created the “Hope4NC Helpline” to provide immediate crisis services and address SDoH impacting individuals and families. Providers also now have access to receive support for themselves. “The Hope4Healers Helpline is an initiative that provides mental health and resilience supports for healthcare professionals, emergency medical specialists, first responders, other staff who work in health care settings and their families throughout [North Carolina] who are experiencing stress from being on the front lines of the state’s COVID-19 response” (NCDHHS, 2020, pg. 7). Perhaps the most surprising benefit of the “new normal” is the rise of telehealth culture. DHHS authorized behavioral health providers to include telehealth in their service arrays (NCDHHS, 2021, pg. 6).
North Carolina made overnight advances in telehealth following the initial pandemic lockdown, despite years of providers advocating its use in practice. As a result, the American Medical Association (AMA) is currently advocating for permanent provider telehealth service expansion. Preliminary research shows that telehealth platforms have proven to strengthen continuity of care, be cost effective, fill service gaps in rural areas, and result in higher utilization of basic services as compared to traditional in-person options. AMA found “this technology can also prevent patients from delaying care for conditions that, if undetected and untreated, can trigger emergency department visits or lengthy hospital stays. Wide-ranging case-study examples of the comprehensive value that virtual care can provide are featured in the AMA’s “Return on Health” research issued in May” (Harmon, 2021).
There are some drawbacks to the telehealth platform. Providers report that unreliable internet access, a lack of stable training and technical assistance are among some of the implementation concerns. Additionally, individuals with severe symptomatology are not best suited for the telehealth platform (Jercich, 2021). However, from a harm reduction and prevention standpoint, providers have noted that telehealth could be a positive line of defense to support individuals when their symptoms are mild or moderate. (Harmon, 2021). Many providers and clientele are willing to continue using telehealth indefinitely, but implementation of telehealth practice comes with its challenges and limitations ((Jercich, 2021). In conclusion, there should be a renewed sense of focus on the “new normal” being more mental health informed and states such as North Carolina should continue to advocate for better access to a robust behavioral health service array. The trauma-informed approach encourages the paradigm shift from “what’s wrong with you” to “what’s happened to you” and COVID-19 has happened to everyone (https://www.nctsn.org/trauma-informed-care). The broader culture has adequately embraced telework virtual meeting platforms, and the behavioral healthcare industry deserves to move forward with the times. It’s important that we build partnerships, share resources, and offer flexible and equitable services for all North Carolinians in a post COVID-19 world.
References
Artiga, S. & Hinton, E. (2018). Beyond Health Care: The role of social determinants of health in promoting health and health equity. Racial Equity and Health Policy. Retrieved from https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-so cial-determinants-in-promoting-health-and-health-equity/#:~:text=Determinants%20of%20Healt h%3F-,Social%20determinants%20of%20health%20are%20the%20conditions%20in%20which %20people,health%20care%20(Figure%201).
Harmon, G. (2021). Expansion of telehealth services must be sustained. American Medical Association. Retrieved from https://www.ama-assn.org/about/leadership/expansion-telehealth-services-must-be-sustained
Jercich, K. (2021). Physicians in favor of permanent telehealth expansion. Healthcare IT News. Retrieved from https://www.healthcareitnews.com/news/physicians-favor-permanent-telehealth-expansion
National Traumatic Stress Network (n.d.). Retrieved from https://www.nctsn.org/trauma-informed-care
North Carolina Department of Health and Human Services. (2020). COVID-19 community readiness: helping meet needs for persons living with behavioral health issues, intellectual/developmental disabilities and traumatic brain injuries. Retrieved from https://covid19.ncdhhs.gov/media/985/download
North Carolina Department of Health and Human Services. (2021). North Carolina Telehealth Playbook. Retrieved from https://www.ncdhhs.gov/media/10611/download
Recovery-Oriented Systems of Care (ROSC) Resource Guide (2010). Retrieved from https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf
