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Table 6 Provider responses and themes regarding major impacts of COVID-19 on implementation of evidence-based practices (EBPs)

From: An observational study of the impact of COVID-19 and the rapid implementation of telehealth on community mental health center providers

Theme Provider responses
Modality specific challenges Play therapy Barriers to implementing services like play therapy that are somewhat dependent on the setting.
Eye movement desensitization and reprocessing (EMDR) Haven’t tried EMDR bilateral stimulation.
Clients discomfort rating Outcome and Session Rating Scale (ORS/SRS) verbally.
I cannot do EMDR treatment—clients not preferring to try the phone way of doing it.
Contingency management / Combined MET/CBT Prize draws and drug screens are difficult to do.
Can’t supply “rewards.”
Can’t administer urine drug screens to assess for substance use.
Group therapy My Intensive Outpatient treatment and Relapse Prevention groups don’t feel as productive using Zoom.
Interaction with each other is more difficult.
People that were in an Intensive Outpatient Program group are now contacted 1-2 times weekly by an LCSW that may not have addictions experience of the level of experience needed. So clients are missing out a lot on the value of group therapy.
No longer facilitating a group and having to contact clients individually, which has been time consuming.
Therapy materials / Worksheets Lack of client ability to access the worksheets
Not being able to hand the client a cognitive distortion list.
Can’t share worksheets with patients
Client is not able to fill out [assessment] themselves.
Getting materials to patients is basically not happening due to the level of tech availability and ability.
I don’t have access to the VPN from home so I have to save everything myself into a folder and remember to send to clients before/during/after appointments.
Confidentiality Privacy Many clients have less privacy at home—may have partners/kids around
Trauma Some client’s [diminished] willingness to process trauma.
I have not been able to carry out TF-CBT properly due to not being able to meet with some of my patients via face-to-face even if it is virtual.
I am uncomfortable with them on healing their trauma due to not being able to see if they are upset, being triggered, etc.
Children Engaging children in telehealth It is difficult to teach my students over the video sessions at times depending on the subject we are discussing and distractions.
Conducting sessions via video or telephone has created some difficulties for young clients that struggle with inattention.
Younger kids often engage better face to face.
Children with complex behavioral health needs It is difficult to explain it to an adolescent, especially ones with learning disabilities/lower IQ over the phone.
Most of my clients are elementary school age children who need behavioral management services and substantial support. Doing this over the computer instead of face to face is not optimal.