Over the course of the pandemic, the way we conduct our private practices has shifted and, needless to say, we are doing things much differently in terms of our contact with clients and how we conduct our sessions. But, with vaccines on the rise, and communities reopening their doors, it’s time for us to rethink how to shift back into our physical private practice space.
As many of us are making the transition back to the office after a year or so of doing exclusively online therapy, things won’t be exactly normal. The truth is, Covid is going to be with us for a while. It has changed our “normal.” But, it is causing us to think more creatively about how we do business and provide our services that are so needed. In fact, for some, it has opened up opportunities to serve in new ways.
For many clinicians, the switch to conducting sessions via telehealth was a challenge. In that sense, it has been good for many to navigate technology and gain new skill sets. Fortunately with our professions as mental health clinicians, the shift to telehealth has been fairly easy for most. Although not the same as in-person therapy, virtual and video sessions are clinically effective. And the truth of the matter is that conducting telehealth sessions is probably going to be much more common moving forward.
During these strange times we find ourselves, it is important to embrace the changes that are occurring. Now more than ever, your services are needed. So, how can you move forward, safely?
According to guidelines by the Centers for Disease Control and Prevention (CDC), if you haven’t been in your office for more than a week, a routine cleaning of the space should suffice before reopening; coronaviruses naturally die in hours to days in typical indoor environments. The CDC’s guide on “How to Clean and Disinfect” is a good place to start for recommendations on how to conduct deep cleaning during COVID-19. As you clean or hire a company to clean, make note of all the sanitizing steps taken; these will be a key point you can include in your communication to clients about reopening, as well.
The Occupational Safety and Health Administration (OSHA) recommends increasing ventilation rates in the work environment. You can easily do this by opening your window after each session. As for high efficiency air filters, the National Air Filtration Association indicates that “in most buildings and in most situations, filters may be considerably less effective than other infection control measures including social distancing, isolation of known cases, and hand-washing.”
Make sure that your seat is set at least 6 feet away from where your clients typically sit, or ideally farther, if your office allows for it. Create a distance comfortable enough for you so that if your client sneezes or moves around during session, you can still focus on what they’re saying, rather than worrying about the potential health implications. If you have a waiting room, you will likely need to close it for the foreseeable future.
Unfortunately for your gorgeous upholstery couch, fabric is one of the hardest surfaces to clean. Consider removing or placing a “no-use” poster on furniture with soft and porous materials, and temporarily using more easily cleanable items. Good alternatives include, chairs with vinyl cushioning or plastic chair covers that you can wipe down after every session. If you see couples or families, make sure to prepare chairs for each individual. Consider foot pedal operated trash cans, and laying out clean tissues so clients don’t need to touch a tissue box.
In addition to your own personal supplies, make sure you have separate materials accessible for your clients, so you aren’t both reaching for the same bottle of hand sanitizer. Stock up on disinfecting wipes, hand soap, paper towels, disposable gloves, and masks in case a client needs one.
While you should, of course, email your protocol to clients ahead of time, it doesn't hurt to also to put a checklist up on the outside of your suite or office door so that clients are reminded at every session to go through it before entering your office. Your checklist may include items like wearing a mask to every appointment, washing hands frequently, and only arriving 5 min prior to the session.
Keeping telehealth as a mainstay in your offerings can be beneficial for you and your clients –– it is more convenient and allows some people to continue treatment, when coming in person is prohibitive because of transportation or scheduling. Many insurance companies have made telehealth a permanent option for their policyholders. Being able to offer this to clients as an ongoing option makes sense on many fronts. It also has the advantage of less exposure to potential spread of the virus. Make sure, too, that you communicate to your clients that if they are not feeling well, have a fever, or have been potentially exposed to people with the virus, that you will not see them in-person. Stick to online sessions.
Extra cleaning and disinfecting between clients takes time, so you need to allow for time between sessions and be able to manage the flow of people to make this happen. It is a good idea to add a greater buffer time between sessions. This not only will give you time for cleaning and disinfecting between sessions, but it will also limit the amount of contact your clients might have with each other between sessions. Leave more buffer time between appointments than you typically would to avoid clients coming in contact with one another. Add in extra time in case appointments run late or you have to deal with unexpected client emergencies.
Wherever possible, keep your systems online. For example, continue sending intake forms via a practice management tool and collect payments via online credit card processors or platforms like Advekit, that can help manage insurance and payments. If you need to give clients a handout, consider sending it to them electronically as a PDF after session instead.
Your clients are likely experiencing a range of feelings, from relief that they can see you in-person, to concern around hygiene and safety. Clear communication and sufficient advance notice prior to reopening will help set the right expectations upfront. Here are some notices to include in your reopening email:
Following the American Medical Association’s (AMA) guidelines, screen clients for COVID-19 symptoms 24 hours prior to the office visit and prior to entering the office. The AMA’s pre-visit screening script is a template you or your intake coordinator can use. Prior to each session you will be asking a client if they have the following symptoms:
Any accompanying individual (such as parents for child therapy) should be screened in the
same manner as well.
There’s no need to switch your clients to in-person sessions all at once. Gradually reopen incrementally to help both you and your clients feel comfortable with being in person. A soft reopening allows you to identify any improvements you can make to avoid contact, keep the space clean, and give your clients comfort around safety. If you are conducting couples or family sessions, consider if you can continue with these clients remotely during the slow reopening period as you get into the rhythm with individual clients.
The future's looking bright and we should all feel a sense of hope. There’s much to be done to prepare your practice, but it will all be worth it to welcome patients back into your office.