“Helping Every Child Thrive” Through the Pandemic:
The Weissman Children’s Foundation COVID-19 Relief Initiative
Adam S. Weissman, Ph.D.
The Weissman Children’s Foundation, The Child & Family Institute,
and Columbia University Teacher’s College
The proliferation of empirically-supported behavioral health treatments into “real world” practice settings (e.g., community health clinics, private practices, schools, hospitals) over the past several decades has led to more U.S. children and families receiving high quality treatments and improved treatment outcomes (Reddy, Weissman, & Hale, 2013; Mohlman, Deckersbach, & Weissman, 2015; Weissman, Antinoro, & Chu, 2008; Weissman et al., 2019; Weissman, 2020; Weisz et al., 2018; Weisz et al., 2019). Even so, the overwhelming majority of these specialized evidence-based treatments (EBTs; e.g., for anxiety, depression, attention, speech, sensorimotor, learning, habit, and behavioral challenges) are still almost exclusively accessible at expensive out-of-pocket private clinics. What’s more, the national healthcare system has not adequately prioritized coverage for evidence-based services in the mental and behavioral health arenas, and insurance reimbursement for most specialized out-of-network treatments is limited. The result is an overwhelming majority of the U.S. population, uninsured and underinsured children and families nationwide, left without access to affordable gold standard mental and behavioral healthcare. In addition, there remains a significant dearth of evidence-based service providers and training programs nationally, particularly in more remote communities.
During the current COVID-19 global economic and public health crisis, it is perhaps more important than ever to increase accessibility of affordable and pro bono evidence-based care for children, families, and communities in need. In addition, the COVID-19 pandemic has created service delivery challenges for mental health professionals and many psychotherapists are now providing services through telehealth platforms. Although there has been some research comparing tele-mental health services to face-to-face (FTF) services, these studies have occurred when clients have had the option of telehealth or FTF services. To our knowledge, no studies to date have assessed the effectiveness of delivering telehealth outpatient psychotherapy in “real-world” clinical practice; additionally, no studies have tested the effectiveness of outpatient teletherapy as a routine treatment modality in the face of a global pandemic. Further, no studies to our knowledge have leveraged innovative technologies, state-of-the-art telehealth and evidence-based tracking software, to study EBT service delivery and implementation models, mental health disparities, and treatment outcomes. The initial pilot phase of the Weissman Children’s Foundation (WCF; Weissman, 2020) will assess the effectiveness of cognitive-behavioral therapy delivered via teletherapy (CBT-TH) through the during the COVID-19 pandemic using a commonly available evidence-based Electronic Health Record (EHR; My Best Practice, Fuller, 2019) to service delivery models, EBT fidelity and outcomes, as well as mental health disparities -- with an eye toward racial and social justice reform -- to scale future EBT dissemination efforts and effectiveness research.
Weissman Children’s Foundation
The Weissman Children’s Foundation (WCF; Weissman, 2020) is a national non-profit organization in development specializing in the training, provision, dissemination, and implementation of evidence-based mental and behavioral health treatments for children, families, parents, and young adults, currently focusing its efforts on a comprehensive COVID-19 Relief Initiative (CRI; Weissman, 2020) implemented exclusively via telehealth. WCF is a partner organization of The Child & Family Institute (CFI; Weissman, 2019), a mission-based interdisciplinary behavioral health private practice, each founded on an innovative EBT “Clinical Practice Dissemination and Implementation” model (CPDI, Weissman, 2019), integrating five core unifying initiatives to address the above mounting public health concerns and mental health disparities: 1) Dissemination of EBTs Through Training, 2) Dissemination of EBTs Through Community Partnership, 3) Dissemination of EBTs Through Integrated Behavioral Health, 4) Dissemination of EBTs Through Multi-State, Multi-Site, Program Development and Implementation, and 5) Dissemination of EBTs Through Technology, all with a common goal of raising awareness and leveraging local and national resources to disseminate and implement accessible, affordable, and pro bono evidence-based care to underserved children, families, and communities across the United States, throughout the current pandemic and beyond.
Dissemination-Through-Training. WCF’s “Dissemination-Through-Training” (DTT, Weissman, 2019) initiative comprehensively trains student clinicians in EBTs for youth emotional, behavior, attention, and habit disorders to help increase the number of evidence-based providers pursuing licensure, as well as the provision of low-fee and no-fee services to underserved communities, including the immediate roll-out of COVID-19 Relief Initiative (CRI) telehealth services nationwide. To accomplish this, clinical psychology and social work training programs were first developed in-house, based on a modular-based CBT approach (e.g., MATCH-ADTC; Chorpita & Weisz, 2009; as well as evidence-based protocols for Selective Mutism; Kotrba, 2014; Obsessive-Compulsive Disorder; March, 2006; Tic and Habit Disorders; Woods, 2008, Dialectical Behavior Therapy; Rathus & Miller, 2014; and the full array of youth psychiatric disorders and related issues). All WCF and CFI trainees receive funding for external EBT training opportunities (e.g., workshops, conferences, CE’s) through WCF’s “Scholarship Training Initiative” (STI, Weissman et al., 2019), including stipends to attend virtual conferences and workshops on cutting edge evidence-based practices, and in turn, the trainees present relevant updates back to the group.
In addition, external collaborations have been developed with local clinical psychology and social work training programs, fostering further access to high quality evidence-based care through a growing collective of pro bono and low-fee student clinics, including a partnership with Columbia University Teacher’s College PhD program and student clinic, servicing Harlem, the Bronx, and surrounding neighborhoods, some of the most highly COVID-19-afflicted, under-resourced communities in the nation. These students, in turn, receive expert EBT training and supervision from WCF and CFI’s renowned training teams.
Finally, WCF and CFI directors also hold pro bono supervisory appointments at local mental health training programs to help train students more broadly in EBTs, and further scale affordable evidence-based service delivery to children and families in need. Indeed, many WCF and CFI-trained students have gone on to start their own clinical practice and training institutes throughout the country.
Dissemination Through Community Partnership. The next WCF initiative is a community partnership model, promoting outreach, consultation, advocacy, and community education/engagement around EBTs. As part of this initiative, WCF and CFI staff present and consult frequently to schools, parents/families, clinicians, and community organizations throughout the U.S., including many currently in crisis, partnering with community stakeholders and renowned experts in the field to expand the scope of EBT community education and access (recent speakers from the WCF-CFI Master Clinician Series include Drs. Bob Leahy, Leslie Sokol, Dennis Tirch, Dean McKay, and Shannon Wiltsey Stirman). In addition, WCF and CFI’s directors reside on city, county, state, and national CBT and psychological association governance boards, and utilize these platforms to forge collaborative efforts and local crisis relief initiatives, host community-wide events, and advocate for best practices with youth from both a clinical and public policy standpoint. Finally, WCF is in the process of launching a school-based CRI, partnering with local schools (e.g., the Ella Baker School, Lang School, Dwight School, and several Westchester County-based school districts to start) to increase direct EBT access to children and families during the pandemic and beyond, who, otherwise, might not have the knowledge and/or resources to access evidence-based mental health services on their own.
In addition to these collaborative efforts, WCF has recently launched a comprehensive educational and resource-rich CRI social media campaign, via Instagram, Facebook, Twitter, and LinkedIn to disseminate the most current information about COVID-19, its mental health sequelae, and related evidence-based resources available through WCF, CDC, WHO, State and City Departments of Health, and the community at large.
Dissemination Through Integrated Behavioral Health. The third WCF initiative is the development of local partnerships among expert evidence-based providers across a wide range of behavioral health disciplines, to foster an integrated virtual behavioral health platform promoting best practices for youth, not only within the field of clinical psychology, but also pediatrics, psychiatry, neuropsychology, occupational therapy, speech therapy, holistic health and nutrition, special educational, and more. In doing so, WCF’s two-pronged goal is to create an ongoing dialogue with, and educate, one another, about evidence-based therapies and services, as well as to provide more integrated behavioral health programming and coordinated care for families requiring multiple ongoing services throughout the pandemic and beyond.
Dissemination Through Multi-State, Multi-Site Program Development and Implementation. The fourth stage of WCF’s CPDI model, currently underway, is a multi-state, multi-site program development initiative to promote greater geographic dissemination and implementation of EBTs, in an effort to reach the needs of more geographically and socioeconomically diverse communities, with an emphasis on those with limited means and/or access to EBTs. To accomplish this, both WCF and CFI leaders have collaborated with local practitioners, organizations, and stakeholders, community by community throughout the U.S. (NY, NJ, CT, FL, MI, CA, PA, DC, WA, AK to start) to assess the mental health landscape, barriers to EBTs, and the impact of COVID-19, for the full range of youth mental health conditions, developing 15 sites to date, 12 in the Northeast- midtown Manhattan, Park Slope, Prospect Heights, Downtown Brooklyn/Boerum Hill, and Carroll Gardens, Brooklyn, Queens/Long Island, Bergen County, NJ, Greenwich, CT, Scarsdale, NY, Harrison, NY, and Mt. Kisco, NY, one Southern site- Aventura/South Florida, two Midwestern sites outside of Ann Arbor, Michigan, and one West Coast satellite office in San Diego, CA, all operating virtually during the pandemic, with prospective plans on the horizon to service the San Francisco Bay Area, Philadelphia, Washington D.C., Washington State, and Alaska. Central to this initiative, WCF strategically engages in specialized niche program development based on the unique mental health needs of each community (e.g., developing a “Brave Voices” Selective Mutism Program, Center for Chronic Medical Conditions, IOP for OCD, Tics, Trich, & Habit Disorders Program, Adoption/Attachment Service, Maternal and Infant Mental Health Service, LGBTQ+ Program, Virtual Reality Therapy & Biofeedback Program, etc. in communities where no such services previously exist).
Dissemination-Through-Technology: Partnership with My Best Practice (MBP). Of central importance to the current pilot study, WCF’s “Dissemination-Through-Technology” (D-TECH; Weissman, 2020) initiative leverages innovative evidence-based technologies and tracking systems to enhance evidence-based interventions, assessment of treatment outcomes, and models for EBT service delivery, program evaluation, and implementation.
First, WCF’s D-TECH initiative utilizes innovative technology-based alternative and/or supplemental EBTs to optimize hard-to-access symptoms and/or treatment content (e.g., virtual reality-enhanced exposure therapy paired with biofeedback for anxiety and phobias, Barton & Weissman, 2019), contributing putative models for enhanced EBT outcomes, particularly while families are in social isolation due to COVID-19 and are unable to access and engage in typical EBT protocols (e.g., social anxiety exposures, as well as OCD, trauma, selective mutism, separation, panic, and phobia exposures that may routinely occur in a public forum). In addition, in light of the current pandemic, and central to the proposed pilot study, WCF employs innovative video- and telehealth technology platforms to reach families adhering to social distancing and “stay-at-home” orders throughout the country, and internationally, including geographically remote regions in need.
My Best Practice
The fundamental pillar of WCF’s D-TECH initiative is its strategic partnership with My Best Practice (MBP; Fuller, 2019), a new evidence-based EHR software that connects psychotherapists and clients over the internet using a session-note platform that allows psychotherapists to schedule sessions, complete session notes, administer routine outcome monitoring (ROM) measures, and receive and provide digital feedback on progress from the ROM measures to their clients. On a macro level, MBP was designed to facilitate within and across-session EBT fidelity tracking, data collection, and program evaluation, including global assessment of treatment outcomes, with the hope of scaling effectiveness research, funding, and site development efforts, and overall access to treatments that work.
Implications for Public Health, Policy, and Practice
Perhaps most central and unique to WCF’s five initiatives detailed above, and its overall core values and mission, is the accessibility and affordability of services for each and every child regardless of socioeconomic limitations and ability to pay, including completely free evidence-based care for uninsured and underinsured families, breaking down generations-old barriers to EBT access in the nation’s most disadvantaged, marginalized, and often highest-needs communities. This guiding vision is perhaps more essential now than ever, with so many families in economic and mental health crisis, simultaneously, throughout the U.S. and around the world.
The integration of standardized telehealth and evidence-based tracking EHR platforms into WCF’s core mission and related initiatives, has unique untapped potential to inform the development of new EBT service delivery and implementation models, compare the effectiveness of EBTs in “real-world” clinical practice across different models, investigate EBT fidelity and its impact on treatment outcomes in routine clinical practice, track mental health and mental health treatment disparities -- with an eye toward racial and social justice reform -- and scale EBT dissemination and implementation efforts more broadly.
Preliminary anecdotal feedback from patients, students, collaborators, local politicians and stakeholders, partner organizations, and the broader communities in the regions served has been enthusiastic, with comprehensive teletherapy services already underway and over 60 children and families in need already receive life-changing support from WCF’s COVID-19 Relief Initiative.
As WCF continues to build upon its five core initiatives, disseminating EBTs to communities across the U.S. throughout the pandemic and beyond, its leaders recently launched a sixth initiative at the World Congress of Behavioral and Cognitive Therapies in Berlin—teaching international EBT practitioners and students how to develop their own dissemination-based behavioral health organizations using the CPDI model, to further disseminate EBTs for youth, scale effectiveness and implementation research in “real-world” settings, and increase access to evidence-based programming—including timely COVID-19 Relief services—on a global scale (Weissman et al., 2019).
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