March 19 Update to Orchard Place Staff

March 19 Orchard Place Update

Dear All,

I appreciate what everyone is doing to contain the spread of COIV 19 in our community and agency. These seem like extraordinary and extreme measures, but we know from watching other countries experience that this time calls for extreme measures. We are doing what must be done and pushing on.

That said, don't forget that while you may not feel the stress of the changes right now, you will undoubtedly feel it at some point. This is a critical time to implement self-care- daily things you do to take of your physical, emotional, and spiritual self. We take time to do self-care because we are worth it and deserve to feel as calm and happy as possible. We don't do self-care, so we are more effective at work, or so we can be super caregivers. That may be a side benefit but cannot be the primary motivator. Please make this a priority for yourselves now. Please don't put it off.

Here are updates on OP COVID 19 efforts. There are also some family communication pieces coming out today that will be posted on the branch website site pages and SharePoint.

Thanks for all you do every day. Sanctuary on! Anne

Organization-wide:

• OP is seeking clarity about the ability to bill for services delivered via telehealth and telephone contacts. We have approval from DHS for telephone contacts with IHP clients and IDPH for Substance Use services so far. We have verbal permission from Wellmark to provide therapy and psychiatric services in this manner. We are waiting on Iowa Medicaid to approve revised telehealth rules. We believe this approval will come through for therapies and psychiatric services. OP has also requested that BHIS be allowed to use telehealth to deliver and bill for services, but have not heard anything as yet.

• OP is equipping school-based and FFT therapists, JCSLs, and some employees with underlying health conditions to work from home with the use of telehealth. We are in the process of testing the software and connectivity and will begin rollout of this today.

• OP is suspending all home visiting services at this time. Primary home visiting programs include IHP, FFT, BHIS, CR&R, and Healthy Start. Each branch is crafting family communication that will be posted and relayed to families.

• Employees should plan with a supervisor as to whether they work from home, whether there is an alternative work option, or whether working on-site is still an option.

The following decision tree is for employees and supervisors to use when assessing a potential need for an employee to remove themselves from the work environment. Dr. Mandler, OP Chief Medical Officer, has crafted this using consultation from the CDC and a physician COVID 19 workgroup.

Scenario A:

The employee is asymptomatic and had to contact with a person with a respiratory problem or a fever. If the employee has no cough nor fever, they may continue working from a telehealth setting, or consult with a supervisor if their work is not telehealth compatible.

Scenario B:

The employee is asymptomatic and has any one or more of these risk factors:

1. Taken a cruise anywhere in the world in the last 14 days.

2. Traveled internationally to a country with a level 3 travel warning in the previous 14 days.

3. Lives with someone who has symptoms of COVID-19 or has tested positive for COVID-19

These employees should stay at home and isolate themselves from other people and animals in the house. Isolation should be in practice for 14 days after the last exposure. As long as the employee is asymptomatic, you may continue working from a telehealth setting, or consult your supervisor if your work is not telehealth compatible.

Scenario C:

The employee is symptomatic with fever or respiratory symptoms (like a cough or difficulty breathing). Most mildly ill Iowans do not need to go to their healthcare provider or be tested to confirm they have COVID-19.

The employee can isolate themselves and may also call their health care provider. If the employee thinks they need healthcare, call the healthcare provider first. The healthcare provider may assess over the phone if there is a real need to go into the office to be seen face to face. Sick staff should stay home and isolate themselves until:

1. They have no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers), and other symptoms have improved (for example, when your cough or shortness of breath have improved) and,

2. At least seven days have passed since the employee's symptoms first appeared.