Caltech Adapts to Deliver Health and Counseling Services in Time of COVID-19

Jennifer Howes, who has served as director of health and counseling services since 2016, recently assumed her new post as assistant vice president for student affairs and wellness. Reporting to Kevin Gilmartin, vice president for student affairs, Howes remains responsible for the Institute's student health counseling, occupational therapy, alcohol and other drug education, as well as new areas including accessibility services for all graduate and undergraduate students.

What changes has the Institute made to the services it provides students as a result of COVID-19?

Between winter and spring terms we had to both pivot in terms of the services we were offering to those students who dispersed, but also continue to meet the needs of the students who were still here. We shifted pretty quickly to a Health Insurance Portability and Accountability Act (HIPAA)-compliant Zoom platform and telehealth, and so all of our counseling staff and occupational therapy staff transitioned to doing appointments via those media.

We quickly developed a range of workshops and other resources designed to support students as they began to work from home or learn remotely. Occupational Therapy put together work-from-home resources that were designed to provide concrete tips and tricks for doing that, as well as managing a lot of the challenges that come up, such as balancing a schedule and feeling like either you're always "on" or you don't get enough space from your work life in your home.

Counseling Services developed new topics for workshops and discussion groups, such as how to deal with moving back into your family home after being away, long-distance relationships, trends in substance use in quarantine, and the overall impact of quarantine and isolation on mental health.

We have made all of our workshop content available to stream and download, including our popular dialectical behavioral therapy skills workshops. We also offer SilverCloud, an online cognitive-behavioral therapy platform that's been pretty popular. It's a self-paced online program with different modules, including one that's specific to managing the stress of quarantine, but there are also modules dedicated to sleep, depression, anxiety, stress management, and resilience. SilverCloud is actually available not only to students but to anyone with a Caltech email address. The program provides different self-assessments and lots of tools. In addition, all of our workshops on sleep and procrastination that we typically offer are all available as well.

We're still providing crisis services, our after hours on-call support [626-395-8331, press 2], to any student wherever they are. We always follow up on those calls the next day, so if somebody gives us a call through that service, even out of state, we'll still follow up with them and check in.

Caltech also provides COVID-19 testing for all members of the community [faculty, staff, postdoctoral scholars, and students] through Student Wellness Services. Community members are eligible for testing if they have COVID-like symptoms or have been identified as a close contact of an ill person, have been exposed to a confirmed case of COVID-19, or have participated in activities that present an elevated risk for exposure. Test results are usually available within 24–48 hours and provided for free.

How significant a priority is Caltech making health and wellness?

Caltech really appreciates the significant impact that health and wellness concerns can have on our students and our community. That's something that I've felt very supported since I've been in this role, and I think that's just continued to be more and more evident.

It shows, for example, in the support of our team as we meet the public health demands of this crisis not only for our students but for the rest of the community as well. There's also been a clear acknowledgement that accessibility services are something that's really important and that we have students who need that support.

Even though there's a range of experiences across our community, we all are struggling with some of the same fundamental challenges here, so the Institute is really trying to help people access the resources that they need in order to manage those more effectively.

What staff does Caltech have dedicated to health and wellness?

We have five clinicians on the Counseling Services team. Lee Coleman is transitioning into the role of clinical director and will handle the day-to-day operations and support the clinical team. Our medical team includes a range of providers including a physician, nurse practitioner, licensed vocational nurse and medical assistant.

We have an occupational therapist, Grace Ho, and an occupational therapy resident as well, and then a couple of other folks who do work with our student health advocates, plus our administrative support staff. Our accessibility services position will be coming online soon, too.

What are some of the major challenges due to COVID-19 this year?

Every single part of the Institute has had to adapt. We had to do everything from learn a new management system, which IMSS made happen in a very short period of time, to CTLO transitioning everybody to remote learning and helping faculty pivot their classes, to figuring out how we're going to communicate and engage with all of the undergraduates who are living off campus.

I think one of the largest challenges is that we're used to dealing with crises that are time limited or well defined in nature, such as an earthquake or even a death in the community: something that is a crisis and very impactful but generally subsides relatively quickly. COVID is not like that at all.

We saw this threat coming. We started activating our response at the end of January, and it's just been an ongoing effort ever since. The staff and everybody across the Institute have been working on these issues. We try to say to one another, "OK, this is a marathon, not a sprint."

The main issue is that there's always something new to confront and always a next thing to have to respond and react to, and that's likely to be the case for another nine to 12 months.

How effective has the online health reporting app been in helping to manage tracking and contact tracing?

On any given day, about 800 people are actively engaging with the app, but we know that we have more people who are accessing campus than that. We've tried to push out information about the importance of using the app, but I think we still have a little bit of work to do there.

One thing that's important to note is that you can use it to attest to not having any symptoms without having to report a location. So, for folks who might come to campus just to pick something up or who are here for a short time and wouldn't necessarily meet the 15 minutes in any specific location criteria, we're still asking them to attest that they haven't had any symptoms.

The other thing to note is that this app is another layer that helps us engage in contract tracing. It's only as good as the information that's in it, and so we really want to encourage people to be diligent about using it so that we have the best set of information available if the need arises for contact tracing.

How has the delivery of care shifted from focusing on individuals to the health of the Caltech community as a whole?

Historically, our Health Services staff has basically offered the services of a primary care clinic for our student population, and we still do. Though they have transitioned to largely telehealth consultations, they've been in the office throughout the pandemic, seeing students in the clinic when that's necessary.

But the focus of the work has changed quite a bit to respond to reports of illness that come in through the app. When our clinical staff gets one of those, we will reach out to the person reporting an illness. We engage in the contract tracing process and initiate isolation or quarantine if indicated, follow that person through the illness, and communicate with the Pasadena Public Health Department for consultation or reporting if we have a positive case. There are many different layers to that process and many different connections with other offices across the Institute and in the city of Pasadena.

In addition to doing the COVID testing for campus, there has been a huge shift in the day-to-day operations of Health Services. I have ended up doing a lot of consultation with people on things like travel or setting up protocols for human-subjects testing, or various sorts of activities that people want to make sure that they're following the public health guidance on.

We also do a lot of consulting about some of the larger initiatives around campus. Things like: How do we deal with the fact that we can't gather? How do we set up the proper protocols for outdoor meetings of lab groups? We are an institution of higher education, but we also have a very clear research mission that operates under separate guidance. We also have people who live here, so there are a lot of different things to balance.

We stay in very close touch with the Pasadena Public Health Department and consult with them regularly about all sorts of little questions that come up but also the larger issues of planning for the winter and spring terms, for example. I think that the medical staff has done a great job in making that shift really quickly into a public health model.