On Friday, May 29 at noon, For All Seasons CEO, Beth Anne Langrell, and Chief Clinical Officer, Lesa Lee, present a Facebook Live business webinar titled “Leading and Living Through Uncertainty: Strategies to Support the Mental Health of You and Your Employees.” The presentation will be moderated by Cassandra Vanhooser, Director of Talbot County Department of Tourism and Economic Development.

As businesses face the challenges of reopening, waiting to reopen, and/or reconfiguring during COVID-19, there are several concerns employers and employees may be facing. Everyone is experiencing varying degrees of adjustment to a changing work landscape. Businesses may be finding a wide range of anxiety levels among staff. Beth Anne Langrell explains, “It’s more important now than ever to lead with mental health in mind.”

Topics will include self-care while caring for others, supportive/active listening, navigating conversations and opinions with employees and customers, dealing with uncertainty and isolation, managing emotional fatigue, and connecting with mental health resources.

From left, Beth Anne Langrell, CEO, For All Seasons and Lesa Lee, Chief Clinical Officer, For All Seasons.

Beth Anne Langrell and Lesa Lee, are both certified as Brené Brown’s Dare to Lead™ facilitators. According to Brown, “Leadership is about the willingness to step up, put yourself out there, and lean into courage.” Business owners, at this moment in time, are required to exhibit strength in the face of adversity. Langrell and Lee promote digging deep, taking a seat as we listen to others, all while providing the space for ourselves and others to have courageous conversations.

This presentation is dedicated to our local businesses who are there for our community in so many ways. Our for-profit and non-profit businesses are a steady source of support to one another throughout the year. It is through the generosity of local businesses that For All Seasons has increased mental health crisis appointments as well as awareness campaigns for suicide and sexual assault.

Register at http://living-leading.eventbrite.com. For more information contact dspiering@forallseasonsinc.org or call 410.822.1018. This is virtual presentation is free and open to the public and presented in partnership with the Talbot County Department of Emergency Services.

For All Seasons provides therapy, advocacy, psychiatry, and education to Caroline, Dorchester, Kent, Queen Anne, and Talbot counties. The agency accepts all private insurances, medical assistance, and supports English and Spanish speaking individuals regardless of one’s ability to pay. For All Seasons 24-Hour, confidential crisis hotlines are 410.820.5600 for English Hotline and 410.829.6143 for Spanish Hotline. Text available in English or Spanish at 410.829.6143.

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Dr. Bill Cerrato, Chief Medical Officer of For All Seasons

Although telehealth has been around for more than 20 years, approval by insurers may have slowed down the evolution of its prevalence in mental health services. COVID-19 has forced the issue to the forefront, however, and behavioral health providers are now offering expanded teletherapy and telepsychiatry services, most notably delivering services while patients remain in their homes. In the last month, For All Seasons staff has had to make these changes as well, expanding these options for its clients as more stringent self-quarantining and social distancing requirements have been put in place on the Mid Shore.

Telehealth is the process of providing health care from a distance through technology, often using videoconferencing. Telepsychiatry, a subset of telehealth, can mirror the range of on-site services including psychiatric evaluations, teletherapy (individual therapy, group therapy, family therapy), patient education, and medication management. Traditionally, patients had to come to a qualified health center and interface with a computer to see their teleprovider who was based elsewhere. COVID19 has propelled telehealth services into the home.

According to the American Psychiatric Association, while some people may be reluctant or feel awkward talking to a person on a screen, experience shows that most people are comfortable with it. They add that some people may be more relaxed and willing to open up from the comfort of their home or a convenient local facility. It may even be successful in reducing the barrier of stigma for people seeking services.

Dr. Bill Cerrato, Chief Medical Officer at For All Seasons, comments, “In child and adolescent psychiatry, where it can be hard to find subspecialists, telehealth will enable us to bridge that gap in our rural area.”

The Rural Maryland Council has awarded For All Seasons funding to cover the costs for onboarding a new Psychiatric Nurse Practitioner and purchasing equipment that will allow the agency to offer telepsychiatry in all six of its satellite offices.

Dr. Cerrato adds, “Through partnering with Iris Telehealth, a telepsychiatry provider group, the addition of a Psychiatric Nurse Practitioner has already helped us supplement our staff to better serve the growing mental health needs on the Shore.”

Through the COVID-19 crisis, the number of patients using teletherapy and telepsychiatry at For All Seasons has grown from 4 percent from the fall of 2019 to 55 percent today, with the majority of staff now utilizing this platform to deliver care.

Dr. Cerrato, who is also the Medical Director at Peninsula Regional Medical Center, notes that since For All Seasons began its traditional on-site telehealth services satisfaction has been high.

He comments, “When patients are home, they are much more relaxed. We find that kids are especially more comfortable at home. They want to show us their pets or a special toy. We also find that with new patients, it is easier to build rapport, and we have fewer patients not showing up for their appointments when we use telehealth to deliver care where they feel most comfortable. Post COVID19, Telehealth regulations have allowed patients to remain in their homes, pushing satisfaction through the roof.”

According to the American Psychiatric Association, research has also shown that overall remote treatment experiences among all age groups have been positive and may help people with autism or severe anxiety disorders as well as patients with physical limitations. It has also shown that telepsychiatry has been found especially effective in the treatment of PTSD, depression, and ADHD. This treatment option has even been shown to reduce the need for trips to the emergency room, reduce delays in care, and can improve the continuity of care and follow-up.

Dr. Cerrato explains that doctors and therapists who really interact with the screen get the best results. He states, “If you do it right, it’s just like you are in the room with the patient. Providers who don’t engage with the screen don’t get as high a satisfaction rating.”

While Dr. Cerrato states most diagnoses are appropriate for teletherapy and telepsychiatry, there can be challenges dealing with psychotic and paranoid behaviors or patients with severe intellectual disabilities. In those cases, family members or loved ones can be helpful when attending the sessions along with the patients.

One of the most important elements of teletherapy and telepsychiatry is the platform that is used to deliver the service. The preferred HIPAA-compliant platform of For All Seasons is Doxy.me which provides a web address that the provider can email to the patient that is the same for each session. During the COVID-19 crisis, however, patients are allowed to use applications such as Facetime, Skype, Messenger on their phones or computers, and just the regular telephone so that care can continue to be provided. For All Seasons also remains steadfast in engaging the entire patient population, utilizing Skype for the group call feature so interpreters can join Spanish speakers.

For All Seasons hopes new Interagency Telehealth initiative will enable the agency’s psychiatrists and nurse practitioner in the Easton office to see patients via telehealth who are onsite at the other For All Seasons offices in Denton, Stevensville, Chestertown, and Cambridge, alleviating travel to Easton.

For Dr. Cerrato, the silver lining in this new treatment delivery is that it can increase access to care in rural areas like the Eastern Shore. He comments, “For All Seasons has always had parity as a priority and is moving this initiative forward.”

Beth Anne Langrell, CEO at For All Seasons, adds, “Dr. Cerrato brings a perspective for treating people in the here and now, but is also forward-thinking about our service delivery for the future. He brings continuity to our medical team and is helping us be a leader in behavioral health in the region.”

For further information, visit forallseasonsinc.org, visit For All Seasons Facebook page, or call 410-822-1018.

For All Seasons provides therapy, advocacy, psychiatry, and education to Caroline, Dorchester, Kent, Queen Anne, and Talbot counties. The agency accepts all private insurances, medical assistance, and supports English and Spanish speaking individuals regardless of one’s ability to pay. For All Seasons Rape Crisis Center offers a 24-HR crisis hotline service, certified sexual assault victim advocates, same-day and ongoing counseling services, and hospital, law enforcement, and court accompaniment by request of the survivor. Contact 410.822.1018 or forallseasonsinc.org for further information. For the 24-HR confidential crisis hotlines call (English) 410.820.5600 for English Hotline; (Spanish) 410.829.6143. Text available in English or Spanish at 410.829.6143.

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Katie Dilley, Executive Director of Mid Shore Behavioral Health

There are some very creative solutions being implemented in delivering behavioral health services to the residents of the Eastern Shore during COVID-19 with coordination through the Talbot County Emergency Operations Center.

Katie Dilley, Executive Director of Mid Shore Behavioral Health, Inc. says, “I am impressed at how connected the Eastern Shore is around this issue. Specifically, there has been an outreach across partners. Our region has always had excellent peer support across partners and providers.”

Mid Shore Behavioral Health (MSBH) is a private, not-for-profit 501(c)(3) regional Core Service Agency that serves the five counties of the Mid-Shore providing community planning, management, and monitoring of publicly-funded, medically-necessary behavioral health services across the life span for children, adolescents, adults, and the aging population. During this pandemic, one of the main goals of MSBH has been to keep the lines of communication open between providers of behavioral health services and advocate for access for consumers to services during this state of emergency. Dilley stays connected with the behavioral health providers through an Eastern Shore Provider Network conference call held twice a week.

She comments, “From an advocacy effort, we are stronger together and it is a safe space to problem solve. Senator Addie Eckardt is on each call to provide support and guidance as well.”

Among the creative solutions to in-person office visits for mental health services are teletherapy, telepsychiatry, and telephonic delivery of care. Dilley explains, “The telehealth expansion and delivery of care have been outstanding. We have adapted quickly to these services for our populations. Through this, we have learned a lot about how we deliver services that could help us in the future to meet the mental health needs of our rural community. Also, from a stigma perspective, telehealth could be a good thing – opening doors for clients who might otherwise be hesitant to pursue services.”

In addition to therapy, support entities like Chesapeake Voyagers, Inc., Alcoholics Anonymous, and others are using the virtual platform to continue to provide services as well.

While many of the issues of the behavioral health delivery system are being solved with teletherapy, telepsychiatry, other creative virtual options, one of the challenges that have developed during COVID-19 is that several substance use residential treatment facilities are no longer accepting new patients in response to limited personal protective equipment. On the Eastern Shore, these facilities include the A.F. Whitsitt Center in Chestertown, Warwick Manor in East New Market, and Hudson Health Services in Salisbury.

Dilley states, “This leaves us with no place for people to detox and receive substance use residential services safely and because of the difficulties people are facing, we are also seeing people re-emerging into substance abuse issues as a result of isolation including overdoses.”

“Ethically, it is unsettling. Currently, substance abuse treatment facilities are not the priority population. We often see that this population has had challenges others haven’t had.”

Right now, recovery houses continue to serve and have been given guidance on procedures to deal with the pandemic in residential settings. Dilley adds, “The educational piece is key. It will feel better when we can get protective equipment for them. Our vulnerable populations are having difficulty being served. That is driving our advocacy efforts.”

Dilley credits Dr. Benjamin Kohl, Jr., President of the Board for MSBH, with providing early guidance to handling the pandemic. He encouraged MSBH staff to support these vulnerable populations, including the region’s homeless population, so that they didn’t re-invent what happened in the early 1900s during the pandemic.  She adds, “It’s been a team effort. I am so appreciative of our State partners, advocacy groups and Governor Hogan for addressing these needs.”

Beth Anne Langrell, CEO of For All Seasons

Beth Anne Langrell, CEO of For All Seasons, a non-profit Behavioral Health and Rape Crisis Center serving the five counties of Maryland’s Mid-Shore, reports that her agency has had to make changes as well, introducing additional telehealth and telepsychiatry options for its clients. For All Seasons offers individual and group therapy, general, child and adolescent therapy, marriage and couples’ counseling, grief counseling, school-based mental health therapy, urgent care services, Rape Crisis Response, Rape Crisis Counseling and Support, 24-Hour English and Spanish Hotlines, and education and outreach programming.

“While our agency’s doors are still open, with some staff still on-site, we are practicing the safe and healthy guidelines of the CDC as we continue to provide much-needed services in the community. We are taking new patients,” Langrell states.

In addition to providing ongoing mental health services to its clients, For All Seasons is reaching out to the community, providing mental health tips for people who are being challenged by changes caused by the pandemic, including online videos and Facebook posts by staff. Langrell comments, “Staying in our homes with our children, our spouses, and even our parents or grandparents for an extended time can create stress.”

She offers the following tips to help people manage their mental health during COVID-19:

• Self-care is important. Eat healthy food, get enough sleep, exercise, meditate, and get some fresh air.

• Know your red flags and identify your feelings. Name what you are feeling and take a moment to get in touch with these feelings.

• Set up a routine. Routines help us stay grounded. Structure and routines help children, in particular, to feel safe.

• Be compassionate with yourself and others. Use compassion, empathy, and self-regulation to feel centered.

• Be with your people as much as you can – virtually. Harness a reconnection with people – try reaching out to five people a day.

• Manage your expectations. Be realistic about the situations you find yourself in and be kind to yourself and others. Recognize that others are having stress responses too.

• Avoid excessive exposure to media coverage of COVID-19.

• Call your health care provider if stress reactions interfere with your daily activities for several days in a row.

Langrell adds that For All Seasons offers crisis appointments, in-person appointments, teletherapy, and telepsychiatry, as well as 24/7 hotlines.

A complete list of mental health resources on the Mid-Shore is listed below.

Mental Health Hotlines  

For All Seasons – 410-822-1018

Sexual Assault and Mental Health Crisis hotlines:

English Hotline: 1-800-310-7273 or 410-820-5600

Spanish Hotline:  410-829-6143

For other mental help tips, visit forallseasonsinc.org.

Affiliated Santé Group – Eastern Shore Crisis Response Services (ESCRS) – 888-407-8018 

Phone counselors at the Eastern Shore Crisis Response and Resource Helpline work 24 hours a day, seven days a week to assist with individuals who need mental health resources.

• Serving nine counties on the Eastern Shore. Four mobile crisis teams located in Cecil, Dorchester, Kent, and Wicomico Counties serving eight out of the nine Eastern Shore counties.

• Available 24/7 seven days a week, 365 days a year to respond to behavioral health and substance use crises as defined by the caller.

Mid-Shore Council on Family Violence – 1-800-927-4673

Available 24/7/365. Victims can also contact our hotline through our Website and from our Facebook, Twitter and Instagram Accounts. Emergency Shelter for victims, their children and pets is available. You can still get a protective order, and we can help you remotely. https://mscfv.org. Call their Easton office at (410) 690-3222 for additional information and non-emergencies.

Mid Shore Behavioral Health, Inc. 

• As of March 18, 2020, all staff is telecommuting.

• The preferred way of contact is email, however, the staff is checking voicemails throughout the day if you prefer to call in.

• Visit https://www.midshorebehavioralhealth.org/emergency-portal for further information.

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For All Seasons, Headquarters on 300 Talbot Lane, Easton, MD.

For All Seasons continues to offer in-person services while providing teletherapy and telepsychiatry for those who require this platform. As outlined in Governor Hogan’s latest COVID-19 update, mental health services are considered essential, which enables the agency to continue providing in-person services for individuals throughout the region.

The agency continues to follow safety regulations, as outlined by the CDC, for in-person appointments including – illness screening measures, 20-second handwashing at the entry to all facilities, social distancing guidelines, increased office sanitation, and restrictions on individuals’ movements to areas necessary for the purpose of the visit.

If someone has cold or flu-like symptoms such as a cough or fever, newly developed shortness of breath, or has recently traveled to an area inside OR outside the United States with known coronavirus (COVID-19) within the last 14 Days, or have been in contact with someone who has traveled or contracted the virus, he or she should call For All Seasons at 410-822-1018 to reschedule an appointment or to make arrangements for teletherapy or telepsychiatry.

According to Beth Anne Langrell, CEO of For All Seasons, “As a Mid-Shore healthcare partner, we have a critical role to play at this time when people must have access to mental health services. We are finding the telehealth is an effective addition to our services and adds to our ability to reach all clients. There continue to be clients requiring in-person assistance, such as sexual assault survivors, clients in crisis, some psychiatry patients, and those without internet capability.”

Throughout the COVID-19 outbreak, For All Seasons is actively monitoring and following state guidelines regarding best health practices. The agency has put a plan in place to utilize the advantages of telehealth so that therapy, psychiatry, advocacy, and education can continue as usual across the five counties of the Mid-Shore.

For All Seasons serves Caroline, Dorchester, Kent, Queen Anne, and Talbot counties. For All Seasons Rape Crisis Center offers certified sexual assault victim advocates, counseling and support groups, free and confidential services in English and Spanish, support in the hospital, police department, and court and referrals to social and legal services. For All Seasons English Hotline is 1-800-310-RAPE (7273) and Spanish Hotline is 410-829-6143.

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Beth Anne Langrell, CEO

With continued evolving public health concerns during the COVID-19 outbreak, For All Seasons is now offering telehealth service options for clients including teletherapy and telepsychiatry. Unless further notice is given by the State of Maryland, For All Seasons offices continue to remain open at all locations, with staff available for in-person services. The agency continues to hold urgent care and crisis appointments in-person. English and Spanish speaking services also continue to be offered. The Rape Crisis Center 24-HR response is actively serving clients through advocacy as well as hospital accompaniment as needed.

For the safety of those who attend in-person appointments, the agency has put into place strict screening measures for clients and staff:

• All individuals entering any of the agency offices will be required to complete an illness screening.

• All individuals will be directed to wash their hands for at least 20 seconds upon entry.

• All individuals should limit their movement within the facility to only those areas that are necessary for the purpose of their visit.

• If someone has cold or flu-like symptoms such as a cough or fever, newly developed shortness of breath, or has recently traveled to an area inside OR outside the United States with known coronavirus (COVID-19) within the last 14 Days, or have been in contact with someone who has traveled or contracted the virus, he or she should call For All Seasons at 410-822-1018 to reschedule an appointment or to make arrangements for teletherapy or telepsychiatry.

According to Beth Anne Langrell, CEO of For All Seasons, “We are actively monitoring information from the Center for Disease Control and Prevention (CDC) and local officials regarding the COVID-19.  The safety and well-being of our clients and staff is our highest priority. Our staff has already begun offering telehealth options and in the event that the Governor changes the restrictions on small businesses, we are prepared to adapt. For our in-person appointments, we are conducting an illness screening, and we have increased the frequency of sanitizing and cleaning our office spaces.”

For All Seasons is observing a more structured visitation procedure. Visits to all locations will be by appointment only for agency clients. General visitors will not be permitted at any office location.   For further information, call 410-822-1018 or visit forallseasonsinc.org.  For All Seasons English Hotline is 1-800-310-RAPE (7273) and Spanish Hotline is 410-829-6143.

For All Seasons serves Caroline, Dorchester, Kent, Queen Anne, and Talbot counties. For All Seasons Rape Crisis Center offers certified sexual assault victim advocates; counseling and support groups, free and confidential services in English and Spanish, support in the hospital, police department, and court, and referrals to social and legal services. For All Seasons English Hotline is 1-800-310-RAPE (7273) and Spanish Hotline is 410-829-6143.

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