Online Therapy Is Showing How to Expand Future Mental Health Services
By Nicholas Joyce
The coronavirus has resulted in stress, anxiety and fear – symptoms that might motivate a person to see a therapist. Because of social distancing, however, in-person sessions are less possible. For many, this has raised the prospect of online therapy. For clients in need of warmth and reassurance, could this work? Studies and my experience suggests it does.
I am a psychologist and counselor at the University of South Florida. When our center named me its online assisted therapies coordinator, many of the staff initially pushed back at the notion of providing services through the screen. These negative attitudes toward telehealth should have surprised me. After all, its antecedent, telephone crisis lines, have been accepted and effective for decades.
Research suggests, however, that online therapy works just as well as traditional face-to-face therapy. Studies, looking at outcomes for clients and the quality of their relationships with therapists, found them equal across telehealth and in-person conditions. Since this meta-analysis (92 studies and 9,000 clients), many other studies have confirmed the value of teletherapy.
Telehealth Versus Traditional Therapy
Private insurance companies like Cigna and Aetna, have come around; they now provide coverage for what they see as a "legitimate" service. And surveys show consumers are receptive to telehealth counseling: no driving to an appointment, no searching for a parking space, no worries about childcare while they're away, no need to switch providers if they move, and no problem if the specialist happens to be far away.
Online therapy opens doors for clients who wouldn't otherwise seek help, particularly patients who feel stigmatized by therapy or intimidated by a stranger sitting across the room from them. Often, people open up more easily in telehealth sessions. Firsthand accounts have detailed positive experiences from consumers.
Overcoming Prejudices About Online Counseling
Now COVID-19 is forcing most traditional psychotherapists to adapt their practice to online counseling. After experiencing the medium, they are overcoming their prejudices. Many will convert some or all of their caseloads to telehealth after the pandemic ends. Most of our clients seem to be good with it: responding to a satisfaction survey, 85% of USF students strongly or somewhat agreed their telehealth experience was comparable to an in-person visit.
All this allows a continuity of care for clients that before was impossible; there is, however, a caveat. Because of the coronavirus, some of my clients at USF who live out-of-state have moved back home. That means, legally, I can no longer serve them. Even though they are still USF students, my license is valid only in Florida.
For telehealth to work effectively, our national system of licensing and regulation law needs to adapt. Although the federal government temporarily halted HIPAA regulations to promote telehealth during this time, not all states are allowing out-of-state practice. The coronavirus may not be here forever, but spring break and Christmas holidays always will. We need seamless telehealth across state lines.
That said, my own counseling center quickly transitioned to remote-only. Although most of the therapists can't wait to get back into the office, they are appreciative they can serve students in need. Certainly many clients and therapists will gladly return to face-to-face sessions, but now they know the tool of telehealth will always be available, if and when needed.
So much is changing. Now, consumers can easily access online therapy. Free e-books are available; one dealing directly with the pandemic is "FACE COVID," by Russ Harris. Apps are around too – some free, some paid. Check out the website psyberguide.org to vet them. Asking for suggestions online will help as well.
Your insurance may allow you to talk to a licensed professional who does online therapy. Most major insurers have a list of them on their website. If you're uninsured, most communities have free or low-cost mental health clinics. Many universities have them too. Also, online directories can point you to places that offer services on a sliding scale, depending on your income, from pro bono to US$60 a session.
After years of dismissing telemedicine, practitioners are getting past their biases in barely a few weeks. Telehealth has allowed psychotherapy to continue unabated. More people who need help will now get it. I'm sad our profession needed COVID-19 to address telehealth, but the benefits will last for generations.
Nicholas Joyce is a Psychologist at University of South Florida.
Disclosure statement: Nicholas Joyce is affiliated with USF and his private practice.
Reposted with permission from The Conversation.
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EcoWatch Daily Newsletter
By Joni Sweet
If you get a call from a number you don't recognize, don't hit decline — it might be a contact tracer calling to let you know that someone you've been near has tested positive for the coronavirus.
Interviews With Contact Tracers<p>Contact tracing is a public health strategy that involves identifying everyone who may have been in contact with a person who has the coronavirus. Contact tracers collect information and provide guidance to help contain the transmission of disease.</p><p>It's been used during outbreaks of sexually transmitted infections (STIs), Ebola, measles, and now the coronavirus that causes COVID-19.</p><p>It starts when the local department of health gets a report of a confirmed case of the coronavirus in its community and gives that person a call. The contact tracer usually provides information on how to isolate and when to get treatment, then tries to figure out who else the person may have exposed.</p><p>"We ask who they've been in contact with in the 48 hours prior to symptom onset, or 2 days before the date of their positive test if they don't have symptoms," said <a href="https://case.edu/medicine/healthintegration/people/heidi-gullett" target="_blank">Dr. Heidi Gullett</a>, associate director of the Center for Community Health Integration at the Case Western Reserve University School of Medicine and medical director of the Cuyahoga County Board of Health in Ohio.</p>
“You’ve Been Exposed”<p>After the case interview, contact tracers will get to work calling the folks who may have been exposed to the coronavirus by the person who tested positive.</p><p>"We give them recommendations about quarantining or isolating, getting tested, and what to do if they become sick. If they're not already sick, we still want them to self-quarantine so that they don't spread the disease to anyone else if they were to become sick," said Labus.</p><p>Generally, the contact tracer won't ask for additional contacts unless they happen to call someone who is sick or has a confirmed case of the virus. They will help ensure the contact has the resources they need to isolate themselves, if necessary. The contact tracer may continue to stay in touch with that person over the next 14 days.</p><p>"We follow the percentage of people that were contacts, then converted into being actual cases of the virus. It's an important marker to help us understand what kind of transmission happens in our community and how to control the virus," said Gullett.</p>
Why You Should Participate (and What Happens If You Don’t)<p>A <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30457-6/fulltext" target="_blank">Lancet study</a> from June 16, which looked at data from more than 40,000 people, found that COVID-19 transmission could be reduced by 64 percent through isolating those who have the coronavirus, quarantining their household, and contacting the people they may have exposed.</p><p>The combination strategy was significantly more effective than mass random testing or just isolating the sick person and members of their household.</p><p>However, contact tracing is only as effective as people's willingness to participate, and a small number of people who've contracted the coronavirus or were potentially exposed are reluctant to talk.</p><p>"Contact tracers have all been hung up on, cussed at, yelled at," said Gullet.</p><p>The hesitation to talk to contact tracers often stems from concerns over privacy — a serious issue in healthcare.</p>
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By James Shulmeister
Climate Explained is a collaboration between The Conversation, Stuff and the New Zealand Science Media Centre to answer your questions about climate change.
If you have a question you'd like an expert to answer, please send it to firstname.lastname@example.org
What was the climate and sea level like at times in Earth’s history when carbon dioxide in the atmosphere was at 400ppm?<p>The last time global carbon dioxide levels were consistently at or above 400 parts per million (ppm) was around <a href="https://www.nature.com/articles/nature14145" target="_blank">four million years ago</a> during a geological period known as the <a href="http://www.geologypage.com/2014/05/pliocene-epoch.html" target="_blank">Pliocene Era</a> (between 5.3 million and 2.6 million years ago). The world was about 3℃ warmer and sea levels were higher than today.</p><p>We know how much carbon dioxide the atmosphere contained in the past by studying ice cores from Greenland and Antarctica. As compacted snow gradually changes to ice, it traps air in bubbles that contain <a href="https://www.cambridge.org/core/journals/annals-of-glaciology/article/enclosure-of-air-during-metamorphosis-of-dry-firn-to-ice/09D9C60A8DA412D16645E6E6ABC1892F" target="_blank">samples of the atmosphere at the time</a>. We can sample ice cores to reconstruct past concentrations of carbon dioxide, but this record only takes us back about a million years.</p><p>Beyond a million years, we don't have any direct measurements of the composition of ancient atmospheres, but we can use several methods to estimate past levels of carbon dioxide. One method uses the relationship between plant pores, known as stomata, that regulate gas exchange in and out of the plant. The density of these stomata is <a href="https://journals.sagepub.com/doi/abs/10.1177/095968369200200109" target="_blank">related to atmospheric carbon dioxide</a>, and fossil plants are a good indicator of concentrations in the past.</p><p>Another technique is to examine sediment cores from the ocean floor. The sediments build up year after year as the bodies and shells of dead plankton and other organisms rain down on the seafloor. We can use isotopes (chemically identical atoms that differ only in atomic weight) of boron taken from the shells of the dead plankton to reconstruct changes in the acidity of seawater. From this we can work out the level of carbon dioxide in the ocean.</p><p>The data from four-million-year-old sediments suggest that <a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1029/2010PA002055" target="_blank">carbon dioxide was at 400ppm back then</a>.</p>
Sea Levels and Changes in Antarctica<p>During colder periods in Earth's history, ice caps and glaciers grow and sea levels drop. In the recent geological past, during the most recent ice age about 20,000 years ago, sea levels were at least <a href="https://science.sciencemag.org/content/292/5517/679.abstract" target="_blank">120 meters lower</a> than they are today.</p><p><span></span>Sea-level changes are calculated from changes in isotopes of oxygen in the shells of marine organisms. For the Pliocene Era, <a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1029/2004PA001071" target="_blank">research</a> shows the sea-level change between cooler and warmer periods was around 30-40 meters and sea level was higher than today. Also during the Pliocene, we know the West Antarctic Ice Sheet was <a href="https://www.nature.com/articles/nature07867" target="_blank">significantly smaller</a> and global average temperatures were about 3℃ warmer than today. Summer temperatures in high northern latitudes were up to 14℃ warmer.</p><p>This may seem like a lot but modern observations show strong <a href="https://journals.ametsoc.org/jcli/article/23/14/3888/32547" target="_blank">polar amplification</a> of warming: a 1℃ increase at the equator may raise temperatures at the poles by 6-7℃. It is one of the reasons why Arctic sea ice is disappearing.</p>
Impacts in New Zealand and Australia<p>In the Australian region, there was no Great Barrier Reef, but there may have been <a href="https://link.springer.com/content/pdf/10.1007/BF02537376.pdf" target="_blank">smaller reefs along the northeast coast of Australia</a>. For New Zealand, the partial melting of the West Antarctic Ice Sheet is probably the most critical point.</p><p>One of the key features of New Zealand's current climate is that Antarctica is cut off from global circulation during the winter because of the big <a href="https://www.tandfonline.com/doi/abs/10.3402/tellusa.v54i5.12161" target="_blank">temperature contrast</a> between Antarctica and the Southern Ocean. When it comes back into circulation in springtime, New Zealand gets strong storms. Stormier winters and significantly warmer summers were likely in the mid-Pliocene because of a weaker polar vortex and a warmer Antarctica.</p><p>It will take more than a few years or decades of carbon dioxide concentrations at 400ppm to trigger a significant shrinking of the West Antarctic Ice Sheet. But recent studies show that <a href="http://nora.nerc.ac.uk/id/eprint/521027/" target="_blank">West Antarctica is already melting</a>.</p><p>Sea-level rise from a partial melting of West Antarctica could easily exceed a meter or more by 2100. In fact, if the whole of the West Antarctic melted it could <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.695.7239&rep=rep1&type=pdf" target="_blank">raise sea levels by about 3.5 meters</a>. Even smaller increases raise the risk of <a href="https://www.pce.parliament.nz/publications/preparing-new-zealand-for-rising-seas-certainty-and-uncertainty" target="_blank">flooding in low-lying cities</a> including Auckland, Christchurch and Wellington.</p>
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By Jo Harper
Investment in U.S. offshore wind projects are set to hit $78 billion (€69 billion) this decade, in contrast with an estimated $82 billion for U.S. offshore oil and gasoline projects, Wood Mackenzie data shows. This would be a remarkable feat only four years after the first offshore wind plant — the 30 megawatt (MW) Block Island Wind Farm off the coast of Rhode Island — started operating in U.S. waters.
Corporates Shift<p>Helping to drive offshore growth, U.S. corporate buyers <a href="https://www.dw.com/en/cities-leading-the-transition-to-renewables/a-42850621" target="_blank">are increasingly relying on wind energy to power their businesses</a>. Walmart and AT&T are the two top corporate wind buyers, while 14 newcomers entered the wind market in 2019, including Estée Lauder and McDonald's.</p><p>"Oil and gas companies have jumped into the U.S. offshore wind market, where they can transfer expertise in offshore fossil fuel development to clean energy investments," says Max Cohen, principal analyst, Americas Power & Renewable research at Wood Mackenzie. Many international oil and gas companies have already recognized this huge potential and entered the US offshore wind market, including Orsted, Equinor and Shell.</p><p>"Given the recent tumult in oil prices, fossil fuel companies may more and more be looking to diversify their portfolios, particularly with assets that are contracted or offer returns uncorrelated with oil and gas," Cohen says. "Offshore wind is an area where they may have a comparative advantage, and they can then leverage the experience with that technology to make the leap to onshore wind, solar, and other renewable technologies," he says.</p>
East Coast leads the way<p>"There is enormous opportunity, especially off the East Coast, for wind. I am very bullish," said former Interior Secretary Ryan Zinke. "Market excitement is moving towards offshore wind. I haven't seen this kind of enthusiasm from industry since the Bakken shale boom," he said.</p><p>Offshore wind initiatives require excessive upfront spending: a 250 MW venture costs about $1 billion, based on International Energy Agency data, but as costs fall the tipping point after which costs fall faster gets nearer</p><p>"The opportunity has been created by Northeastern states seeing the large price declines for offshore wind in Europe," says Cohen. Onshore wind is historically the lowest cost renewable resource, but is at its most expensive in the Northeast, he adds. "But costs are falling slower than for other technologies," he says.</p>
Jobs and Coastal Revitalization<p>U.S. wind energy now supports 120,000 US jobs and 530 domestic factories. A study by the University of Delaware predicted that the supply chain needed to build offshore turbines to feed power to seven East Coast states by 2030 would generate nearly $70 billion in economic activity and at least 40,000 full-time jobs. An American Wind Energy Association's (AWEA's) March 2020 report estimated that developing 30,000 MW of offshore wind along the East Coast could support up to 83,000 jobs and $25 billion in annual economic output by 2030.</p><p>Having said that, not all of the jobs are American jobs. The offshore wind developers with commercial leases in the US are all foreign companies. There is growing interest from the shipbuilding sector in the Gulf of Mexico in partnering with offshore wind companies to provide services. As a result, some of the US oil trade associations have submitted comments supporting certain aspects of offshore wind. "However, it is unclear to what extent offshore wind developers plan to use US vessels and crew, and the existing projects did not incorporate US vessels or labor at all," Hawkins says.</p>
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