On a typical day in the Baltimore City school where she’s a therapist, Maggie Schultz sees up to eight kids ranging in ages from five to 14, all of them with emotional and behavioral issues.
But ever since schools have been shut down because of the COVID-19 pandemic, that number has been sliced dramatically. The most she saw over a recent week was four in one day.
And that was mostly because she could go online to connect with her kids after the administration of Gov. Larry Hogan loosened restrictions around telehealth.
Now, Schultz can use teletherapy to connect to her students.
They can do group therapy sessions using Zoom, a free video conferencing application, though Schultz concedes that can be “a little chaotic.” Or sometimes they’ll do “Zoom-tivities,” where they might draw a story and then screen-share it with each other.
Schultz says the kids are able to adapt to the newness quickly and she sees the benefits.
The Hogan administration's changes have made teletherapy more widely available through Medicaid.
"Maryland has basically redesigned the delivery mechanisms in three weeks. We’d been working on that for ten years," says Shannon Hall, the executive director of the Community Behavioral Health Association of Maryland.
Hall, whose organization represents almost 70 providers serving about 170,000 Marylanders a year, says teletherapy has long been available to Medicaid patients but it had major limitations. Patients had to be in a health clinic to use teletherapy or they had to use specific computer programs to do it.
Now, she says, Hogan and his administration have made two critical changes through his executive orders.
"[Now] you can use commonly available tools like Zoom or Facetime to provide the video connection,” she says.
But many of those who qualify for Medicaid may not have the phones or computers for video chats, or they may not have the necessary data plans. So, Hogan’s changes allow teletherapy to now be held over the telephone.
Hall says the new policies have given behavioral health workers flexibility they didn’t have before. And she wonders whether Medicaid will continue to cover teletherapy in this way when the COVID-19 pandemic passes.
"The reality is with mental health and addiction services, there are too few clinicians and too few of the services available when people need them and where people need them,” she says. “And telehealth can be a tool to address that."
Still, she says, teletherapy is not for everybody.
Schultz, the school-based therapist in Baltimore City, says it’s easier to have family sessions via video chat and it’s helpful for her to see a student’s home.
But that doesn’t mean there aren’t some problems.
She says she sometimes needs to talk to a student alone about problems they’re experiencing at home. She says she recently asked a child about a situation and was told they "couldn't talk about that right now."
They eventually found a more private setting and were able to talk, but Schultz says it reminded her of all the children she's not able to reach.
"I think about the children that I work with who I have had to make [Department of Social Services] reports for and now they’re stuck in a house and there’s no other adult who gets to see them five days a week."
In addition, it can be hard to get the kids on the call or the Zoom meeting, she says. They often miss appointments. And if she can’t see them or talk to them, she can’t bill Medicaid.
"[It's] concerning because if we’re not able to bill Medicaid for sessions and get reimbursed for that, then there could be some big financial impact on our program," Schultz says.
And if she can’t get to all of her students and bill for them, there could be one less therapist available to take a kid’s call.