AMHI TELESUPPORT POLICIES AND PROCEDURES
STEERING ADVISORY COMMITTEE
AMHI TeleSupport will provide support services, via a secure, video-telephone support line platform to providers in Armenia and Artsakh.
Services rendered by the AMHI TeleSupport line will be provided by volunteer licensed mental health providers. Each volunteer will have access to trainings provided through the Steering Advisory Committee on the skills listed below.
TYPE OF SUPPORT
The volunteers will provide active listening and support. Volunteers will not be establishing a physician-patient relationship with callers, and will not be engaged in a clinical assessment, treatment planning, or prescribing of medication for callers.
HOURS OF OPERATION
The AMHI TeleSupport line will be available 7 days a week, at varied hours, dependent on the volunteer's availability and mindful of the time difference with Armenia and Artsakh.
POLICIES AND PROCEDURES
Volunteer Sign Up: Volunteers may sign-up for half hour or one hour shifts on a shared calendar provided via the amhi.org website. There is no minimum or maximum requirement. Please be mindful of the time difference. Most utilized times will likely be 6pm to midnight Yerevan time.
The integrity of this support line is based on the self-accountability of each volunteer. If an unforeseen circumstance occurs and the primary volunteer is unable to make their shift, they will be responsible for calling the backup volunteer to take over or contacting the caller to reschedule.
Volunteer training: There will be regular complimentary refresher courses for our volunteers in various therapeutic crisis intervention topics throughout the duration of this service, including videos, live lectures, and journals/articles/manuals/books.
Volunteer Debriefing Sessions: There will also be virtual meeting debriefing sessions for the volunteers from the week before to process their experiences and emotions and learn from other peer volunteers on strategy, time management, and rapport. These sessions are not mandatory, but available as a source of logistical guidance, education and peer support.
Platform: We will be using the doxy.me, which allows face to face interaction with the caller. The platform allows the caller to remain anonymous if they so choose, as they can turn off their camera. We ask volunteers to keep their cameras on at all times.
Supportive intervention: Support will be general, non-clinical support. Volunteers may use acute problem focused intervention, motivational interviewing, active listening, and provide validation and empathy. No medications, supplements, over the counter (OTC) or other drugs or supplements will be recommended or prescribed. No money will be exchanged. No ongoing physician-patient relationship will be established through interaction on the support line platform.
Risk of Harm: In the case of clearly stated suicidal or homicidal ideation/intent and plan (not including passive death wishes, hopelessness, or idle threats) or if the caller discloses instances of child abuse during the call, the volunteer will ask the caller to disclose the caller’s location. The volunteer will then attempt to contact the local law enforcement. An attempt will be made to engage the volunteer in a “soft handoff” with law enforcement, meaning we will try to keep the caller speaking with the volunteer while the call is being made to law enforcement. If the caller ends the encounter, it will be logged that the volunteer attempted standard of care practices in suicidal/homicidal/abuse intervention to the best of their ability, and followed guidance of local law enforcement. We are working with contacts in Armenia to identify how we can properly contact local law authorities or programs that can help the caller locally.
Documentation: Each volunteer, after their shift, will be asked to document (in a shareable spreadsheet) the following basic information, if provided by the caller: length of each call, reason for call, location of caller, medical specialty, type of support used, and any referrals if applicable. This will help us focus our training and support going forward in this evolving pandemic. Volunteers must not include any information that may identify the caller (including name, physical description, place of employment) in the spreadsheet.
Liability: Volunteers may look to both Federal and State laws pertaining to volunteer or “Good Samaritan” immunity from liability in the provision of the AMHI TeleSupport services, such as the recently enacted CARES Act. Section 3215 of the CARES Act provides that “a health care professional shall not be liable under Federal or State law for any harm caused by an act or omission of the professional in the provision of health care services during the public health emergency with respect to COVID-19.” However, the services provided must be within the scope of the license, registration, or certification of the volunteer as defined by the State of licensure, registration or certification. Further, the liability protections under the CARES Act do not apply if the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights and safety of the individual harmed by the health care professional, or the health care professional rendered the volunteer services under the influence of alcohol or an intoxicating drug.
While liability is often a fact-dependent, case by case determination, the policies and procedures, and the nature of the services themselves, as set forth herein, have been tailored to maximize volunteer protection.
DISCLOSURE TO THE CALLER
The following is a sample script/prompt for volunteers to review and summarize to callers at some point in the encounter who seem uncertain about any of our policies.
When callers initially place a call, they will be greeted with a message similar to this:
“We are mental health professionals here to help you navigate an immediate stressor. This is not a doctor-patient, therapist-client, or any similar type of relationship and no medications will be prescribed, or payment accepted. This service is not a substitute for professional mental health treatment of any kind. No identifying information will be recorded or disclosed to others. If you are experiencing a medical emergency, please contact your local health or law enforcement programs.”
Then the volunteer can begin the call:
“Thank you for calling the AMHI TeleSupport line. Before we start, please let us know what is your current occupation?”
“Thank you. How can I help you today?”
If a call is likely going to go overtime it is your choice to continue or end at the scheduled time. Please do not give our your personal contact information. This is to ensure proper boundaries and ultimately for your protection.
Role: To use your training in the role of peer support. You are not establishing a physician-patient relationship, so you will not be permitted to prescribe or recommend medication, perform psychiatric assessments, or make other specific treatment recommendations. Should you violate these threshold requirements, we, AMHI TeleSupport, will not be held liable for any adverse outcomes.
Confidentiality: You must treat each call as confidential and not disclose any identifying information received during the call to anyone, unless the caller is, in your professional medical opinion, an imminent harm to him/herself or others, or if there is suspected child abuse. You will also take the caller’s confidentiality seriously, by not asking for identifying information, such as name, birthdate, etc. unless they voluntarily disclose.
This also means you will not talk about callers to your friends or family, post information about callers on social media, or give information from the support line to another agency without that caller’s permission. There will be weekly volunteer virtual debriefing sessions where specific situations and emotions will be worked through, but without sharing any identifying information.
If the caller voluntarily discloses such information, it must not be shared with anyone except in emergency circumstances noted above.
Ethical standards: Volunteers are prohibited from meeting with callers privately, exchanging personal information, telling callers to follow a specific religious practice, or establishing a treatment plan or making any treatment recommendations.
Data obtained: Call logs with basic non-identifying information (date/time, Volunteer, location of caller, general description of problem, length of call, type of support used) will be recorded during or following each shift, and destroyed after 24 months. We will not do follow-up calls through the support line, but you can take on the caller as a patient independent of the TeleSupport line pursuant to the requirements of your individual state licensing laws, or refer callers to seek therapy in their state. If the caller asks for a referral for a physician to establish a formal doctor-patient relationship, you may refer them as you see fit, but please mention it on the encounter log.
Clear and consistent message: It’s important that people feel they are receiving clear, consistent messages, that may include volunteer use of active listening, psychoeducation about processing trauma, mindfulness, using acute cognitive-behavioral skills, motivational interviewing, supportive help, and problem solving, if appropriate.
Key competencies or core skills required:
Ability to be non-judgmental
Ability to develop a connection or rapport with the caller
Ability to use different therapeutic modalities such as active listening, motivational interviewing, supportive help or acute cognitive behavioral skills if needed
Ability to explore options for problem-solving with the caller as collaborative problem solving is part of this service delivery model
Ability to listen and help caller begin emotional processing of struggles with the war, COVID-19 pandemic, mental and substance use disorders, family violence, childhood and current trauma, grief and loss, chronic illness, addictive behaviors.
Dismissal from Service: Failure of any volunteer to comply with the terms of this volunteer agreement may result in that volunteer’s dismissal from the service.
After reading the above policies and procedures, by signing below, I agree to my role, responsibilities and limitations as a volunteer physician as outlined above.