PHYSICIAN SUPPORT LINE POLICIES AND PROCEDURES

STEERING ADVISORY COMMITTEE

Mona Masood, D.O., Board Certified in general adult psychiatry. She is an outpatient psychiatrist in the greater Philadelphia area and a Board member of the non-profit community mental health organization, Muslim Wellness Foundation, that provides mental health educational services to the American Muslim community. Dr. Masood is the founder and chief organizer of the Physician Support Line.

Pu Cheng, M.D. (AKA Ben) Board Certified in general adult psychiatry, community psychiatry, and addiction medicine. Currently serves as inpatient director at Meridian Health Services Muncie, IN and volunteer clinical assistant professor at Indiana University School of Medicine- Muncie. Dr. Pu Cheng’s social media peer support initiative for health care workers in Wuhan, China was the original inspiration for this endeavor. He serves as a co-founder and education coordinator for the Physician Support Line.

Allison Cotton, M.D. Board Certified in adult psychiatry and child and adolescent psychiatry, Dr. Cotton is an assistant professor and serves as the Psychiatric clerkship director at the University of Nevada, Reno. She practices primarily inpatient child and adolescent psychiatry. Dr. Cotton serves as a co-founder and public relations and advertising coordinator for the Physician Support Line.

Smita Gautam, M.D. is double boarded in Adult Psychiatry and Child and Adolescent Psychiatry. She also practices outpatient child, adolescent and adult psychiatry at The Family Institute, a non–profit organization affiliated with Northwestern University, Chicago, IL. She is heavily involved in community mental health education in the city of Chicago and its northern suburbs. Dr. Gautam serves as a co-founder and volunteer coordinator of the Physician Support Line.

Suzan Song, M.D., M.P.H., Ph.D. is a Board Certified Child and Adolescent and Adult Psychiatrist who is also the Division Director of Child, Adolescent & Family Psychiatry, at the George Washington University. Dr. Song also is a humanitarian protection consultant to the United Nations and U.S. Department of State and Department of Health and Human Services.  Dr. Song serves as a co-founder and is the legal and ethical coordinator for the Physician Support Line.

POPULATION SERVED

The Physician Support Line will only provide support services, via a secure, telephone support line platform, to licensed attending physicians, residents, and fellows involved in the diagnosis and treatment of COVID-19 patients during the period of the healthcare national emergency related to COVID-19.

STAFFING MODEL

Services rendered by the Provider Support Line will be provided by volunteer licensed psychiatrists only (M.D., D.O., or equivalent). Each volunteer psychiatrist will have access to refresher trainings provided through the Steering Advisory Committee on the skills listed below.

TYPE OF SUPPORT

The Physician Support Line 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 Physician Support Line will be available 7 days a week, from the hours of 8:00 a.m. - 1:00 am ET, until the President has ended the national health emergency due to COVID-19.

POLICIES AND PROCEDURES

Volunteer Sign Up: Volunteers of the Physician Support Line services can sign-up for one hour shifts on an editable spreadsheet distributed the week prior to the shift. The week’s on-call shifts will begin Monday 8am EST. The spreadsheet will ask for the name of the primary volunteer(s), back-up volunteer, contact phone number of all volunteers, and state(s) where the volunteer psychiatrist is licensed.

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.

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 weekly 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 Telzio smartphone application, which allows telephone voice interaction with the caller and/or secure text chat. The platform allows the caller to remain anonymous if they so choose.

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.

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 (city, state) 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 Physician Support Line 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 psychiatrists here to help physicians 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. We will do our absolute best to take your call as quickly as possible, but we cannot guarantee immediate availability. No identifying information will be recorded or disclosed to others. However, we are mandated to intervene in cases of imminent homicide, suicide, or disclosure of child abuse and, in such cases, will need you to disclose your location. If you are experiencing a medical emergency, please dial 911 or go to the nearest emergency department immediately.”

Then the volunteer can begin the call:

“Thank you for calling our free peer support line. Before we start, please let us know in what state do you practice medicine?”

If you are NOT an M.D. or D.O., or international equivalent, please refer to:

• Disaster Distress Helpline 1-800-985-5590

• National Suicide Prevention Lifeline 800-273-8255

• Crisis Textline text TALK to 741741

“Thank you. How can I help you today?”

MODIFIERS

If a call is likely going to go overtime: Let the next volunteer know that you are going overtime with the current caller and will let them know when you are logging off your session by contacting them using the number provided in the sign-up sheet. Continue the call with the physicians you are helping until its conclusion. Then log off.

VOLUNTEER AGREEMENT

Role: To use your psychiatric and therapeutic 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, Physician Support Line, 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, State 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 Physician Support 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 to www.physicianmentalhealth.com to find a provider in their state.

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:

• Empathic listening

• 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 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.

Filling out the form below serves as an electronic signature and acknowledgement of the above agreement to the Physician Support Line’s Policies and Procedures.