CHAT Gathering April 27^th 2020 – Therapy and Assessment

This is a summary of the discussions which took place at our second Covid 19 CHAT themed discussion on Therapy and Assessment.

Many therapists are making a successful transition to working online. Assessments that have been supported via video conferencing include FEDS assessments for non-critical issues and ASD assessments. Hanen parent training also being delivered online. Some therapists reported that,  for a number of clients, online assessments work especially well: clients  have better concentration during these sessions as visual stimulus without having to navigate the social context of face to face assessment a  can be helpful. Access to hardware and training for parents is also proving to be an issue.

Joint appointments can be challenging. Some innovative families who are embracing this online service enthusiastically however, with one therapist saying that their best session to date involved one parent on the phone and a client’s mother with a laptop ie. 2 devices, 2 parents. Other sessions are proving more challenging. It takes a lot of pieces to fall into place together for a fully successful interaction.

Issues around concentration and focus can arise where large number of service users  are on line in intellectual disability services, which is prompting one to one sessions. There are difficulties discussing personal issues, but one to one sessions not easy either. Phone calls have mixed success. The novelty of moving online is starting to wear off: some individuals/families seeking face to face and individual sessions. Staff training going forward is a significant need as it has not proven as successful as they’d like it to be.

It is also the case that some service users do not want to engage with technology services, other find Teams difficult. Broadband is an ongoing issue with many finding mobile internet is better than wifi.

Videoconferencing platforms:

Everyone is using different platforms:  it hard to manage and support that form a national perspective. Broadband and device issues are also very real for people Participants thought it would be ideal if a service provider can select one platform and roll that out consistently. This requires staff training with a key requirement being accessibility of platforms for service users.

• Some therapists and other staff are using Zoom for home-based assessments with positive results. Using Zoom as it is the only real option for some services. Zoom is more useful when groups are larger.
• Others are delivering one to one therapy sessions being delivered through Telehealth.\
• Other services are using Microsoft teams with mixed experiences, partly due to broadband issues. There is an outstanding query regarding its compatibility with iPads/iOS. One service is conducting initial interviews with parents over Teams for new referrals.
• Sign language sessions being delivered via Skype. Early Start Years group being facilitated through Zoom (Lámh and signs).

Consent and Privacy issues:

Increased verbal consent is needed when using technology. We also need to acknowledge that there are some things we just can’t do over technology. One organisations is taking additional verbal consents when using videoconferencing with service users.

• Ethically, technology cannot be a total substitute for human contact.
• Confidentiality of sessions with adolescents and adults is very difficult as service users are back home with their families and in small houses there is nowhere to have space to conduct an undisturbed session.

GDPR queries arose relating to:

• Skype for Business: should be compliant as it is a Microsoft product
• WhatsApp: more problematic as messages cannot be deleted after a period of time.

Feedback from conducting assessments online to date:

• There is a possible solution in using video sessions with screen share for feedback as therapists want to point out things that would be present in an assessment video to parents. Clinicians are yet to try this but hoping to feedback in the coming weeks.
• Clinicians have been using Powerpoints for managing anxiety/coping skills with screen share tools. However, concentration and attention can be challenging for service users.
• Telephone calls were seen to be more useful and easier for service users to “open up” and talk.
• Clinicians are making videos on vocabulary and practical activities for parents to use at home. This is quite time consuming.
• Social skills groups on Teams; these will have to be maximum of 3 people due to Teams ability to view others. (Over coming month, this will increase to 9 participants being visible at any one time). Prioritising children with no siblings who have ASD as these children are limited in their social interactions.
• Clinicians working on materials for home programmes for families and staff training for communication.
• Physiotherapists finding it difficult as physio by nature is so hands on – difficult to provide this over telehealth. With the 0-6 group this is easier as parents can learn and help over the call. However, with the older groups this is more difficult as the child is bigger.
• Very difficult for physios to work with adults due to the risk of getting into certain positions.
• Occupational therapists finding equipment is very hands-on and this is difficult to translate to video calls also.

 

Key message: HSE is listening now in a way that they haven’t listened before, so in terms of moving provision of services and resources forward, now is the time to make clear what is needed and there is huge value in sharing perspectives like this. There is an opportunity here for ongoing conversation.

CHAT Gathering April 7^th 2020

The following are summaries of the diverse and animated discussions which took place in themed break out rooms as part of an online CHAT Gathering on April 7^th 2020, titled

Covid 19: Challenges and Opportunities

Facilitator: Juliann Bergin, Enable Ireland

Issues raised

• Lack of technical knowledge on the part of both therapists and service users/families
• Lack of clinical knowledge of how to implement telehealth services.
• Priority of Therapy/Assessment? Is it our priority as Service providers, to show we are doing “something”? Or is it a priority to Service Users/families at this moment in time. Do families have a fear of rejecting the offer of service input? Is it increasing pressure on families at a time where they may already be dealing with other family/health/education/employment issues?
• Is there any guidance being provided by therapists’ professional representational bodies? Psychological Society of Ireland (PSI) have issued guidelines, Association of Occupational Therapists in Ireland (AOTI) are holding a webinar in the coming days, Irish Association of Speech and Language Therapists (IASLT) haven’t issued any documentation, unsure of other professional bodies.
• Prerequisites for working remotely with service users: not all have email on record etc. Unsure as to which medium suits/is preferred by service user. Lack of preparation ahead due to sudden closure of services.
• Level of awareness among therapists of the best and safest platforms to use – not all staff have a company phone/laptop, access to organisation resources, relying on their own devices when working from home.
• Suitability of platforms – GDPR a major issue around which to use. Microsoft Teams, Zoom, Teamviewer, Skype were all mentioned as platforms currently being used, along with email and phone calls.
• Are we looking to do too much? Will phone calls/emails/home programmes suffice? Aware that we may be providing an information overload to Service Users/families.
• Rosie Gowran from UL asked how OT Students could offer support? Suggestions included devising a survey to ask Service Users/families what their priorities are, providing step by step guides to some of the platforms etc.

Resources identified

• Phone calls are primary mode being used at present, by many therapists. Need to understand better the relationship between GDPR and remote service provision. (Reference Access to AT group discussion also).
• Progressing to delivery of online therapy and/or group sessions with AAC users: challenging to carry out online – How? Tele-therapy? More supports needed to enable therapists to implement online therapy/supports
• Some families don’t have access to the technology required to enable remote support
• AOTI seminar on Telehealth, free to members
• Key role may simply be as an information source: Webinars, online resources, etc
• Important not to bombard families with information – weekly newsletter may be very practical and useful
• Important to acknowledge that we are not sufficiently prepared this time: can we identify individual preferences ahead of time in future?