Delivering care remotely: lessons learnt
by Nikki Thompson
With the status quo being challenged, we have experienced a new and enlightening perspective on the delivery of occupational therapy in the community. Nikki discusses 9 key benefits of delivering care remotely.
As occupational therapists, our role is to facilitate and support clients to achieve their maximum level of independence within their environments. For some this environment is their home or school, for others it is their community or workplace. Pre COVID-19, our services were only delivered through the traditional model of visiting clients and engaging with them face to face. When the pandemic forced a community lockdown, restricting face to face visits, we rapidly reviewed our delivery options and developed our Remote Services to ensure clients could continue to access occupational therapy. Working with our operational and clinical teams, we have continued to refine our approach and techniques to establish a remote service model that maintains our high standards of occupational therapy for our clients.
So much that we traditionally thought could only be achieved through a face to face interaction, we have discovered is possible remotely. Giving clients an enhanced level of flexibility and control, whilst offering referrers a more cost effective and timely method of accessing the best therapy for their client.
It is clear from the results we have seen that remote therapy, for many situations, has emerged as a viable alternative to face to face visits with equally successful outcomes… and in some cases with additional benefits.
In this article we aim to explore these benefits and through our therapist’s accounts share how remote therapy has enhanced their client’s occupational therapy experience.
1. Elimination of transmission risk
Our first priority is always the safely of our therapists and clients. Delivering assessments or treatments remotely is the only way to eliminate the risk of COVID-19 transmission.
A remote model also allows those who are shielding or vulnerable to still access occupational therapy support. One of our occupational therapists Karen, has conducted number of OT assessments remotely during lock down for clients with seating needs and highlights;
"One of the clinical benefits for clients is simply that an assessment is completed, they are one step closer to getting the assistance that they require and assistance can be provided post-assessment in a timely fashion; they have not been forgotten. If these assessments were not completed, then these clients would remain at risk which can be detrimental to their function, quality-of-life and indeed their life itself."
2. Increased therapist selection
We have a team over 200 expert occupational therapists throughout the UK. With a traditional face to face model we aim to keep therapists within an hour of their client, to minimise travel and maximise their clinical time, also keeping the travel costs to a minimum for the referrer. Given the coverage we now have, it generally is not a challenge to match a therapist to a client, however if a client requires a specific skill set this could mean that case managers would need to make a compromise between finding the absolute best clinical match for a client and managing travel costs. Remote therapy allows us to draw on the entire network to allocate the very best OT based purely on a clinical skill match for each client, regardless of location.
Currently we have OT’s in Scotland treating clients in Norfolk and clients in London receiving specialist rehabilitation programmes from occupational therapists in Manchester! One of our OT’s Jane, based in the South East explains;
"I have successfully assessed children all over the UK during the pandemic. I can see how this could continue to be useful once social distancing is eased. I will be able to assess clients in less accessible locations, such as in the Channel Islands and the Isle of Wight, where a local therapist with relevant skills may not be available."
The remote model opens up the therapist selection process and ensures we can draw on our highly specialist therapists to deliver the very best clinical care to the client.
3. Increased engagement
We have found that client and carer engagement in therapy can be significantly increased when using a remote model. Zandri, one of our paediatric OT’s explains how one of her teenage clients Kyle found remote therapy less anxiety provoking, leading to better engagement and more productive sessions, in turn delivering better therapeutic outcomes than when she was seeing him in person;
"To say that Kyle has blossomed would be an understatement. As cliched as it may sound, he is a completely different child interacting with me on a screen when compared to how he interacted when we were face to face. Kyle is more engaged and uses a great amount of verbal and non-verbal communication. We laugh together and are able to talk about why he may not want to do a certain task instead of him just refusing. Kyle is now participating in tasks that he previously avoided and is more spontaneous in his interaction and speech. He has become more assertive and autonomous, not always relying on his mother (who joins us for sessions) for answers or explanations. This has allowed him to develop in various skill areas and grow as a person."
We have published Zandri’s full account of how remote therapy has facilitated a significant improvement in the engagement of her client with ASD. Read more: Remote Services: Working with ASD by Zandri Edser.
The use of technology for some clients is a familiar and comfortable method of communication. We have found that clients can share information more freely and comfortably through remote methods allowing for a more engaged and productive session than perhaps we would have had in a face to face environment.
For remote assessments the OT and client or family member need to spend time speaking in advance of the assessment date. This is to help the client set up their IT and for the OT to provide details of the assessment process and any information they need in advance of the assessment such as measurements. This important liaison forms part of the therapeutic relationship and we have found that the investment of this time naturally causes an enhanced familiarisation between the OT and the client. In turn this has a direct impact on the client and or their family feeling more at ease at the assessment allowing free flowing assessment dialogue.
4. Flexibility
With no travel time our OT’s are able to offer clients greater flexibility with their appointment times to ensure they can receive the maximum benefit from their session. Whether it be to manage fatigue, family or work routines the effects of medication, a wider variety of appointment times means that clients can select the optimum time for their needs therefore affording them a greater control over their therapy. One of our hand therapists, Rachel, explains how this flexibility is allowing her client to have his therapy sessions around his work commitments;
"One of my current clients works in the agricultural industry and works long hours. For him virtual consultations mean less disruption to his working day; he can continue to work in remote locations and stop wherever he is to receive a call."
The flexibility of a remote model also allows more flexibility to accommodate breaks in sessions. Medical conditions, fatigue and / or pain can play a significant part in many of our client’s therapy, by being able to break sessions into smaller, more manageable parts, we have found clients are able to engage with an assessment or therapy programme fully. One of our OT’s Louise explains her experiences of being able to offer greater flexibility to her clients;
"I assessed a client with short bowel syndrome who needed to use the toilet every 30 minutes. By building regular five-minute breaks into our Zoom assessment, this gave the client a sense of ‘control’ over the assessment process, resulting in a less stressful experience and more comfortable experience for them."
Louise has been instrumental in helping us develop our Remote Services and is involved in our remote therapy training programme for our OT’s. We have published an article where she reflects on the impact of lockdown and some of the key lessons she has learnt about delivering therapy remotely. Read more: Remote Services: Key lessons learnt transitioning to remote therapy intervention by Louise Martinez
5. Skill acquisition
We have found that some of our clients who were previously less familiar with technology, given some support, have embraced it and found a new lease of life. We have been able to use technology as a treatment methodology and in many cases opened up lines of communication to family and friends that were previously absent. Louise shares her experiences of how the support we provide as part of the remote service technology 'set up' has in itself benefited her clients;
"Some clients had told me that they had wanted to learn how to use Zoom, for example, to stay in touch with their grandchildren, but had not wanted to ask busy family members, often key workers, for help, not realising that simple training can be successfully provided over the phone. In teaching them how to use a new method of communication during virtual assessments, it can result in increased confidence using such technology. One client fed back after assessment that they now felt more confident to arrange their online counselling sessions, which had stopped weeks ago due to the Covid-19 pandemic."
This experience is mirrored by another of our therapists Karen who also writes how remote therapy has increased the social contact and skills of her clients;
"It has given them the opportunity to learn how to use technology if they did not know how to already, and understand the different ways of being able to keep in contact with their families that often live far away, not only just during these times of social distancing, but forevermore."
6. Accuracy of assessments
Throughout an average day, a client’s performance levels can vary depending on multiple factors such as fatigue, heat, meal times, medication etc. With the traditional face to face approach, this variability can pose challenges for the assessing OT. They need to ensure they visit at a time that will allow them to see an accurate picture of the client’s functional levels and write a balanced assessment and report. Sometimes this timing is successful and other times less so, which can leave the OT having to base their recommendations on subjective reported information rather than their own observations. A remote assessment means that the client or their carer can video periods throughout the week, pre or post assessment, as per the therapists’ instructions and send them to the OT allowing them to view actual evidence of the client’s functional challenges. Katy, one of our paediatric occupational therapists who specialises in working with children with complex needs tells us how the collation of information pre and post assessment…
"has been particularly successful for looking at home environments and possible adaptations or pieces of equipment that may be needed. These new ways of working have often provided increased contact with parents as they will send across extra snippets of information more readily than they have done when we see children and their families face to face."
Equally, by interacting with a client via video link you are able to be in the client’s space without being there in person. This non-invasive approach allows a client to feel more relaxed and therefore the OT to observe interactions both with people and the environment in a spontaneous way that may not otherwise be captured.
7. Cost reduction
With a remote model we do not need to charge any travel or mileage costs for assessments or interventions. This means that costs can be significantly lower for referrers. Rachel, explains the impact of remote therapy on the funds available for her cases;
"Not needing to factor in travel time has enabled me to increase my capacity and take on clients over a wider geographical area. This has reduced client wait times and reduced costs associated with treatment sessions, often freeing up funds for additional contact time or equipment. I can be more flexible to the needs of the client; offering a greater variety of appointment times or being able to reschedule treatment sessions at short notice."
Rachel provides a broader perspective on the benefits of remote therapy for referrers in her article reflecting on her transition from face to face visits to a remote model and what it means for referrers. Read more: Remote Services: Benefits to referrers by Rachel Oliver
8. Responsiveness
Without the need to travel therapists are able to offer increased capacity to their clients. Equally, without the anxiety of a therapist physically being in their home for assessments (which can be several hours) we are seeing clients also offering more capacity for remote sessions. This is meaning that assessments can often be carried out much quicker post referral than in a face to face model. We have had same day referrals and assessments with the report and recommendations returned within 24 hours. These are timeframes that we are unlikely to ever be able to meet with a face to face model.
We have also found that when we opened up the therapy landscape to a remote model, clients would utilise our support for timely resolution of issues, Jane explains how the remote processes have helped one of her paediatric clients with complex needs access a timely solution:
"I have had several occasions when a parent or carer has told me of a potential issue with the child’s postural seating or with moving and handling. I have used video calling to see the issues for myself and provide advice to the family and resolve the issue remotely by ordering new equipment and arranging socially distanced repairs through suppliers. This could be useful after the pandemic, as I could resolve an issue quickly, and the family would not need to wait for me to visit in person."
Jane is an experienced paediatric OT specialising in working with children who have complex needs and their families. We have published an article Jane has written, reflecting on the lockdown, where she explains the positive impact timely remote therapy support has for her clients. Read more: Remote Services: Enabling responsiveness and the difference it makes to children and their families by Jane Reid
9. Consistency
In any regular treatment programme, there will be sessions that the OT or the client need to cancel due to external factors such as traffic or adverse weather. This can potentially lead to a delay between sessions and rehabilitation progress. With a remote model we have seen an increase in consistency in clients therapy appointments leading to clients reaching rehabilitation or treatment goals faster. External elements have little bearing on a remote session and therefore are less likely to lead cancelled appointments and a rehabilitation ‘lag’. Jane explains how external factors have previously impacted on her ability to deliver face to face therapy and how a remote service can overcome this;
"When I look back at the past few years, there have been times when visiting clients has not been possible, either due to severe weather conditions such as flooding, high winds and snow or because a child is too unwell to have visitors. I can see potential for video calling to enable more consistent therapy at these times."
A remote model of therapy delivery was an unfamiliar one to us all a few months ago. Through our training sessions (delivered remotely of course) our therapy team have had the opportunity to explore techniques for remote therapy in more detail, share experiences and best practice and fully understand The OT Practice standards for this new way of working. They have embraced it whole heartedly and we are proud to have a team of skilled and well-trained clinicians providing remote therapy to clients both nationally and internationally.
Whilst we have broken down the benefits into clear headings, it is important to note that these are not mutually exclusive of each other and one benefit often feeds into the next. Assessments, treatments, a wide scope of rehabilitation programmes and MDT working are just some of the needs that we can successfully meet through supporting clients remotely. With technology being more accessible and usable for people than ever before, and the clear benefits remote intervention can often bring, our remote service will be an offering we will continue to develop and enhance beyond its necessity during lockdown.
We also recognise that whilst a remote therapy model has many merits, it is not right for all and there will always be clients who therapeutically need their therapy to be delivered through face to face sessions. If you want to find out more about how and when we make face to face visits, you can read more on our dedicate Face to face visits page.
