Remote Services: Enabling responsiveness and the difference it makes to children and their families
by Jane Reid
Jane is an OT Practice Occupational Therapist working with children and adults, who has helped develop and refine our service for the remote delivery of therapy. Here Jane gives us some insights on how to achieve a successful outcome from remote intervention and in particular how it enables therapist to be more responsive.
Since the lockdown was first enforced, I have carried out dozens of both initial and follow-up assessments and meetings using remote technologies and I already have five assessments planned just this week! One of the advantages of the remote model is that I am able to offer more timely support to families.
For an assessment of a child with complex needs I ensure that prior to the assessment, I explain to the parents over the phone and by email how the assessment will work. I ask them to have props, such as toys and cutlery, ready for the assessment. I always send a questionnaire for the parents to fill in and email back to me in advance. This includes some basic questions about names and ages of family members, prescribed medications and details of the child’s medical and therapy team. As I am not able to measure the child during the assessment, I ask the parent or carer to measure them in a seated position. I use Google Maps and Streetview to provide context to the location of the home. This information all helps with the overall assessment.
I find it useful to speak to the parent or carer at the beginning of the call, especially if it is an initial assessment. I then ask to speak to the child and, depending on their level of understanding and communication, I explain who I am and why I am speaking with them. I sometimes use ice breakers with young children such as ‘peek a boo’.
During the assessment, what I see is in the hands of the person holding the camera and their video skills can vary. They may forget to turn the camera round on the screen so you can see their face rather than the child. Or they may forget to hold the camera up and show me the floor. I sometimes need to be gently directive in asking them to slow down or show me the child carrying out actions and certain parts of the environment. If the child needs assistance for tasks I ask for two adults or an older sibling to assist with the assessment. One will hold the camera while the other performs tasks or assists the child.
I have found many advantages to video assessing. It can be less intimidating for children on the autistic spectrum to see and hear me on a screen as I am not present in the room and requiring eye contact. This can especially be the case for teenagers as they are used to using video calling and can seem less self-conscious about carrying out some tasks.
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.
I ordinarily limit my clients’ locations to about one hour from my work base due to the time constraints of travelling to see them regularly. However, 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. Even if it is necessary to visit the child occasionally in person, video calling could make intervention more frequent, thereby providing a more satisfactory service for the client and their family.
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.
There can be disadvantages to not visiting a client in person, such as the lack of physical interaction and not being able to assess a child’s tone or complex postural needs. There are also safeguarding considerations as I may only be seeing what the parent wants me to see. I try to ask relevant questions and pick up on any strain or tension in the family. I also liaise with the medical and therapy team when possible to mitigate this risk.
Although I ask the parent to show me the home, I rely on the accuracy of third-party resources such as room measurements and heights of steps as I am not there to measure them for myself. However, architectural plans for the home layout and space in the environment can assist with this.
There have been many advantages to using video calling during the pandemic. It has allowed me to continue my intervention and ensure clients feel safe and are having their needs met.
I have even trained formal support workers in safe moving and handling using video calling and a PowerPoint presentation. I have also carried out site visits and house viewings by video call.
I can also see potential for a change in the way I work after the restrictions are eased to continue to ensure that children and families can access support in a timely fashion. Some children, young people and families can have the choice of face-to-face contact or video calling for assessments and follow-up interventions. Parents could record a video of their children during some behaviours which they would not display with a therapist present, and send the clip to me, thereby making my assessment more complete. I can also see potential for families in areas with no local therapists with relevant skills being provided with the intervention they need.
I have embraced the opportunity to work in different ways and will endeavour to provide choice to my clients about how they would like to receive the intervention they need.
