Remote Services: Key lessons learnt transitioning to remote therapy intervention
by Louise Martinez
Louise has been instrumental in helping us develop our Remote Services and is involved in our remote therapy training programme for our OT’s. Louise reflects on the impact of lockdown and some of the key lessons she has learnt about delivering therapy remotely.
Although initially driven by necessity, rather than choice, the virtual assessment process has continued to develop throughout with some interesting lessons learned about this way of assessing/engaging with the client. All of which point towards an effective way of working which may indicate adoption of virtual assessments as an alternative to face to face assessments, in future. I have described my key lessons below.
1. The importance of the pre-assessment telephone call to manage expectations/reduce anxieties
All virtual assessments require a pre-assessment telephone call. This is key, due to the need to discuss a suitable online platform to use, check access to a tablet, laptop or smartphone. The added benefits to this call have been:
- To develop a rapport with the client and or their family resulting in a more successful assessment. Having already talked through the assessment process and provided with reassurance, clients have said that they often feel more comfortable and relaxed by the point of assessment.
- For clients who find meeting new people difficult, this is a great way of grading the process. It also allows for planning of the assessment, including asking a family member to be present, or preparation of equipment.
2. Training clients how to use technology which could help to increase confidence using online therapy sessions in future/ reduce their social isolation
My experience has shown that clients of all ages and demographics have shown willingness to learn how to use a new technology, be it Skype, Zoom or even WhatsApp. Many clients in their seventies and even eighties have succeeded in learning a new skill during assessments. Teaching client’s basic steps over the telephone in how to use technology, such as what button to press to get started, where the iPad should be placed and how to set up a Skype account and username to name just a few.
The added benefits have been:
- 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 feedback 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.
- Assessing how your client is able to follow your instructions to use virtual technology can provide the therapist with an insight into their cognitive functioning in detail, including an assessment of their executive skills, working memory and sequencing skills.
3. The importance of creating the right setting for an assessment
Throughout any virtual assessments, it is likely there will be occasional periods of low connectively or screen "freezing". This requires a little more effort in asking the client to repeat information or provide feedback on whether they have heard the question. Despite this, it is possible to develop just as good rapport as with a face to face assessment. The positioning of screens allows for a 'close up' view of your client which you would not necessarily achieve sat in their lounge from over two metres away. The conversation flows just as easily, and in some cases, clients have reported that they may have felt more comfortable discussing sensitive yet important topics over video link, for example bowel patterns, emotional wellbeing and relationships. It can be much less 'intimidating' for some clients to discuss any issues via video link.
4. Virtual Assessments allow for breaks
Should the client become tired, need to access a toilet or attend to their medical condition (for example to take medication), the client can take this break in the privacy of their own home, without the need for the OT to be sat waiting. For example, 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.
5. Photographs and measurements can still be taken
In many instances, photographs and measurements of the client can still be obtained during assessment. Some clients, with guidance, will be capable of taking basic measurements of themselves or their environment, subject to the necessary risk assessments of their mobility and cognitive functioning. Photographs can also be provided by either the client or their family members.
6. Functional assessments can still take place
It is still possible to complete functional assessments of the client during a virtual assessment. For example, with some planning to set up the necessary items for the task beforehand, I have been able to complete a functional assessment of the client’s feeding and hand function. The quality of the Zoom/Skype picture is sufficient for this purpose, and can allow (subject to the necessary consent) for the assessment process to be recorded if necessary, to inform report writing.
