Shifting to Telehealth is More than Just the Camera and Speakers

The ad hoc session might’ve been doable before, but shifting a whole clinic takes a lot of planning, and tools to engage the client beyond the session. How will you manage new clients? What processes are in place to streamline client experiences? Whilst we all come to grips with our new social-distancing reality, clinics are needing to rethink how they structure their businesses to stay relevant and maintain value for their clients. 

The Session

A therapist’s standard day has just been turned on its head. The clientele base might be the same but dynamics have changed. You might not be able to control all aspects of the client's environment: unavoidable distraction, technology failing—the list goes on. This isn’t meant to be scary, it’s just a new way to plan your session. The environment is different.

As a paediatric occupational therapist, I’m part of the many allied therapists shifting patients to telehealth. But, as someone also who runs a health tech company with a key objective to boost client engagement, I realised the importance of preparing the client’s experience before jumping into my own telehealth sessions. I’ve put together a list of questions I've gone through in transitioning to telehealth.

Set-Up

Before anything, first comes the system. Then formalise the process. When undertaking this transformation, you'll need to assess the culture of your clinic—is it positive to telehealth? This can be a big hurdle in your clients adopting the new sessions (even if only temporary).

• Know what hardware/software you'll use (ideally it will be consistent across your clinic)
• How long should it take to set-up the platform for each client?
• What are the new procedures clinics need in place for all their therapists?
• Whilst therapists are at home, will they be able to access all necessary systems?
• What information are you sending to your clients to prepare them?

ACTIONS: 1. Trial a session between therapists. This tests out the process and client’s experience; and 2. Set up an easy avenue for therapists to support one another, share ideas, express frustrations and work together. All ideas are valid.

The Tech

For whatever solution you’ve settled on, what are the fall-back options if the tech fails in session (e.g. if Zoom crashes) and what if there are other tech issues (e.g. poor internet, camera won’t connect, client can’t work audio)? It’ll never be fool-proof, but prep can go a long way to maintaining control of the session.

ACTION: Have a set of back up options. In my case, I’ll have fallback activities in case my selected activities aren’t working across our telehealth solution.

The Location

Two-fold: It’s both about setting up your environment as guiding the client on theirs. 

ACTION: Pre-set your in-house location. Make sure you have all your tools within arms-reach. If you need help with general set up, I recommend this video by AJW Adventures.

Pre-Session

Before you start telehealth-ing, what's your pre-session process? This is the big one.

• Can you prepare your client? e.g. Tips on finding a quiet well-lit space for the child to interact. This might be at a dining table or the playroom.
• What space would make the client feel most comfortable? For me, I’ve prepared a simple one-pager with a checklist. This helps my clients prepare the space and guides me on what they have available, so I can customise the session to their space.

You can’t just conduct your normal in-clinic session with them via a Zoom link. Who’s present, will they be there the whole time? What are you focusing on this session and what needs to be available? Over time with the client, your pre-session prep will become lighter but it’s important to work out what the client needs and how to prepare the parents so you continue to deliver the same quality service as in-clinic sessions.

The Session

Ultimately, the session can be conducted in three different ways:

1. Coaching style
2. 1:1 therapy with the child
3. Parent consult and reviews the child’s progress from the week

Setting up the session will depend on the client and their state of therapy. It’s important to prepare parents on how the session will run, as it may impact which parent or carer attends.

• Start the video call with the session outline, and be direct on the expectations you have for the parent/carer (e.g. they’re in charge of moving the camera when needed)
• What’s your back-up plan if the child walks away?

Remember: If you’re trying to assess, don’t ask leading questions. And converse and watch the client complete tasks—use observational skills.

Beyond the Session

Make sure you're not doubling up on paperwork just because that's the way you did it when the client was in-session. Use tools, like Theratrak, to create and track home programs and then copy the data straight into your notes. Shifting to telehealth will require additional pre-session work (until you’re in a good rhythm) so don’t double up on work unnecessarily. 

Tips: 1. Be mindful of the time you’ll need to wrap up your telehealth session. You may need to increase the gaps in the short-term.
2. Assess which games/activities work well over telehealth and improve future sessions. Share this with colleagues to improve overall clinic service.

Personal Care

The structure of your day has changed—make sure to keep some routine. My tips are:

• Log off at the end of each day
• Use work-approved collaborative platforms to ‘check-in’ with colleagues. We use Slack and email—other clinics are using MS Teams and Asana
• Plan your hours: What time are you officially starting work? When are your breaks? Don’t forget, most applications allow you to snooze notifications. If you’re in Asana/Slack, set your ‘office hours’ to help separate home from work.

Need more help on shifting to telehealth? Read over the British Journal of General Practice's Guide. It might be GP focused, but it follows the same principles.

About the Author

Laura Simmons is a Paediatric Occupational Therapist and CEO and Founder of Theratrak (tech startup for Allied Healthcare).