A practical guide to working with children and families through telehealth

Ben Rogers, Australia, 2020

For many practitioners, the transition to telehealth consultations can feel overwhelming. Although telehealth offers exciting new ways of working with children and families, the transition can also be quite challenging.

This resource aims to develop your knowledge and confidence in using telehealth with children and families. It will provide you with practical ideas on where to start, how to prepare and what to do during a session.

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Where to start:

  • Review your national board’s guidance
  • Review your organisation’s policies
  • Review the technology
  • Review the family’s current goals

Where to start?

1. Review your national board’s guidance.

The starting place for any practitioner is to review their national board’s expectations in relation to telehealth sessions. Most national boards will provide you with a Telehealth Code of Conduct, containing discipline-specific information related to delivering safe and quality care, approaching confidentiality and privacy, and ensuring culturally safe and sensitive practice. The board will also provide you with information around insurance and strategies for working collaboratively with other practitioners.

 

2. Review your organisation’s policies and protocols.

Following a review of any discipline-specific guidance, you can turn your attention to any telehealth policies and procedures within your organisation. This will ensure you are delivering practice which is aligned to your organisation’s protocols. It will also provide clarity around consent, confidentiality, and documentation.

If you are unsure of your organisations policies, work closely with your supervisor to establish steps that support safe and quality practice.

 

3. Review the technology.

In order to feel confident in your first session with a family, it is important to familiarise yourself with the technology you will be using. Take some time at this point to review your telehealth platform and assess the functionality and level of interactivity available. You could also use this as an opportunity to facilitate a test session with colleagues or, if appropriate, observe another telehealth appointment.

 

4. Review the family’s current goals.

Prior to contacting the family, you may want to take some time to review their current goals and determine which of these can still be addressed through telehealth appointments. This process can be helpful in establishing how sessions might be facilitated and who needs to be involved. It can also help to build your confidence in this approach as you begin to see the broader possibilities of telehealth.

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How to prepare:

 

  • Prepare yourself
  • Prepare the family
  • Prepare any resources
  • Prepare the environment

How to prepare

5. Prepare yourself.

It is normal to feel uncertain about telehealth until you have had an opportunity to see its effectiveness firsthand. You may want to explore any concerns you have about using this modality and find ways of addressing these, prior to contacting the family.

Factors which can lead to practitioner uncertainty include concerns around engaging the family, managing confidentiality, and potential technical difficulties during a session. By checking in with yourself and identifying these concerns, you can then take any steps required to support your skills and confidence with this work.

 

6. Prepare the family.

Prior to the session, it can be helpful to reach out to the family and prepare them for the appointment. This conversation may involve discussing the technology, reviewing the goals together, and answering any questions they may have about the appointment. This is also an opportunity to discuss confidentiality and any resources available to the family at home that may be helpful for the session.

 

7. Prepare any resources.

It can be helpful to prepare any relevant resources and forward these on to the family prior to the session. This allows the parent to become familiar with the materials prior to the appointment, so they can adequately prepare the environment at home. This may also open up opportunities for the parent and child to complete relevant activities prior to the session and report back to the practitioner.

 

8. Prepare the environment.

It is important to take time to prepare your home environment for telehealth appointments. Key considerations include minimising potential distractions in view of the camera and in your entire workspace, as well as making sure the environment remains confidential.

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What to do:

 

  • Think about your connection
  • Think about communication
  • Think about checking in
  • Think about collaboration

What to do

9. Think about connection.

The first telehealth session should focus on ensuring the family feels safe and comfortable using this modality. You can use this appointment to explain why you are using the technology, and spend time exploring the platform and its overall functionality together.

You may like to use this time to play games with the child and parent, including using the ‘whiteboard’ function to draw pictures; choosing different backgrounds; and talking through various resources using the ‘share screen’ function. This exploration gives you an opportunity to build trust and rapport with the family.

 

10. Think about communication.

There are some subtle changes in how you communicate during a telehealth session that can directly influence your level of engagement with a family. It is important to be aware of your presence on the screen and how this is being conveyed. Maintaining a constant gaze into the camera, rather than frequently looking away at other screens or notes, lets the family know they have your full and undivided attention. This provides the foundation for trust and collaboration. Using an expressive affect and tone of voice, along with increased hand gestures can help to clearly convey your intent. Frequent summary statements, reflections, and observations can also reassure the family that you are listening.

 

11. Think about checking in.

Regular check-ins with the family can be helpful when adjusting to using the platform. At times, it may be difficult to accurately read visual cues from the family. These check-ins can be an opportunity to get verbal confirmation for your observations and interpretations.

It is important to touch base with families around any technical difficulties as well, and to ask how they are finding the overall telehealth experience. This can help you to make small adjustments to support engagement and ensure your sessions are comfortable and effective.

 

12. Think about collaboration.

At times during a telehealth session, a family may sit back and wait for the practitioner to ask them questions. In order to support collaboration, it can be helpful to provide extra opportunities for the child and family to guide you on the goals, resources and structure of the sessions.

One major advantage of telehealth is the opportunity to collaborate with the team around the child and family, including grandparents, siblings, and local services (e.g. teachers, healthcare providers). This type of collaboration offers a chance to get everyone on the same page and working together in a coordinated way.

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REFERENCES

AHPRA & National Boards. (16 April 2020). Telehealth guidance for practitioners. Melbourne: Australian Health Practitioner Regulation Agency. Available here.

Glueck, D., Myers, K., & Turvey, C. L. (2013). Establishing therapeutic rapport in telemental health. In K. Myers & C. L. Turvey (Eds.) (2013). Telemental Health: Clinical, Technical and Administrative Foundations for Evidence-Based Practice. Waltham, MA: Elsevier, pp. 29-46.

Keane, Y. (2020). Telepractice for early childhood intervention practitioners. Norwest: Early Childhood Intervention Australia. Available here.

McGrath, P., Wozney, L., Rathore, S.S., Notarianni, M., Schellenberg, M. (2018). Toolkit for e-mental health implementation. Ottawa: Mental Health Commission of Canada. Available here.

Seager van Dyk, I., Kroll, J., Martinez, R., Emerson, N., & Bursch, B. (in press). COVID-19 tips: Building rapport with youth via telehealth. Available here.

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