Supporting children and families through telehealth
Narrator [00:00:02] Welcome to the Emerging Minds podcast.
Sophie Guy [00:00:08] You’re with Sophie Guy, and today I’m joined by Tayla Iellamo, who is an occupational therapist with Royal Far West. Royal Far West is a service based in New South Wales, dedicated to ensuring that children in rural and remote locations get access to the healthcare they need, and Tayla works in the Windmill and Telecare programs within that. Her role as an occupational therapist involves supporting families to help their children achieve their everyday goals, from play and engagement to motor and self-care challenges. She has a passion and interest in working with families and children, especially those in rural and remote areas of Australia, and has been providing telehealth services to families and schools in New South Wales for the past year. In this episode, we get into the details of what holding a telehealth session actually involves. We discuss what preparation goes into running a telehealth session, as well as what in particular to consider about engaging children via video. We touch on the advantages and challenges of telehealth, and Tayla also offers suggestions about how to get started for practitioners who haven’t run telehealth sessions before, but are considering doing so.
Sophie Guy [00:01:17] Hi Tayla, and welcome to the Emerging Minds podcast.
Tayla Iellamo [00:01:20] Thanks for having me.
Sophie Guy [00:01:22] So we’re here today to talk about telehealth service delivery, and what could be useful to think about so that families and the practitioners working with them get the most out of these sessions. And the issue has suddenly become very relevant for a lot more practitioners as a result of the adjustments that we’re having to make in response to the COVID-19 pandemic, but the organisation that you work for, Royal Far West, has been offering telehealth services for some time. I wonder if just to start with, could you tell us a little bit about your background and how you came to be working in the telehealth space?
Tayla Iellamo [00:01:58] Sure. So I’ve been working as an occupational therapist for about five years now, and I’ve always worked with, with family and children. I’m actually originally from Western Australia, so when I was working over there, I noticed that there was a real gap for families to access services when they lived outside the city. I had families travel hours for therapy, I had, I remember one family actually travelled six hours for weekly therapy. [Wow]. So when I moved to New South Wales, I came across Royal Far West and really resonated with their values and their philosophy of working with vulnerable populations, especially in rural and remote areas. So I’ve been working as part of telehealth for about a year now, so as part of Royal Far West, I worked with the Telecare program and I also work for our Windmill program, which is where clients come in to Manly and access services.
Sophie Guy [00:03:02] So that refers to the services that you offer face-to-face?
Tayla Iellamo [00:03:05] Correct, yes. So we have the Windmill program and then we also have a paediatric development program as well, which families can access here in Manly with a range of health professionals.
Sophie Guy [00:03:18] And so how is telehealth used broadly in the services provided by Royal Far West?
Tayla Iellamo [00:03:24] So like you said, we’ve been providing telehealth services for a while now. We’ve actually started off in 2013 providing services. So we have a Telecare into schools program, which includes delivery of therapy from a range of allied health professionals. That includes occupational therapists, speech pathologists and psychologists as well. And that’s across New South Wales, Queensland and W.A.. So this also includes consultations with schools, teachers, principals, and we provide trainings as well for school staff. We also use telehealth as a mode of delivery for services. So whether this is into the client’s home or whether it’s with partnerships such as GP clinics or community health centres where we might provide assessment services as well. So a majority of our services is into schools, however with the change from COVID-19 and the restrictions put into place, we did provide a lot of services into the home. So it is becoming an area that’s definitely growing and we’re providing more support now into clients’ homes.
Sophie Guy [00:04:35] Okay. Yeah, I’d like to explore that. But perhaps before we do, I just wanted to ask you as well, you know, with Royal Far West and the way that they’ve provided services to rural and remote, I’m interested to know what sort of role does that play for families in rural and remote locations being able to have access to these telehealth services?
Tayla Iellamo [00:04:54] Yeah, I think it provides a really convenient, accessible way for families to access services that they might not have access to in the rural and remote areas.
Sophie Guy [00:05:07] Yeah, and I think many other services (are) providing telehealth services to rural and remote kids?
Tayla Iellamo [00:05:14] We do have partnerships with a few different services, and I think now that with the COVID-19 situation that more services are coming on board with using telehealth and hopefully more services will be able to provide support to rural and remote communities.
Sophie Guy [00:05:34] And that’s always been its core focus has it, it’s about bringing services to families and children that are in remote areas and can’t access them otherwise.
Tayla Iellamo [00:05:44] Definitely. Something that I really value as working for Royal Far West is that really strong voice we have with rural and remote communities and that really strong value and ethos of equal access to health services.
Sophie Guy [00:06:01] So how do kids get referred to Royal Far West and what sorts of concerns do they get referred for?
Tayla Iellamo [00:06:09] So children can get referred through a few different programs through Royal Far West, so they might get referred through our paediatric development program, which looks more as an assessment-based program, and this might be through their GP or local health service. We also have referrals through our Windmill program, which is more of our intervention-based program. And then we also have our Telecare, which is referrals from, from schools. So children get referred from a range of different reasons. They might get referred from concerns around, around behaviour or concerns around their social engagement with others. They might also get referred for speech and language concerns, motor skills, sensory differences, as well as from schools that have also identified areas that might be impacting on the child’s learning.
Sophie Guy [00:07:13] Okay. Sure. Well, perhaps now, let’s switch to unpacking what it’s like when you sit down to start a telehealth service with a child and/or their family or a staff member at a school, but perhaps let’s go with the example of, say, a mother. If I was a mother and I had a five-year-old child and I was about to have my first telehealth service with you. What could I expect to happen?
Tayla Iellamo [00:07:39] Well, telehealth can really be delivered, I feel in three main ways. So you could have a coaching style session or it could be one-on-one with the child, but you could also have parent consults. So I think it’s really important to prepare families about what’s to be expected from the session. So you might call them beforehand and talk about what’s expected of them, what their role will be, how involved you want them to be. You can also do this when you log into the session as well. But that first session it’s, it’s really about building rapport and building relationships with the child and the family. So, yeah, I’ve had, I’ve had children take me on tours of their house or show me their favourite toy or figurine. Anything that will really help that child to become comfortable with talking to somebody they don’t know over video.
Sophie Guy [00:08:40] Yeah, sure. And so how is that different to how you might go about building rapport if you were sitting down with someone face-to-face?
Tayla Iellamo [00:08:47] To be honest, the delivery is very similar. It’s just the mode that you’re doing it has changed. So I’m still going to use what the child is interested in. You might use their favourite toys or you might use their favourite figurines. You do have to be more resourceful, be more creative, you have to use what’s, what’s in the room because you don’t have access to things that you would if it was delivered in a clinic setting. You might use whatever they, the family has around the house, the amount of activities and games that I could say with a piece of paper or, you know, a dining chair or a balloon, you really have to be creative with what you’ve got and what is in the child’s environment. Yeah, it always helps to have fun it always helps to be a little bit silly and and animated. It might be using dress ups. You know, if the child’s favourite superhero is Spider-Man, you might dress off as Spider-Man on your end or you might use, yeah, you might use toys or, or resources on your end as well to help that child engage in, in the session as well.
Sophie Guy [00:09:59] And that these things that you would be doing anyway if the child was in the office, so spending this time connecting with them and exploring the things in the room?
Tayla Iellamo [00:10:07] Definitely. You definitely want to be able to follow the child’s lead, whether you’re delivering services over telehealth or you’re delivering it in person, you want to be using what’s motivating for that child, you want to use what they’re interested in, and you also want to follow their lead as well. And all those things stay consistent, whether you’re delivering it over telehealth or you’re delivering it in person.
Sophie Guy [00:10:30] You touched on that you probably would have a phone call with the parents beforehand and just go through what to expect in the session. Are there any particular things you’re doing at the time? You know, perhaps when you first connected via video to help the parents feel more comfortable before getting on with the session?
Tayla Iellamo [00:10:48] Yeah, and I think that’s a really important point, is helping the families be comfortable using technology. You know, families shy away from accessing telehealth because they don’t feel comfortable using technology. So I think taking that time to really prepare the families and taking that time to really help them become familiar with whatever platform that you’re using to deliver telehealth. Yeah, taking the time to really go through the setup of what might be needed in the session. So are they using a laptop? Are they using a desktop computer? Sometimes I find it’s helpful to have another portable system that they can use, such as an iPad or an iPhone. And that really helps if you’re doing any sort of tabletop activities that you can see what the child is doing, but it also helps when you’re doing assessments, if you’re trying to see something on the desktop or on the laptop. It also helps when the child might walk out of the room, that you can say to the parent, “grab the iPad or grab the phone and lets go follow them, let’s see what they’re wanting to do now”. You know, “why have they gotten up and walked away?” So that can be a really helpful thing to help families with.
Sophie Guy [00:12:06] Okay. And would you tend to do that before the first session or would that maybe be part of the first session is just spending a bit of time familiarising and getting your way around the technology?
Tayla Iellamo [00:12:17] Yeah, it’d be great if this could be done before you actually start telehealth so that the family is familiar with the process.
Sophie Guy [00:12:25] Yeah. Yeah. And so if we did talk a little bit about how you go about engaging children, is there anything else to add to that and around how it might be different to engaging in a face-to-face session?
Tayla Iellamo [00:12:39] I think it really helps to have backup plans. Have a backup plan of activities that in your, in your bank that you might use because you know, it might not always go the way you planned. I think it really helps to be familiar with Zoom and the features that you can use on Zoom. You know, there’s some great things that you can share your screen so you can share videos or you could share a PowerPoint presentation. There’s features on there where you can use a whiteboard, where you can play certain games like Pictionary on the whiteboard. You might even share remote control, so with kids that like to have that control in a session, it’s, it can help to allow them to control the computer screen. I think a big part of it as well is that our role is to help the families and is to build the skills of the families to be able to feel confident with delivering therapy, and I think that’s a real advantage of telehealth, is that families feel more empowered to deliver therapy. It helps them to be the agents in the therapy, and it really helps to build their confidence and help them to feel comfortable, and also help to learn skills from, from the clinician or strategies from the clinicians that they can then put into everyday life in their homes.
Sophie Guy [00:14:05] Is it harder to keep kids engaged because they’re at home and they’re so comfortable and, you know, they suddenly remember something in another room they feel like doing, they might just run off and do it?
Tayla Iellamo [00:14:18] It can have its challenges and that definitely can be one, but I think it’s the importance of following the child’s lead. You know, if they are leaving the room to show you something, I think it’s important to acknowledge that and follow on with that, and then also coach the families on how to bring the child back and how to hold the child in the engagement, especially with our OT sessions, it is less about us and more about the family and more about the family’s interactions with their child. So I always let families know that it’s look, it’s okay for them to walk away. And sometimes that’s what the child needs, sometimes the child needs to take a break from the interaction to then come back. So it’s, it’s important to honour that for the child.
Sophie Guy [00:15:06] Sure, and perhaps in that way, it’s actually a, an easier or more suitable way to be doing it, because in their own environment, they can go and take that break because they feel like it, where they might not feel like that that’s an option if they’re sitting in a, in a room somewhere in a service that’s unfamiliar.
Tayla Iellamo [00:15:24] Definitely. And I think it can be because they’re in their home, they are more comfortable. And my experience is the children love it, the children love being out of showing me their home, the children love being able to show me their favourite toys. I’ve had clients that have, we’ve done therapy sessions outside or they’ve taken me around their property to see all the animals they’ve got. So I think it can be really helpful and useful mode to deliver therapy.
Sophie Guy [00:15:57] Do you find that you like to do face-to-face work as well to mix things up and have both of those modes of connecting with families?
Tayla Iellamo [00:16:06] Yeah, it’s definitely good to have a mix. Telehealth has become one of my favourite ways to deliver therapy because of how accessible it is, but it is great to work with the child face-to-face again, and that’s something that when the restrictions ease, it is something that I’m really looking forward to, is seeing the kids back here or to actually go out and do some more outreach community work with the kids as well. So it’s always good to have flexibility.
Sophie Guy [00:16:37] Sure, yeah. And you talked about coaching and how it sounds as though when you’re working in a telehealth mode of delivery, that it is more about coaching and supporting parents to be able to perhaps deliver some of the therapy themselves. I was curious about when you talk about coaching, was that a set of skills that you had to develop when you started in this telehealth space as well?
Tayla Iellamo [00:17:06] Mm hmm. Yeah, coaching is definitely a skill or something that you learn ongoing. I think it is a challenge of telehealth because as clinicians, we’re taught and we’re trained to work face-to-face with clients, so developing the communication skills and developing those coaching skills can take time. And it’s, it is, it’s ongoing and it’s good to have support from from others that are experienced with using telehealth.
Sophie Guy [00:17:35] And what is meant for you by coaching skills as opposed to explaining to a parent what to do?
Tayla Iellamo [00:17:41] To me, coaching is more about the parents being able to come up with their goals, the parents being able to come up with strategies that are working. It’s about the families being able to see the bigger picture as well of why they’re working with different health clinicians and what the purpose is and what they want to get out of it. And it’s about, “I feel that I’ve done my job if I become obsolete.” To me, that’s a really important role of, of coaching is to help the families to become more confident.
Sophie Guy [00:18:17] Yeah, sure. At Emerging Minds, we, we have some principles that guide the work that we do and the resources we develop that are around things that I’m sure you’re familiar with, like looking at the child’s local ecology and their relationship. How does that feed into your work? If a child might be referred for some sort of perceived problem around their behaviour, often it’s broader than that And there’s other things going on in the family. How do you work with that via telehealth?
Tayla Iellamo [00:18:50] I think it’s a really important point is that you do need to work holistically, you need to consider all aspects of a child’s life. And that, I think a great thing about telehealth is that you can really work with the child in their natural environment, some where that they feel safe, somewhere they feel comfortable working with their families as well. I think it’s great that families can have access to a broad range of health professionals through telehealth. So possibly in their local area, they might not have access to a specific health professional because they’re not available in their local area or the waitlist is really long. Whereas with telehealth, they have access to medical professionals, but they also have access to allied health professionals that can really support the family and consider the child from a holistic point of view.
Sophie Guy [00:19:42] Yeah. And is there ever any challenge do you feel at sort of getting a clear enough sense of what the issues are, or do you not find that that’s a barrier to doing it via video rather than face-to-face?
Tayla Iellamo [00:19:55] Yes, I think that can definitely be a barrier. If we’re looking in terms of assessment, then it can be difficult to make sure that you feel like you’ve got enough information from what you can see you over Telecare, what you can observe over Telecare to make a diagnosis or whatever it may be. But in terms of intervention, I think it can still be as effective, and research is now showing that you can be as effective as face-to-face therapy.
Sophie Guy [00:20:27] Okay. Yeah. I guess I was a little bit curious about, is that any trickier sort of when you perhaps you need to just talk to the parent by themselves or you want to work with the kid by themselves. Is it any trickier when you’re doing telehealth?
Tayla Iellamo [00:20:40] I think really being clear on what’s expected at the start of the sessions. So you are wanting to speak to the parent privately, you know, making parent aware of that, I think that’s really important. I think it’s important to help the families, especially in terms of that confidentiality, how to do that in the home, how to make sure that they’ve got a private room or how to set up the space for therapy.
Sophie Guy [00:21:07] What are the instructions that you do give around setting up a private space or ensuring that they can have a confidential session?
Tayla Iellamo [00:21:15] Making sure that there’s a well-lit space so that you can actually see on the other end. Making sure that as much as possible, it can be distraction-free. Is there room that is more private in the home? You know, how to navigate siblings that might be in the house as well, because they can be a very big distraction. And somewhere that the child is comfortable, somewhere that the family is going to be comfortable as well during the therapy. Sometimes we find having a dedicated space for therapy can be really helpful because the child knows what to expect when they log on and they enter that room. It can be, and this is another beauty of telehealth is that it can be delivered anywhere. We had one particular family where we delivered services into a paddock because that’s the place they could get the best reception. So we do help families to figure out these best places to, to do the telehealth. It can also help to give families a bit of a cheat sheet or a bit of a checklist with some photos or with some ideas of how to set up the space, what might be needed, some things that you could use in the sessions. We found that’s been something that’s really been helpful.
Sophie Guy [00:22:34] Okay. And so what sorts of things are on that checklist?
Tayla Iellamo [00:22:37] So what might be needed in space? Any equipment, especially for OT sessions? We move around quite a bit. So what does the family have in their home environment already that we could use? How can we set up the space, minimise distractions? Theirs could be something around technology, how to use the technology, any additional things that might be needed, such as an iPad or an iPhone, and also what’s expected of the family during these sessions, how involved they want to be in the sessions? As, as part of Royal Far West, we do offer a telehealth accelerated learning program and that’s specifically for allied health clinicians, to, who are looking at providing telehealth service. So as part of this, clinicians can have access to webinars, but they can also have access to a two-hour session with a clinician that has experience using telehealth.
Sophie Guy [00:23:43] And this is a training program that Royal Far West offers, is it?
Tayla Iellamo [00:23:48] Yeah, yeah, it’s a learning program that they can access. So it has information about how to set up the technology, planning your sessions, engaging activity examples. It also includes some video examples of some occupational therapy, as well as some speech pathology and psychology sessions. So you really see the difference in how those different modalities provide the telehealth. [Okay]. It also has some information about privacy and confidentiality requirements, as well as part of telehealth.
Sophie Guy [00:24:22] Given the national situation, I imagine there’s, there’s a lot of practitioners who are probably considering incorporating telehealth into what they might offer. And so I’m just wondering if you have any suggestions about what sorts of things can be helpful to think about for practitioners who are wanting to do it and perhaps are a bit unsure about getting started?
Tayla Iellamo [00:24:42] Yeah, definitely. And I can resonate with that. When I first started using telehealth, I was also feeling unsure about how to use it, but I think being prepared as much as possible before the session, being familiar with the platform that you’re gonna use, testing the technology, really get to know the features that you can use, finding different ways that you can engage the child, making it individual to them, their interests, really using whatever’s in the child’s environment to help them engage with yourself or with the families. And I think it’s important to use other ways rather than just speaking to the client, using your body language and being animated and using your tone to help the child stay engaged. I think it really helps to communicate with other clinicians that are also delivering telehealth. It’s good to be able to share ideas, it’s also good to talk about what might be difficult or what might be frustrating. And it’s good to have a team around you that’s also going through the same thing. As a team, we meet up regularly once a month to go through and share ideas about things that we might have been using in our telehealth sessions. And I found this to be really helpful.
Sophie Guy [00:26:08] Yeah, yeah, I could imagine, because it would be hard to come up with new things all the time, wouldn’t it?
Tayla Iellamo [00:26:12] It is. It is definitely. Yeah. Yeah. There’s only so many things you can do, you need a team around you, you need to be had to share ideas. Another point to touch on is the importance of self-care, though, because we’re spending so much time and like you said, the current situation, we’re in lockdown, we’re spending more time on technology that it is important also to consider ourselves. And once you’re done with your sessions, turning off your computer, walking away, getting time to go outside, I think that’s a really important point for clinicians as well.
Sophie Guy [00:26:47] I just wondered if it was anything else you would want to share around. Are there any challenges, particularly around telehealth services that are useful to mention?
Tayla Iellamo [00:26:59] I think technology is a big one.
Sophie Guy [00:27:02] And is that maybe around sort of helping the families at their end, that initial training and getting familiar with it?
Tayla Iellamo [00:27:09] That but also just the fact that technology can be unreliable. [Sure]. You know, there was always going to be that, that challenge with it, whether it’s video cutting out or the sound cutting out or the reception not working, that can definitely be a big hurdle to get over. But with that, it’s good to have a backup plan, it’s good to have you know, I’ve had it in sessions where maybe the sound’s cut out. So I’ve just called the family, had my phone there available so they can still hear me while watching the video as well. So you do have to improvise sometimes. [Yeah]. But that’s definitely a really big challenge as well as, it can be, it can be daunting for families to use videos and, for example, like play with their child while someone else is watching on a video. That can be a challenge for families as well.
Sophie Guy [00:28:02] More so than if they were with you face-to-face, do you think? Or is it, it’s just that that is a daunting thing to be doing?
Tayla Iellamo [00:28:10] Yeah. Yeah. I’m not sure if it would be more or less, but it’s definitely still a challenge for families. I think the fact that they are in their home and they are more comfortable in their homes and their child is using play objects that they might play with during the day, I think it makes it a little bit easier. That’s where the relationship with the family is really important so that they can really feel comfortable to feedback to you about stuff that they’ve tried or for you to observe when you’re conducting your session. And I think it’s important then, you know, if the family is not comfortable with delivering it over video, then finding a way that’s going to make them feel most comfortable. We’ve had families that they’ve said to us we don’t feel comfortable playing over video, so what we’ve done is that they videoed the child and them playing during the week and then during our telehealth sessions, they’ve shown us the video and we’ve kind of unpacked it a little bit and spoken about what we might be seeing and then providing some more ideas or collaborating on some different strategies they could use.
Sophie Guy [00:29:20] Okay. It does sound like you can be quite innovative and creative in the way that you go about delivering services via telehealth.
Tayla Iellamo [00:29:28] Definitely. It’s something that I’ve grown to love, is the fact you can be really creative, you can improvise, you can be strategic, it’s something that I’ve grown to really enjoy.
Sophie Guy [00:29:39] Cool. Well, finally, I think I’ll just ask you if there’s anything else that you can think of to share around practitioners new to telehealth. Is there anything else to touch on?
Tayla Iellamo [00:29:53] Give it a go, have fun, relax into it. I think the beauty of it is as well, you know, even though the families are in their homes, that you can also deliver it from somewhere that you feel comfortable.
Sophie Guy [00:30:06] Thanks very much for your time today, Tayla, it’s really valuable to speak to you and glean your wisdom about working with families via telehealth.
Tayla Iellamo [00:30:15] Thanks for having me.
Narrator [00:30:18] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.