- What is telepractice and how can it be delivered?
- How does telepractice benefit clients and services?
- How can I help clients access our online services?
- How can I maximise privacy and confidentiality when working with parents via telepractice?
- How do I minimise disruptions during telepractice sessions with families?
- How do I facilitate interactions in online video-based group sessions?
- What evidence-based parenting programs are available online?
- Who might be suited to telepractice services and programs, and under what circumstances?
Telepractice is the use of telecommunications to deliver parenting support and other services remotely. It draws upon experiences in the delivery of telehealth and can include synchronous (e.g. virtual home visits) and asynchronous (e.g. email, text) approaches.
We use the term telepractice rather than telehealth to avoid the perception that these modes of service delivery are restricted to healthcare settings. Other commonly used terms in health care include eHealth (referring to the use of internet technology) and mHealth (encompassing mobile and app technologies).
Modes of telepractice can be categorised as:
Synchronous (interactive): in which services are delivered in real time with an individual or group of clients, for example through:
- telephone consultations and support lines
- videoconferencing or webinar technology
- internet chatroom platforms
Asynchronous: where information or advice is shared over time with clients or digital conversations occur, for example by:
- email and text messaging
- social media platforms
- digital delivery of guided self-help content where online materials such as reading or videos are supplemented by practitioner contact via email, phone or video conferencing.
- Neither participant nor practitioner needs to travel, which leads to time and cost savings. This is particularly beneficial for those with mobility impairments or other health complications.
- It reduces inconvenience for those who are supporting participants – such as carers, family members and parents – in relation to time, travel and work commitments.
Increased participant choice and preference
- Telepractice can help to reduce feelings of stigma involved in visiting a therapist or receiving home visits.
- Participants who feel uncomfortable or self-conscious in a face-to-face situation may find it easier to build a trusting relationship with a practitioner.
- Telepractice can increase participants’ independence and sense of control; for example, participants have more choice over the environment for support sessions (e.g. home, workplace) and can fit sessions around their day.
Increased service reach
- With telepractice, services can extend support beyond office hours (also increasing convenience for participants).
- Services can cross geographic boundaries, particularly beneficial to rural and regional areas where access to a wide range of skilled practitioners can be limited.
- Services can support more participants as a result of these and the logistical benefits.
Increased service flexibility and quality
- Improved logistics and flexibility enable increased flexibility and responsiveness to workforce needs.
- For services that are traditionally offered at the service location (not in the home), telepractice enables practitioners to assess and support participants in their natural environment.
- Practitioners are better able to offer shared care, consultation and collaboration with specialists – a benefit for rural and remote areas in particular.
For people to use online support services, there are three things that service providers can often help with:
- affordable data plans
- access to the internet on suitable devices
- the skills to use technology effectively.
These conditions for digital inclusion are lowest for some of the key populations who access social services, in particular low-income households (income < $35,000 per annum), mobile-only households and people aged over 65 years.
Affordability has improved only marginally since 2014 and is the starkest problem for low-income families. One contributing factor is a reliance on mobile phones, which may be perceived as cost effective but can be constrained by limited data plans. Single parents with school-aged children are one group that are more likely to be mobile-only reliant. The size of a mobile screen also limits navigation and engagement with many services.
Accessibility is also a problem for some low-income families, particularly those living in multi-dwelling units where NBN ‘fibre to the basement’ is the infrastructure for internet connectivity. Due to the construction of some multi-dwelling units, Wi-Fi connectivity is limited, meaning there are barriers to some solutions (e.g. Wi-Fi to each floor). The responsibility rests with the owner or household to connect into the home.
Solutions to issues such as accessibility are often policy-based and reliant on accepting that internet access is an essential service. However, there are some things that service providers can help with.
Telecommunications companies have programs to assist those on a low income or facing financial hardship – information on this and consumer rights can be found at www.accan.org.au.
Two examples of online programs that increase digital ability are:
- Digital Springboard – a program to help people learn the digital skills they need to thrive in work and life
- Be Connected Network (Good Things Foundation) – Australian Government initiative to increase the confidence, skills and online safety of older Australians.
Respecting and maintaining privacy and confidentiality is an integral part of service delivery for organisations that support children and families. The use of telepractice introduces some unique benefits and challenges.
Privacy refers to an individual’s right to control the extent to which their personal information is available to others, while confidentiality aims to ensure that we protect information that has been shared in confidence.
Practitioners delivering telepractice sessions with families can take the following steps:
- If working from home, check that there is no identifying information visible about you or your family (e.g. school newsletters, photographs, notice board).
- Ensure that there is no personal information about other clients that participants could see in the background of a video call (e.g. documents, whiteboards, computer screens).
- Having separate devices for private and professional use gives greater protection to sensitive client information (such as audio recordings) and reduces the chance of a family member inadvertently accessing confidential information when using your device recreationally.
Practitioners can take advantage of telepractice to give parents greater control over their own personal information. Consider discussing these ideas with parents before beginning telepractice sessions:
- Ask parents who else is nearby and how they feel about them seeing or hearing the session. Remember that other people have a right to remain anonymous – parents may have a role to play in protecting their privacy.
- When videoconferencing, both practitioner and parent can close any documents/windows that are open to avoid accidental sharing.
- With telepractice technology it is easy for all participants to record sessions. Discuss issues relating to recording sessions, and the importance of keeping any recordings secure and confidential.
For more ideas, visit Speech Pathology Australia’s Telepractice Resources page, in particular the PDF ‘FAQs – Technology, Privacy and Security for Telepractice’.
Managing disruptions that arise during a telepractice session is important in ensuring the session runs smoothly and professionally. Here we outline the types of disruptions you may face in virtual sessions and the different strategies you can use to manage them, based on a literature scan and findings from a practitioner discussion group.
Disruptions may be experienced in your own space or in the client’s environment. These can include:
- personal interruptions from family members or work colleagues
- visual distractions (e.g. sunlight glare or technical difficulties)
- technological factors (e.g. internet disconnection or lagging)
- objects in environment capturing attention
- personal fatigue, which may cause a lack of concentration.
Strategies that can help manage disruptions in the client’s environment:
- Set up expectations with families before a session – together, explore solutions to potential barriers (e.g. ensuring that their device (mobile/laptop) is charged).
- Screen sharing to refer to resource materials during a session can be a useful technique to help maintain engagement and increase interactivity, promoting greater concentration from the client.
- Organise session times around parents’ schedules to minimise likelihood of interruptions (e.g. child’s nap time).
- Consider session times – studies suggest the ideal length for virtual sessions are shorter than face-to-face session lengths, as people are more likely to disengage or become fatigued. However, some practitioners schedule longer sessions to account for interruptions and allow for breaks during the session.
- Address a disruption when it occurs and deal with any challenges together (e.g. “I can see something is happening there, do we need to take a break?”).
- Use an interruption from a child as a learning opportunity to model positive interaction with the child (e.g. smile and praise child, encourage them to tell you something).
Strategies that can help manage disruptions in the practitioner’s environment:
- Choose a room with plain décor to help reduce participant distraction.
- Try to avoid having intense lighting above or behind you during video calls to reduce the impact of glare or reflective light, which may distract the client(s).
Strategies that can help manage disruptions for practitioners and clients:
- Turn off/silence mobile phone.
- Work from a quiet room where you will not be overheard, ensuring your full attention can be on the client(s) and vice versa.
- Put up a sign or notify people in the home or office that a telepractice session is underway.
The transition to telepractice has been a rapid one given the current COVID-19 context. However, focus group findings indicated that practitioners and families were pleased to have the opportunity to continue sessions, and in some cases would like to see virtual sessions offered as a viable alternative in standard practice. Minimising disruptions will help ensure the success of these sessions.
The rapid transition to telepractice during COVID-19 has seen practitioners deliver their sessions in new and interesting ways, such as online group sessions. Lack of interaction with or between participants is a difficulty that professionals may experience in their facilitation of virtual group sessions. Based on a scan of the available literature, here are some strategies to help facilitate interactions to ensure practitioner and clients get the most benefit from a meeting.
The two main group types that will be focused on are:
- Participant-focused groups: where most of the interaction is between clients. These sessions can create online social support networks, which act as a way for clients to maintain social connections with others remotely (e.g. a social group, support group).
- Practitioner-led groups: where the practitioner delivers a training/information session and most of the interaction is between the practitioner and the clients. These meetings can be a means for a practitioner to continue information delivery or training with clients remotely (e.g. an educational group, training group).
Strategies to promote interactivity in both session types
- Aim for consistent membership of the group, as this creates greater cohesion between group members
- Outline the agenda for the session and send it out to clients before the meeting so they can understand group expectations and prepare ideas
- Periodically check in with participants throughout the session for any comments or questions
- Encourage feedback at the end of sessions to allow for continual improvement of practice.
Strategies to facilitate interaction in different session types
In participant-focused virtual sessions, some strategies to increase interactions between participants include:
- keep the group size relatively small to ensure sufficient opportunity for discussion and contribution by each member – the recommended number of people for an online group session is 5-10 participants
- undertake one-on-one meetings with each participant before a session to establish rapport and convey what they to expect from the group session
- send out surveys after each session for participants to complete, or invitations for feedback can be extended to participants by the facilitator – this helps participants feel a sense of agency in the session’s delivery, promoting more active involvement.
In facilitator-led virtual sessions, some strategies to increase participants’ interaction with you as the facilitator include:
- encourage participants to un-mute and ask questions during the session – if they are uncomfortable doing so, provide the option to write questions in the chat function or polls can be created in Zoom, Microsoft Teams or other video conferencing software for response to questions
- use virtual whiteboards (e.g. in Zoom or other interactive software such as Miro) to share lists, notes or other information – this can also be a method for ideas from the group to be depicted visually
- screenshare resource or training materials to present content visually to participants – this also works to reduce the self-consciousness some participants may feel when using camera streams, as participants’ attention will be drawn elsewhere.
A more detailed exploration of navigating group telepractice sessions can be found in this Group Telepractice Guide.
Many parents and families may benefit from structured parenting programs that teach parents skills such as managing child behaviour and supporting child development and wellbeing. However, parent attendance at such programs can be as low as 50 per cent when delivered in their traditional, in-person formats (Heinrichs, Bertram, Kuschel & Hahlweg, 2005). There is some evidence that attendance increases when programs are delivered online, with an attendance rate as high as 83 per cent (Flujas-Contreras, García-Palacios & Gómez, 2019). This seems to support the premise that online services delivered to parents via telepractice increases engagement and participation.
In 2019, a systematic review of studies of parenting programs delivered online identified 24 relevant studies published up until August 2017 (Flujas-Contreras, García-Palacios & Gómez, 2019). Across these studies, the authors reported that the interventions targeted improved physical and/or psychological wellbeing of children (child outcomes) through one or more of the following changes in the parents (parent outcomes):
- parental self-efficacy
- parental knowledge
- general parenting
- parent-child interaction
- problem solving
- daily activity levels
The approaches used to target these outcomes were divided into four categories:
Triple P (Positive Parenting Program) was developed at the University of Queensland as a program to help parents in at-risk families manage the behaviour of young children. There are now multiple versions of the program, including versions that focus on children with a disability, older children/adolescents, and families in the context of separation. Traditionally delivered as four two-hour modules, there are now various formats available, including a self-paced online version.
Parent-Child Interaction Therapy aims to enhance parental warmth and behaviour management through direct, live coaching of the parent by a professional (usually through an earpiece) as they interact with their child. It entails 12-20 sessions of one hour each, although researchers note significant positive effects are found even when parents drop out after as few as four.
Professional development in Parent-Child Interaction Therapy is provided in Australia by Karitane.
Cognitive-behavioural therapy generally includes supports that help recipients adjust their thinking and behaviour to improve the way they feel and their capacity to work towards their goals. This category includes diverse parenting programs that help parents develop skills in emotion perception and regulation, coping, conflict management, communication, and positive reinforcement, amongst others.
Psycho-education includes programs that educate parents about the nature of their child’s illness or difficulty and their role in supporting the child. They also often include caring for the child more broadly, and elements aimed at increasing parental self-efficacy (belief that they can overcome parenting challenges).
A separate meta-analysis from 2019 compared the effectiveness of online and in-person parenting programs, in this case specifically for behaviour management. The researchers found the online parenting programs were equivalent in effectiveness to their in-person counterparts (Florean, Dobrean, Păsărelu, Georgescu & Milea, 2020). Although further research is needed, this should give practitioners confidence that it is possible to achieve excellent results with online parenting programs, possibly with significantly better attendance through enhanced accessibility.
Note that parenting programs may vary in how easily and effectively they can be delivered online. Practitioners will need to make sure that they are sufficiently trained in the program itself and seek advice from the developers or qualified trainers in how to proceed.
Families and children may experience factors that contribute to a lack of engagement with in-person services and programs, such as fear or shame, a lack of transport options or carer responsibilities. Certain groups are also underrepresented in service delivery, including young parents, fathers and isolated families (Cortis, Katz & Patulny, 2009).
If we look at these barriers through a telepractice lens, it increases our opportunities to engage families in ways that suit them. In other words, it reframes the issue to acknowledge that services, not families, are often hard to reach (McDonald, 2010). It provides an alternative solution that may be more effective than other strategies employed by families, such as seeking potentially inaccurate information online or ignoring a problem (University of Sydney, n.d.).
For example, evidence indicates that technology-assisted parenting interventions can be effective for, and in fact better suit, some families. Telepractice can offset difficulties associated with accessing in person services (e.g. service location, inflexible work schedules) (Harris et al., 2020). Increased access has also been noted for clients who are geographically isolated, living with a disability or experiencing social difficulties (Reimer, 2020).
The following form can be used to help guide practitioners in negotiating with a client about whether telepractice is a preferred or viable option:
- Printable form: Is telepractice a preferred and/or viable option?
- Digital form: Is telepractice a preferred and/or viable option?
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Supported by the Victorian Government Department of Families, Fairness and Housing.