Having a good level of basic knowledge when setting up telepractice sessions helps improve the experience for all involved. This page addresses some commonly asked questions about the ins and outs of telepractice.
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:
For people to use online support services, there are three things that service providers can often help with:
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:
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:
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:
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:
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:
In participant-focused virtual sessions, some strategies to increase interactions between participants include:
In facilitator-led virtual sessions, some strategies to increase participants’ interaction with you as the facilitator include:
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):
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:
When starting telepractice with families, consider these ideas to build a foundation that maximises safety and prepares for risks that might arise.
This information should complement the protocols and guidelines of a practitioner’s organisation, sector or legislative/regulatory bodies. It is not intended as stand-alone or comprehensive guidance.
The above suggestions focus on building a foundation that maximises safety when starting telepractice with a family. For ideas to consider when concerns about risk arise, click the heading ‘How can I respond when concerns about risk arise in a telepractice session’ on this page.
The section above provides strategies for maximising safety when using telepractice. This section presents ideas to consider when responding to identified risks in telepractice.
Importantly, general risk assessment principles also apply to telepractice. Examples include:
If a risk is identified when using telepractice, practitioners could consider:
This information aims to complement the protocols and guidelines of a practitioner’s organisation, sector or legislative/regulatory bodies. It is not intended as stand-alone or comprehensive guidance. Where needed, protocols and guidelines should be carefully adapted to the specific telepractice mode.
Practitioners can also refer to the heading ‘How can I maximise safety in telepractice sessions?’ on this page. This offers ideas for proactively building a telepractice foundation that maximises safety and prepares for risks that might arise.
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