Responding to risks

It is not always easy to ascertain the quality of the connection at the client’s end, and different clients may have differing tolerances for reductions in quality. For example, some clients may become anxious if the connection is slightly disrupted from time to time, while others may not be affected. It is best to ask clients directly about their experience of the call quality at the start of and during each session. If call quality issues persist, consider using a telephone connection.

Ask the client to let you know about any issues with connections or access to technology and/or online services. Explain that it’s important that both participants can contact and understand each other well and in a timely way. Evaluate the likelihood that the client might not have access to a device (for example if it might be shared with a family member). Check if they have plans to visit an area at the time of the appointment that might lack good reception, e.g. visiting a friend’s house. If the practitioner has been using SMS messages, email or other apps, evaluate whether these are still appropriate and adequate, factoring in whether the client’s access or propensity to use these might be impacted by their risk status.

Use more direct questioning when assessing and monitoring an identified risk via telepractice. The capacity for practitioners to make direct observations that inform their risk assessment, such as features of the local environment and the physical appearance of family members, is reduced. Ask the client to describe aspects of the environment around them or their experiences. This may be more time-consuming than recording direct observations, as may happen in-person, but is necessary. Develop a list of key questions, which can help guide practitioners with this process and can assist with documentation.

Appropriate follow-up actions could include calling their secondary contact in the local area (this person’s identity and contact information are established at the start of receiving a service and are reviewed periodically), calling a service in the local area to check in on them, calling the Police in the local area, or calling 000 if there may be immediate danger. The choice of action must be sensitive to the nature of the particular risk and the practitioner’s assessment.

Advise clients of the procedure to be followed for escalation should they lose contact with the client during the intake process.

Note that telepractice makes it particularly easy for clients to discontinue sessions as a matter of choice, compared to in-person services. Generally, with the press of a button they can end a session immediately. Protocols for responding to risk reflect this by establishing how to respond when a practitioner believes a client has ‘hung up’ on them prematurely. This could be a healthy instance of the client exercising their right to choose when and how to participate in supports, or it could reflect an elevated risk. Remain alert to the potential for clients to be coerced by others into discontinuing sessions and that this may not be apparent to the practitioner via telepractice.

Clients may not fit neatly into being either engaged or disengaged via telepractice. Their level of engagement may vary over even a short time. This presents a challenge for telepractice, due to difficulties differentiating between a non-concerning level of change in engagement and one that is significant to managing an identified risk. Consider all possible causes of changes in engagement when determining risk.

Consider using more frequent contacts during periods of elevated risk, in order to monitor the risk more closely. This also helps support the quality of the relationship between the practitioner and client. Note that it may also be appropriate to reduce the duration of each contact.

Consider, on a case-by-case basis, warm referrals to services in the client’s local area that can provide in-person contact. Some clients experiencing elevated risk may benefit from support that can’t be provided, or can’t be provided as effectively, via telepractice. Consider a range of services – local family services and allied health might be an obvious option, but bear in mind that these may not be readily accessible in the local area. Other options include GPs, schools, childcare centres and Aboriginal and Torres Strait Islander services. Discuss options with the client and explain the types of support they can provide. Seek informed consent to contact the other service.

Discuss with the client options for sharing the risk management plan with local support services. This may be valuable in activating ‘on-the-ground’ supports when needed, such as safe places to go and people to check in on the family. Options to consider include a local health service or the local school. It is especially important to inform schools of risk related to students, but sharing the management plan may also help improve the capacity of local supports to respond quickly when the practitioner is supporting the family remotely.

To enhance understanding of the risk within the family, it may be useful to take an up-to-date inventory of all family members. This is a way of compensating for the practitioner’s lack of physical presence and ability to notice and interact with family members less formally. This may help identify further risks and could be invaluable in completing the risk management plan.

If relevant, ask the client to use the camera on their video call device to show various aspects of their home. This may facilitate a better understanding of the circumstances surrounding an identified risk and is done in discussion with the client. Explain the reason for wanting to be able to see more of the home and how this will help the client and their family.

Assess the potential for telepractice services to be monitored by others in the client’s environment. This will be affected by factors that may not be present, or may be easier to assess, when working in-person. Possible means of monitoring include:

• overhearing
• accessing emails
• accessing smartphone apps (including messaging apps or apps relating to the particular risk, such as family violence support)
• accessing internet browsing history
• accessing linked devices that may reveal location, online activity etc. (e.g. via Google or Apple accounts)
• aeeing the practitioner’s face and/or name on-screen during a video call (this may make it hard for the client to disguise who they’ve been talking to)
• phone call or text message history, or saved contact numbers.

Discuss risks of monitoring with the client and implement management strategies. This could include teaching the client how to erase traces of their online behaviour, to the extent this is possible (however, also discuss whether an erased history may be noticed or questioned by a perpetrator). It could also include coaching the client on how to respond if they are asked about their online or telephone activities.

• Advice from the e-Safety Commissioner on web safety is a valuable resource – consider directing families to this site for assistance with staying safe using technology.
• Understanding the various forms of coercive control is important. Further information is available from Australia’s National Research Organisation for Women’s Safety (ANROWS).

Consider asking to speak to another family member. Speaking to additional family members may provide further insight into the nature of the risk and its immediacy. If relevant and appropriate, consider asking to see and/or speak to any children in the home. This may help to observe things like injuries or signs of neglect. Children may also be able to offer useful perspectives on the risk, and older children may be able to participate in making and enacting plans to manage it. Ask to involve children in future telepractice sessions, where possible, to increase their visibility.

When working with multiple family members (such as two parents), check that all participants can see and hear clearly, and can be heard clearly. Note that many digital devices are intended for use by an individual, and may have features like directional microphones, which are intended to filter out sounds that don’t come from where the device is pointed.

Discuss how and when the client can contact the practitioner. It may be that for some clients, telepractice blurs boundaries with professionals. They may be used to contacting family and friends through text messages, or online apps such as WhatsApp or Messenger, and therefore may implicitly see practitioners as more available and responsive than they might be.

It’s important that a client gets guidance and clear information about when and whether a practitioner will be available to respond immediately during an emergency or period of heightened risk – as this is not always a feature of the practitioner’s role. Clarify with clients that they must contact an emergency service in an emergency. Also discuss how and when the practitioner might respond. Even if a practitioner habitually responds to a text message within a few minutes, for example, this may not be the case all the time, and possibly not after hours. This is important information for the client to understand in the context of heightened risk. Let clients know via a detailed recorded voicemail greeting when unavailable.

Participants in telepractice often will not have complete control of who comes in and out of their local environment. Children or adults entering during a telepractice session may impact risk. Develop a process for clients to alert the practitioner if their circumstances change during a consult, e.g. their partner arrives home or a child enters the room. Do this in consultation with the client, where possible.

Be aware of vulnerabilities of certain groups and how this increases risk. This includes individuals with disabilities. Be mindful of these additional risk factors and incorporate them into a thorough risk assessment. Further resources are available from Women with Disabilities Victoria and 1800 RESPECT.

Telepractice services and associated risk assessments need to be culturally appropriate and informed by cultural differences. Be familiar with attitudes towards technology, sharing information outside the family, and family violence (article discussing cultural competence in telepractice).

Ensure interpreters are highly skilled due to the risk of information not being transmitted clearly (either from practitioner to client or client to practitioner) or being edited to fit cultural norms. The Waitemata District Health Board in New Zealand has published a guide on the use of interpreters.

If needed, help the client investigate services available in the local area. Check if they have a safe space to go to if needed. Ask for further detail to clarify, especially if the local area is unfamiliar.

Identify a local (informal) support person. If working remotely, it may not be practical to investigate in-person if a client is not responding to telepractice communications. A local support person may be essential not only in emergencies, but to help raise awareness of situations that may impact telepractice participation, such as family obligations, work commitments, mood changes, etc. Explain to the client the role of the support person and how and when they might be contacted.