Supporting people with disabilities via telepractice
It is not necessary for a person to have a diagnosed disability to benefit from the measures outlined. Given the focus on improving accessibility, these measures have the potential to benefit all clients, including those who don’t have a disability. The adoption of any of these recommendations should be done as part of a client-centred approach that seeks to understand and respond to each individual client’s needs and preferences.
This resource is intended as an introduction to how telepractice interacts with disability. Practitioners who are not familiar with issues surrounding the experience of disability, including the social model of disability, are encouraged to familiarise themselves with the topic before using this resource.
Due to the emerging nature of evidence in telepractice, service providers should continually monitor and adjust any approaches adopted.
This resource is not intended as an introduction to working with people with disabilities, but rather how the use of telepractice interacts with disability.
People with Disability Australia has this definition:
Impairment is a medical condition that leads to disability; while disability is the result of the interaction between people living with impairments and barriers in the physical, attitudinal, communication and social environment.
There are four general categories of disability:
- Sensory – sight or hearing are affected
- Intellectual – difficulty learning or processing information
- Physical – restriction in mobility or dexterity
- Acquired – stroke or acquired brain injury.
For further information, see National Disability Services.
Telepractice is the use of telecommunications to deliver parenting support and other services remotely. It draws upon experiences in the delivery of telehealth.
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 either as synchronous or asynchronous.
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.
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-guided content.
Benefits of telepractice
Telepractice offers a range of benefits that mean it should be considered as part of the continuum of care for all clients, including those with disabilities. These benefits include:
- Overcoming transportation challenges: Telepractice allows clients to access services at a convenient location, most often their home. This can circumvent challenges around transportation, including the need for accessible transport.
- Reduced anxiety: Some people may experience anxiety if required to attend in-person, especially at unfamiliar locations. Reduced anxiety may in turn increase a person’s ability to participate fully in support sessions and services.
- Increase client control: Clients have an increased ability to engage with services on their own terms. They have the ability to leave a session quickly if they feel the need to and can access asynchronous supports when it suits them to do so.
- Preferred environment: Clients have access to preferred belongings such as toys, fidget and comfort items. They can also access preferred food and drink and use any relevant equipment (such as adapted seating).
Assess and discuss accessibility during intake and review
Right at the outset of engaging with a family, discuss what you might work on together as well as how you might do so – the mode of working. Try to get a detailed understanding of the family’s circumstances and how they might participate. This includes their needs, as well as their preferences. The aim is to achieve a way of working together that enables the family to participate, and beyond this, to engage fully and get the maximum benefit.
Consider how parents and carers might contribute to the telepractice support you offer to children and young people. This could include helping the child or young person achieve a comfortable set-up in their own environment and transition between activities. Be prepared to offer the parent or carer advice, feedback and opportunities to practice their role.
Remember that receiving support via telepractice might be a new concept for families, so they may need guidance in understanding what’s possible. You could propose trialling different types of engagement, using different types of equipment.
Remember – you can ‘blend’ together more than one modality, such as a weekly videocall plus sharing information via text messages in between. This applies when working in-person also – being physically present may be important for a client, but could they also benefit from telepractice supports to supplement this?
Provide client briefing materials ahead of time
Help clients get the most out of your telepractice supports and get the most value out of your own time by sending clients helpful resources that explain the telepractice technology you’re considering. Invite clients to contact you if the resources are not clear to them or if they foresee any issues.
You may also want to set up a dedicated testing session, where you test the telepractice technology’s features, discuss how you might use them together, and troubleshoot. For example, you could set up an appointment time where you call the client on the phone while they’re sitting in front of their computer, and talk them through the steps for joining a Microsoft Teams meeting with you. Then once they have successfully connected with you via Teams, you can use that platform to communicate about how you might use its features. You can also test out any assistive technology or accommodations that might be used.
Good sources of briefing material include Be Connected and raisingchildren.net.au, or you may wish to prepare your own versions for a more personal, tailored approach. When preparing briefing materials, where relevant develop Plain English, Easy Read versions (UK-based CHANGE has a How to make information guide). If using briefing material published by others, you may want to add you own content specifically focused on how you will work with the family, using the technology.
Consider how assistive technology might be used
Some clients with disabilities may use assistive technology including Augmentative and Alternative Communication (AAC) devices. Where these devices have typically been used in-person, consider whether and how they could be used via telepractice.
Some AAC tools can interface with technology such as computers and iPads, which may enable screensharing or “mirroring” for communication. In other cases, it may be possible to set up a second camera to capture the AAC tool. It is recommended that this kind of setup is supported by staff with specialist knowledge in this area.
Identify whether additional equipment might be needed to support telepractice and how it might be funded. Investigate whether NDIS funding could be used in this way, on a case-by-case basis.
Investigate the accessibility features and options of the platforms you use
Standards such as the Web Content Accessibility Guidelines and Section 508 of the Rehabilitation Act in the US mean many technology providers incorporate some accessibility features into their products. Becoming familiar with some of these features enables you to bring them to families’ attention, where relevant.
Some examples include adjustable font sizes, custom keyboard input and screen reader support.
Accessibility features of various popular telepractice technologies
Consider using live captions/transcription
Various platforms, such as Zoom, Microsoft Teams, Google live translate and Otter, offer live transcription based on artificial intelligence. This means that what each participant in a video call says can be displayed on screen as text. This has the potential to aid participant understanding. Note that there may be a small delay between a person speaking and the text being displayed, so you may need to adjust how you speak (such as speaking more slowly or leaving slight pauses between phrases to allow the software to catch up). Note also that the technology is not perfectly accurate so you may need to monitor the text that is being displayed.
Use asynchronous modalities to help clients process information
An advantage of asynchronous modalities is that clients can access them at times that suit them and at their own pace. Compare this to synchronous modalities, such as video and phone calls, where the client needs to process the information in real time, while talking to the practitioner. The asynchronous approach may aid understanding because of this. At times synchronous methods, where it’s necessary to process information relatively quickly, may cause varying degrees of stress or anxiety for some clients, which means that they may find it easier to participate asynchronously.
Note also that asynchronous methods allow the client to return to content multiple times. This is particularly advantageous when a client is learning a new skill or approach, or where the content is lengthy. For these reasons, asynchronous methods may be particularly helpful for clients with learning or attention difficulties.
Even where synchronous methods are being used, such as videocalls, phonecalls or in-person meetings, consider following up with asynchronous communication to supplement this and aid client understanding and retention of information. When using phone or video calls, another option is to record all or part of the call and share it with the client after, so they can then gain the benefits mentioned of accessing it asynchronously. Remember to obtain informed consent before recording.
Further information on supporting your clients’ understanding and decision-making is available in the NSW Department of Communities & Justice’s Capacity Toolkit.
Be aware of and manage potential client anxiety related to the technology
Some clients may experience anxiety around participating in telepractice if the technology is new to them. Think about ways you can ease the transition and help them build familiarity and confidence.
Ideas to ease technology anxiety
- Reassure families that the session need only last for as long as they want it to. Give them permission to end the session at any point should they feel the need (reach out to them afterwards to follow up if they do so). You may also wish to suggest an arrangement whereby they can move away from their device temporarily for a break then return to re-engage with you when feeling comfortable to do so.
- Provide information ahead of time so that the family knows what to expect. This could include a session plan for what you intend to do during the telepractice session. Use symbol-supported information to help convey this.
- Be prepared to spend additional time (perhaps your first few sessions with a family) building familiarity with the telepractice platform. Reassure the family by letting them know this time is available.
- Where a behaviour support plan is in place, request input from the relevant clinician for inclusion of strategies for positive engagement. Familiarise yourself with the behaviour support plan prior to the appointment. Further information about behaviour support plans is available from the NDIS Commission.
Adapt the client experience to individual social needs
Some clients, such as those with Autism, may have varying preferences when engaging with other people, including around eye contact, visibility and attention.
While general advice around videocalls suggests that you should look into or close to the camera as much as possible, this may not be good practice with some clients. In these cases it may be better to position the camera away from your eyeline or turn off the camera altogether.
Although being able to see each other on camera is considered beneficial for many clients, some clients may not wish to be visible during telepractice engagements. It may be better to turn off the camera, or the client may wish to have their camera pointed away from them. When your own camera is turned on, check that the lighting makes your image look clear and close to how you look in-person.
Some clients may prefer not to feel like they are the focus of your attention during telepractice. Consider using the shared screen feature to work on a whiteboard to reduce the feeling of being focused on.
You may need to be flexible about the telepractice modality used. If a client prefers not to be seen, they may find phonecalls or text messages preferable. They may also prefer different modalities for different topics – for example, they may be comfortable to tell you about a given topic via a text message that they felt uncomfortable to address on a videocall.
Increase use of large, simple supporting visuals to communicate key information
Most, if not all, major videoconferencing platforms suitable for telepractice provide the capability to share content on your computer, often by sharing your screen. You can use this feature to help clients with disabilities engage with you by sharing large, simple supporting visuals as you discuss relevant topics with the family. Some recommendations are provided below (see How to make information accessible by UK-based CHANGE for more detail):
Using high contrast will make it easier for clients, especially those with vision impairment, to process visual information. Generally speaking, avoid grey text and grey backgrounds.
Large, easy-to-read fonts
Use a large font size, such as 24-point, or zoom in on your screen so the text displays larger for you client. It’s generally good practice when screen sharing to ask if the client can read any text clearly. Use simple fonts, generally sans-serif types such as Arial, Verdana and Helvetica.
Icons and images
Simple icons and images can aid comprehension when paired with text. These could be line drawings or cartoon-style images, or ‘clip art’.
Layout and spacing
Use simple, clear, well-spaced layouts that group related information together. Titles should sit close to the text they relate to. Avoid having text ‘flow’ tightly around images.
A simple strategy that draws on this approach is to put a key word and accompanying image for each topic you want to discuss on a slide in a slideshow and progress through these as you discuss them with the client.
Review the client user journey through your service for accessibility
While the other recommendations in this resource focus on the specifics of telepractice engagements, it is worth considering your digital presence more broadly and how this is experienced by people with disabilities. This includes things like posts on social media, use of telephones and text messaging to respond to enquiries or set up appointments, the content available on your website and any digital documents or resources produced for families.
While you’re thinking about how to improve telepractice with people with disabilities, this may be a good time to conduct a mini ‘self-audit’ of accessibility right through the client journey through your service. The guides below provide some information that may help you do this:
- Make content accessible – digital guide
- Introduction to Web Accessibility
- Online Accessibility Toolkit
It is also recommended that you consider hiring an accessibility consultant to help with this process. You should also seek input from people with disabilities as part of this process.
Use Online/digital activities to support engagement
One advantage of videoconferencing in family services is that both you and the family have access to a digital device that you can use throughout the session. You may be able to find games and applications that help structure sessions and keep families engaged with you.
Suggestions for online activities to support telepractice engagement
- Disability Horizons Blog: Provides a list of accessible games and activities with accessibility features.
- MoodFit: An app that facilitates various activities that could be walked through with a client, such as goal-setting, self-care and activity tracking.
- Nanogames: Accessible games designed for use in support scenarios.
- Game Websites for Learning Disabled Children: A blog post that lists various accessible games.
- Fun, Games & Telehealth: A blog post that lists ideas for keeping children engaged online.
- Online Speech Therapy Games: A collection of links to websites that host online activity options.
- Free games and tools for virtual counselling: A blog post with more online activity ideas.
- Cardgames.io: Simple versions of classic card games.
General tips for good telepractice
Some basic telepractice strategies are likely to help all clients engage with you, including those with disabilities:
- Minimise distractions by positioning yourself in front of a blank wall. Further information on minimising distractions can be found in Telepractice basics.
- If unsure if telepractice will work, try it for one or two sessions first.
- If running a group activity, always have two facilitators, one to run any activities and one to respond to technology issues and the chat box. Further information on using telepractice with groups can be found in the Group telepractice guide.
- Familiarise yourself with common technical difficulties so you can guide clients if required (for example, checking that the correct camera or microphone is selected, checking that their volume is set correctly).
- Encourage participants to use whatever mode of communication feels most comfortable to them. This could be speaking via audio, typing in the chat box, using emojis, writing on a shared whiteboard within the app, etc.
- Allow time and space for silence and quiet reflection. A person doesn’t have to be talking to be engaged.
References and bibliography
The Parenting Research Centre acknowledges expert input from Northcott and Lifestyle Solutions in the development of this resource.
With thanks to the following
Association of Children’s Welfare Agencies
Life Without Barriers
NSW Department of Communities and Justice
The Smith Family
My Forever Family
COMMUNITY OF PRACTICE
Association of Child Welfare Agencies
Catholic Care Sydney
Catholic Care Wilcannia Forbes
Life Without Barriers
My Forever Family
NSW Department of Communities and Justice
Settlement Services International
The Benevolent Society
The Smith Family