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Responding to risks
There may be times when you will need to respond to risks identified during a telepractice session. This guide puts forward some considerations to use in this context.
Parenting Research Centre Tools Telepractice Telepractice guides Responding to risks
Considerations for responding to risk
This resource is intended as a guide to adapting existing methods for responding to risk in-person for the telepractice context. It is essential that components of good risk management processes are not lost in translation to telepractice.
Here we list some examples of processes for your consideration – consult your organisation’s risk management guidelines to ensure you cover key areas.
Initial considerations and risk assessments
At assessment and intake, assess the mode or modes of telepractice that are suitable for any particular client and their circumstances, including establishing the benefits and risks of various telepractice (such as videocalls, phone calls, text messages, emails, file sharing) and in-person options.
In circumstances where in-person services are unable to be provided, assess the level of risk associated with commencing telepractice in situations where safety or other risks may lead to the termination of the telepractice service.
This may include consideration of the level and type of services available locally to the client. This must also be weighed against the risk associated with not providing the service.
- Identify and record the name and one or more contact numbers of a local contact person for the client.
- Assess the potential for the client’s digital activities to be intercepted or monitored, due to the significant risk this can pose.
Monitor client risk regularly and actively. Assess the risk of participation in telepractice based on understanding of the client’s circumstances, and informed by the client’s level of understanding, preferences and available technology.
The quality and reliability of the remote connection between the practitioner and the client is an additional factor that must be regularly monitored and managed by the practitioner.
- Establish professional supports that are local to the client, as an adjunct to the support provided via the remote communication technology of choice (e.g. a support worker, teacher, playgroup facilitator, peer worker etc.).
- Build an understanding of the family’s physical surroundings, remotely, to compensate for being unable to observe this in person.
- Establish methods for activating local supports who can reach the family quickly should emergencies arise. Discuss when and how these will be activated with the client and record this as a protocol on the client’s file (e.g. Name and number of trusted family friend, local health service contact person etc.).
Practitioners and families may move dynamically between telepractice and in-person service delivery to suit the needs and current risk present within a family, in cases where both are possible. For example, it may be appropriate to discontinue telepractice temporarily in response to a risk identified during a telepractice session, switch to in-person services while managing that risk, then return to telepractice if the risk can be alleviated.
Practitioners will need a framework for deciding under what circumstances they discontinue telepractice and enact other forms of support, if telepractice is no longer the safest, most effective way to manage the risk. Organisations have responsibility for capacity building, coaching and supervision of practitioners as they build their telepractice skills. Managers have oversight of responses to risk.
- Undertake risk assessments. When a risk is first identified, undertake a thorough assessment of that risk, including its severity, urgency and details of the context. Regularly assess existing risks for management and mitigation.
- Record keeping. Make sure record keeping requirements translate into the telepractice mode. If this involves switching from hand-written, paper-based notes to digital record keeping, provide guidelines for how these records are made, securely transferred to a digital record and securely stored in accordance with organisational documentation policies and procedures. Establish protocols for storing digital evidence of risks (such as emails, text messages, observations via video call).
- Risk management plans. Record a plan for how the risk will be managed. Outline how each party involved will respond should the risk develop in specific ways. Involve the client in the development of the plan and provide them with a copy to refer to.
- Contact emergency services if required. Know the organisation’s pathways and the role of emergency services in escalating care. When it is required, just as for in-person services, call 000 if someone is in immediate danger. Understand how to activate emergency services by other means. Contact crisis services such as emergency accommodation or acute care mental health teams when danger isn’t immediate.
- Mandatory reporting. Just as for in-person services, understand how and when to make reports to the appropriate state bodies when concerned about risk of harm.
- Inform and involve clients in risk response. As much as possible and where appropriate, discuss possible risk responses with the client and involve them in decision making processes. Where this is not possible, keep them informed of referrals made or services contacted, communicating clearly why this is necessary and how it might benefit them, their children or others in their family.
- Informed consent and confidentiality. These principles apply equally to telepractice as they do to in-person services. Be aware that clients could view telepractice services as more ‘light touch’ than their in-person counterparts, so the full implications of participation must be spelled out clearly. Develop clear organisational processes for gaining and documenting informed consent, including verbal consent, via telepractice. Examples can be found at Digital Health CRC.
Connectivity
If using video calling, confirm the best phone number to call in case the connection is interrupted, or the video call quality drops. The precise threshold for when the quality of the connection has dropped below an acceptable level may be a grey area.
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.
Key questions
- What is the best alternative phone number to use today, if the video call drops out?
- Sometimes the quality of our video call might come in and out. Let’s check in with each other if this happens and decide if we need to switch to the phone.
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.
Key questions
- It’s important that we can see and hear each other clearly – how’s the connection at your end? Is there anything we can do to improve it?
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.
Key questions
- Who’s present in the home today? Are you in a safe place to talk now?
- What did you and the children have for lunch today?
- Do you like to read to your children? What books do you have?
- How are you going for essentials? How many nappies do you have?
Unreachable clients
Consider the need for emergency follow-up procedures if the connection to a client is interrupted during a session, or the practitioner is otherwise unable to reach the client during a period of elevated risk. This is because it may be unclear whether the disconnection is related to risk or is due to technology.
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.
Adjusting and supplementing support
Always obtain informed consent before sharing a client’s personal information with anyone, unless there is an immediate safety concern that must be acted on first.
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.
Key questions
- I’m concerned about you at the moment – is it OK if I call you again tomorrow? We don’t have to have a big discussion, I’d just like to check in and say ‘hi’.
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.
Key questions
- Do you have a regular GP? I’m wondering if I might just get in touch with them just to let them know I’m working with you.
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.
Key questions
- Are there other people we might share this plan with, so that they know some of what’s going on and can be ready in case you need help?
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.
Key questions
- Who is around the house today?
- What about the rest of your family? Could we talk about each person and see how they relate to what we’ve talked about today?
Understanding the family
Working over telepractice may limit opportunities for incidental observations that inform an understanding of and response to risk. Compensate for this by attempting to make more direct observations.
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.
Key questions
- Thank you for letting me see inside your home, I’d like to see more of it – could you show me around using your phone?
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).
Key questions
- How confident are you about keeping the fact that you’re talking to me private? Could we check that you know how to protect your online information?
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.
Key questions
- I’m interested in how the children are going, are they around? Could I have a chat with them?
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.
Key questions
- Are you both able to see clearly? Could we do a check – can you both say something so I can hear if you’re coming through clearly?
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.
Key questions
- It’s great that technology helps us stay in touch easily, and I want you to text or email me any time you feel like it, but I won’t always respond right away – can we just check you know when I’m available and when I’m not?
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.
Key questions
- Suppose we get interrupted today by someone coming into the room – how would you like to handle that? Is there a special phrase you could say to let me know?
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.
Access to other supports
Check the client’s knowledge of how to access support when needed. It’s important the client is well informed in this regard when practitioners are working remote to the client.
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.
Key questions
- What if you needed to get out of the house and go somewhere safe – where would you go? Are there people nearby you could go to in an emergency?
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.
Key questions
- Do you know someone in your area who I could call if I have trouble getting in touch with you?
Disclaimer and acknowledgements
This resource presents considerations when responding to risks identified during a telepractice session in the family services context. It is intended to supplement existing risk management protocols endorsed within organisations and jurisdictions – it is not intended as a complete stand-alone risk management approach. We suggest that service providers who use telepractice undertake a practice review whereby practice leaders update existing risk management guidelines, informed by this resource and guidelines provided by state, federal and peak bodies.
A systematic implementation strategy is needed to accompany any updates to management procedures, to ensure that they are acted on by practitioners. Further information on effective implementation is available from Child Family Community Australia.
With thanks to the following
INVESTOR GROUP
- Association of Children’s Welfare Agencies
- Key Assets
- Life Without Barriers
- NSW Department of Communities and Justice
- Social Futures
- The Smith Family
- Uniting
SUPPORTER
- My Forever Family
COMMUNITY OF PRACTICE
- Association of Child Welfare Agencies
- Barnardos
- Catholic Care Sydney
- Catholic Care Wilcannia Forbes
- FAMS
- KARI
- Key Assets
- Life Without Barriers
- My Forever Family
- NSW Department of Communities and Justice
- Settlement Services International
- Social Futures
- The Benevolent Society
- The Smith Family
- Uniting