Contemporary Disability Practice
At DSC, we are always looking for ways to celebrate innovative and contemporary disability practice.
In that spirit, this is the first in a series of articles that will explore innovative practices in allied health. First up, we will be looking at a telepractice. I recently saw a presentation on telepractise at an NDIS forum, and it really challenged my preconceptions.
Telepractice involves utilising videoconferencing technology to provide place-based and person-centred therapy support in homes, schools and other settings across Australia.
Until last month, I believed telepractice was an initiative for people in “far, far away” places – that it was a bit like a fairy tale. But the evidence blew my mind. Here’s why:
Telepractice eliminates the barriers to centre based services such as difficulty accessing transport, finding a car park, and finding appropriate supports to take you.
Telepractice also eliminates the barriers to in home services, such as balancing your supports with the privacy of all the other members of the household and the feeling that you home has turned into someone else’s workplace. No more needing to wash the dishes lest the OT thinks you’re a slob.
Telepractice is not just for those who can’t travel, nor just for those who can’t have people in their home, but for anyone who wants more choice in how they receive therapy. It won’t be for everyone, but that’s what having choices is all about.
The Perfect Workforce
Very often, I hear allied health businesses say they find it extremely hard to recruit a workforce specialised in disability. However, Sue Cameron from Therapy Connect tells me that that is not a problem for telepractice. Why? We know the allied health workforce is mostly female. Often a female worker has developed a serious amount of skills and knowledge in a specialised area before leaving the workforce (hopefully temporarily) to have children. These highly skilled therapists love the flexibility telepractice offers them. They can work from home, for the number of hours a week that suits them.
My son loves technology. He sees a speech therapist to help his communication. This is hard work because he hates talking, being told what to do and being challenged. However, when it is built into a video game and he gets to wear a headset and see himself on a computer screen, his engagement levels go up. The headset is also a really good way of blocking out all the extra sensory stimulation and helping him concentrate.
The relationship between a therapist and the people they support is really important. In disability, this relationship can last for years and can sometimes create some dependency. But in telepractice, the therapist is never in the person’s home. If equipment needs to be sourced, the Participant needs to find it around the house or purchase it. They cannot just borrow the therapist’s equipment. In this way, they are setting themselves up to be able to practise at any time, not just when the therapist brings her equipment around. Moreover, in telepractice, hands on techniques need to be taught to parents or a support worker. This builds the capacity of the support network from a really early stage, it empowers them. The geographical distance ensures the therapists is not the most important support in a person’s life. It re-defines the therapist’s role as to support a skilled and knowledgeable support network - from a distance.
What Does Evidence Say?
The evidence says that telepractice efficacy is similar to face to face and that it is acceptable to consumers (Iacono et al. 2016). Check out the list of journal reviews at the bottom this article.
If you are considering adding telepractice as a therapy modality, then you might need to make some changes to make it possible. You will need:
Fantastic internet and some (not heaps) of technology skills.
To adapt resources so they can be shared and used online. There are many tools that are already accessible online, including games, videos and apps. And it is really easy to email worksheets you have developed.
Skills in helping people turn their environment into a therapy space, including supporting people to source equipment and an appropriate space.
But you do NOT need to see physiotherapy as a barrier. Karen Finnin from Online Physio has a successful online business supporting people with musclo-skeletal problems from all over the world.
Consider whether you want telepractice to be your specialisation or just another delivery mode in addition to your existing home based, centred based and community based therapy sessions.
Telepractice also opens up opportunities to sell resources including online developments and equipment to consumers.
Your Chance to Shine
If you would like your allied health business to feature in this Innovating AH Practices article series, please contact her on firstname.lastname@example.org
More Journal Articles
American Occupational Therapy Association. (2010). Telerehabilitation position paper. American Journal of Occupational Therapy, 64S, 397– 405.
Cason, J. (2014). Telehealth: A rapidly developing service delivery model for occupational therapy. International Journal of Telerehabilitation, 6(1): 29–35. doi: 10.5195/ijt.2014.6148
Freckmann, A., Hines, M., Lincoln, M. (2017). Clinicians’ perspectives of therapeutic alliance in face-to-face and telepractice speech–language pathology sessions, International Journal of Speech-Language Pathology, 19:3, 287-296, DOI: 10.1080/17549507.2017.1292547
Hanft, M (2014). Mapping Rural and Remote Early Childhood Intervention Therapy Services. A report drafted for Services of Australian Rural and Remote Allied Health (SARRAH)/ National Rural and Remote Support Services (NRRSS)
Iacono, T., Stagg, K., Pearce, N., & Hulme Chambers, A. (2016). A scoping review of Australian allied health research in ehealth. BMC Health Services Research, 16:543. doi: 10.1186/s12913-016-1791-x
Speyer, R., Denman, D., Wilkes-Gillan, S., Chen, Y., Bogaardt, H., Kim, J., Heckathorn, D., & Cordier, R. (2018) Effects of telehealth by allied health professionals and nurses in rural and remote areas: A systematic review and meta-analysis. Rehabilitation Medicine, 50: Epub ahead of print