Examining the pros and cons of telehealth

Dr Fiona Graham, of the University of Otago’s rehabilitation and teaching unit, worked on the telehealth project with Morgan Curry and Lena Sutherland, alongside the South Island CDS working group.

Telehealth can be an effective option to provide care for families accessing child disability services, but a hybrid approach works best, a telehealth project analysis has revealed.

The project is one of several South Island Alliance Child Development Services (CDS) innovations, examining quality of care and new ways of working. Telehealth is the use of digital communication technologies to deliver healthcare remotely, via cloud-based video conferencing services such as Zoom.

Dr Fiona Graham, of the University of Otago’s rehabilitation and teaching unit, worked on the project with Morgan Curry and Lena Sutherland, alongside the South Island CDS telehealth working group.

“We wanted to take a close look at the best parts of practice using telehealth, unpack the subtleties, and see if there were any lessons to be learned,” says Dr Graham. “We were pretty sure it could work for some families and that it probably wouldn’t work in other situations – but we weren’t clear about what those situations were.”

One of the first components of the study was asking therapists if they felt like their organisation supported the use of telehealth. Did they feel adequately trained? Was it viewed positively by their professional culture? “This is really important in the context of delivering telehealth, as people are unlikely to adopt a new method of working if they don’t feel it’s a valued, recognised legitimate practice, or don’t feel confident enough in their own skills.”

A range of methods were used to gain qualitative and quantitative information for the project, including a two-hour training workshop, and interviews with both clinicians and families.

The training workshop was created by the project team and was attended by many clinicians across the South Island. The event included self-funded international research from Mindy Silva, of Nelson Marlborough CDS, and high-quality engagement with Māori, presented by two academic scholars from the University of Otago – Anna Tiatia Fa’atoese Latu and Arianna Nisa-Waller.

The final component of the project was a set of interviews with clinicians who had their case notes audited, as well as feedback from families who received telehealth. Dr Graham, who was contracted to assist with the study, says this part of the process was “really enlightening”.

“It was fantastic because for both clinicians and families, telehealth generally worked really well for them – but they also all talked about its limits and when it doesn’t work. So, this is what we need to address or to take on board as we design better services that are better suited to telehealth.”

Analysis of evidence-based practice telehealth showed some issues with limited resources and limited training. “Although we provided a workshop, clinicians wanted more support to be able to take that initial step into telehealth. Something more comprehensive than our two-hour introductory session seems to be warranted.”

While some of the obvious advantages of telehealth included increased convenience, flexibility and less travel time, one advantage was more unexpected – the therapist was able to gain much clearer insight into the families’ real life when using telehealth.

“Quite a few therapists as well as families mentioned that when using telehealth, the behaviour of the child and the family routine wasn’t interrupted by them being there in-person. For example, seeing the mum with the headset on and the phone in her hand as she’s going through her normal routine with their child, is very insightful for the therapist.”

Other feedback included that while telehealth sessions are more convenient, some of the “gloss” is off, compared to child-direct hands-on therapy. “One of the comments was that apart from saving travel time, it’s just more fun and easier to catch-up with someone in person.”

Working mothers were also positive about the ease of scheduling a telehealth session over an in-person consultation. Some families talked about both positive and negative aspects of telehealth but said overall it made no difference to the level of outcome achieved for themselves. “Aside from the differences in telehealth compared to in-person service delivery, families and therapists valued telehealth because of the difference it made to other people – enabling more families to access services.”

One of the downsides of telehealth is when a child’s behaviour is particularly challenging, or the family is going through a stressful phase. “During peak times of stress, in-person can be better.”

In cases where a family’s contact with their child’s therapist was largely via telehealth, they all said it worked because they trusted the therapist and had already met them in-person at one point. “This was deeply felt by the caregivers and even the clinicians said they felt it worked better with an in-person contact initially – and we did not interview anyone who had not had that.”

Both the therapists and families described exemplary care during telehealth sessions. In particular, high levels of family engagement in problem solving, and sophisticated communication skills by the therapist. “Many families commented on how well the therapist listened to them and understood them. So how therapy is delivered definitely matters, particularly how the therapist engages.”

Dr Graham says the project was the ‘perfect marriage’ between interested and curious clinicians, and the advantage of academic skills to frame the project and findings to peer review standards, while also distilling findings that are applicable locally. “For me, the level of engagement from all the stakeholders in this project has been absolutely instrumental in its success.”