Use of Teletherapy for allied health interventions in community-based disability services: A scoping review of user perspectives

Lessons Learned from a Community-led, Pilot Teletherapy Group for Older Women Living with Depression and HIV

Older women with HIV face challenges to their quality of life, including neurocognitive decline, early-onset menopause, and chronic health issues. Chief among these concerns is depression, the most common psychiatric comorbidity among people living with HIV, with rates twice as high among women as men. However, tailored interventions among older women living with HIV and depression are lacking. Following the ADAPT-ITT framework to adapt existing interventions for cultural relevance among groups of people living with HIV, the study team revised an evidence-based intervention, the 'Stress Management and Relaxation Training/Expressive Supportive Therapy Women's Project (SMART/EST),' for online implementation. Working with two community stakeholders, the study team conducted focus groups, theater testing, and manual adaptation. This resulted in the development of e-SMART/EST, an online teletherapy group co-facilitated by a Licensed Psychologist and a credentialed Peer Counselor. The adapted, eight-session weekly intervention was tested with an exploratory pilot sample of eight older women (55 years and older) with HIV and depression. Participants rated the acceptability, feasibility, and appropriateness of the intervention, as well as symptoms of depression and HIV-related quality of life before and after the group. The e-SMART/EST Women's Project demonstrated high acceptability, feasibility, and appropriateness. Engagement was high, as women attended an average of 6.8 sessions. In qualitative interviews, participants reported peer co-facilitation, culturally relevant themes (e.g., HIV-related minority stress, critical consciousness, grief, and sex and pleasure), mindfulness techniques, and cohesion with other women as main favorable elements of the intervention. Barriers to online implementation included technological issues, distractions due to remote participation, and hindered emotional attunement compared with in-person group therapy. Findings support further research to test similar interventions in full-scale trials with older women living with depression and HIV.

Healthcare Social Workers' Scope of Practice during COVID-19

The COVID-19 pandemic pushed the U.S. healthcare system to its limits, resulting in the need for flexibility in care delivery. This study aimed to describe healthcare social workers' scope of practice since the start of the pandemic. Semi-structured interviews for this qualitative study were conducted using the Zoom platform between July and August 2020. This study used a basic qualitative content analysis with integrated deductive and inductive coding to explore participant perspectives. Their scope was assessed based on healthcare social work practice standards. Four practice standards and eight themes that emerged from the data were knowledge and skills (care planning and intervention and social worker-patient relationship), workload sustainability (workload expansion and workload facilitators), interdisciplinary collaboration (collaborating beyond the scope of responsibilities and collaboration challenges), and cultural competency (institutional and societal). The findings add a deeper understanding of the roles social workers perform, how they think about these roles, how they want to be understood, and how they are best utilized in ways consistent with their training and expertise. Moving forward, healthcare systems may consider well-delineated roles and responsibilities for everyday practice and during pandemics.

Telepractice implementation experiences during the COVID-19 pandemic, a qualitative exploration of Australian disability allied health providers: A diamond in the rough

Telepractice has existed for decades, but as a result of the COVID-19 pandemic, it gained value and increased desirability across the disability service and health sectors, as a mitigation strategy for the viral transmission risk. The increased desirability of telepractice encouraged organisations to invest and correspondingly enhance access to services delivered remotely via digital technology including allied health therapy interventions. The investment and uptake of telepractice provided greater learning opportunities and ability to investigate telepractice implementation in specific contexts such as disability services, enabling service providers the ability to tailor to specific population needs.

Methods

This study investigated the experience of telepractice implementation during the COVID-19 pandemic from 13 allied health clinicians and managers of disability organisations across Australia between November 2021 and February 2022. A contextualist and critical realist theory was applied through the study, with reflective thematic analysis used as the data analysis method and findings described using a metaphor method centring on diamond formation. The method selection aimed to produce findings grounded in qualitative methodology and methods while remaining accessible to the disability community.

Results

An exploration and analysis of the data by the authors identified six themes addressing the experiences of participants and used the metaphor of diamond formation to describe changes in allied health clinicians and disability organisations during the COVID-19 influenced telepractice implementation.

Conclusion

The allied health clinicians and managers who participated in this study demonstrated an overall sense of hope that telepractice would be a viable and sustainable delivery pathway for services in the future. This article endorses the integration of a planned telepractice delivery pathway that capitalises on the momentum created by the COVID-19 pandemic in a purposeful and accessible way that looks to enhance rather than replace current practices.

Self-rating via video communication in children with disability - a feasibility study

Background

Different barriers may hinder children with developmental disabilities (DD) from having a voice in research and clinical interventions concerning fundamentally subjective phenomena, such as participation. It is not well-investigated if video communication tools have the potential to reduce these barriers.

Aim

This study investigated the feasibility of administering a self-rating instrument measuring participation, Picture My Participation (PmP), via a video communication tool (Zoom), to children with DD.

Materials and methods

PmP was administered to 17 children with DD (mean age 13 years). The pictorial representations of activities and response options in PmP were displayed in a shared PowerPoint presentation, enabling nonverbal responses with the annotate function in Zoom. Child and interviewer perceptions of the interview were measured through questionnaires developed for the purpose.

Results

All the children completed the interview. Most PmP questions were answered, and no adverse events were registered. Technical issues could generally be solved. No special training or expensive equipment was needed for the interviews.

Conclusion

Interviewer-guided self-ratings of participation and related constructs through video communication may be a feasible procedure to use with children with DD from age 11.

Significance

Offering video communication may increase children's chances to contribute subjective experiences in research and clinical practice.