Partnering for Occupational Therapy Telehealth Services: Collaboratively developing telehealth and hybrid occupational therapy student placements

ABSTRACT

In 2020, in Ireland, challenges associated with the COVID-19 pandemic disrupted occupational therapy student practice education placements availability. New innovative placements were required. A collaboration between University of Limerick (UL), Ireland, and Dyspraxia/DCD Ireland (DDCD Ireland) has to date enabled 30 occupational therapy students to undertake practice education placements via telehealth. Originally, this placement was designed to allow students to meet learning objectives remotely. This case report outlines how an area of innovative practice at an Irish occupational therapy student education programme evolved, during the crisis associated with Covid-19, culminating in the establishment of the Partnering for Occupational Therapy Telehealth Services (POTTS), which is now a hybrid service (telehealth and face-to-face service).

KEYWORDS:

• Occupational therapy student practice education
• telehealth
• collaboration

Introduction

UL is the only university on the island of Ireland offering a Graduate Entry Masters programme in occupational therapy, to approximately 30–35 students each year. As with all occupational therapy programmes, accredited by the World Federation of Occupational Therapists (WFOT), the provision of quality practice education placement opportunities is a mandatory part of pre-registration training (WFOT, 2016).

In March 2020, the onset of COVID-19 negatively impacted the availability of traditional face-to-face practice education placements, creating a dilemma for the UL occupational therapy practice education team (OTPET). To mitigate these challenges, the OTPET developed an innovative student-led telehealth service in partnership with DDCD Ireland.  DDCD Ireland is a national voluntary organisation delivering supports and services to children, adolescents, and adults with Dyspraxia or Developmental Co-ordination Disorder (DCD), and their families and supporters (Dyspraxia/DCD Ireland, 2022).

This case report details the collaboration between the UL OTPET, MSc.OT students, and DDCD Ireland in providing occupational therapy services for persons with DCD/Dyspraxia via telehealth, and its subsequent development into being a hybrid placement.

Reason for new practice

In response to the needs identified above, the UL OTPET developed a sustainable model of placement delivery, using a community partnership model. The telehealth modality was chosen as a viable option to circumvent the challenges posed by COVID-19.

COVID-19, and the restrictions associated with it, has led to a worldwide uptake in telehealth services (Bhaskar et al., 2020). Telehealth is described as an ideal delivery model when in-person services are not practical (WFOT, 2014). Given that occupational therapy is extremely broad in scope and flexible in application across different populations, locations, and areas of occupational dysfunction (Jiménez-Arberas et al., 2021), establishing the POTTS was considered an appropriate timely development.

Background

This was a new service. The UL OTPET established all systems, policies, timetables, induction material and structure of the placement, seeking continual feedback, while endeavouring to optimise the experience for all.

Students had the opportunity to work at all stages of the occupational therapy process, from referral through to client discharge and possible onward referral. The predominant telehealth platforms used were Zoom and Microsoft Teams. Occupational therapy assessments were conducted online through interview and active observation. The Canadian Occupational Performance Measure (COPM) (Law & Canadian Association of Occupational Therapists, 1991) and the Child Occupational Self-Assessment (COSA) (Kramer et al., 2014) were utilised with many of the client group. Intervention was occupation focused, task based, and supervised by experienced occupational therapists. As part of interprofessional education, the occupational therapy students also collaborated with music therapy students and physiotherapy students. Additionally, occupational therapy students liaised with external agencies and services for onward referral as required.

Role of occupational therapy

The UL OTPET had a role to supervise and support the occupational therapy students on placement, ensuring that all placement competency areas were met, and a quality learning experience gained. The OTPET assessed students’ competencies using the Competency Based Fieldwork Evaluation for Occupational Therapists (CBFE-OT) (Bossers et al., 2002). The occupational therapy students delivered occupational therapy assessments and intervention to children, adolescents, and adults with a focus on occupation, function, and participation. A further role of occupational therapy within this context was to ensure the delivery of an evidence-based, safe service to an organisation who did not have occupational therapy input. Students co-created resources with the children, adolescents, and adults whom they worked with, based on needs identified, evidence-based practice, and current research. Examples of resources included webinars, and online activity cards. A final occupational therapy role was to provide resources and a service that was sustainable beyond the completion of the student placements.

Implications and impact

Since March 2020, five rounds of student placements have taken place, all delivered fully online. Students completed either 296 h if it was placement level three, or 370 h if it was placement level four (final placement) out of the 1000 h of fieldwork that is required. There is no consensus on the number of placement hours that should be considered optimal to be designated telehealth or face-to-face. However, some placements are using a model of 60:40 hybrid placements where students’ placements are part face-to-face and part virtual/telehealth. 30 Occupational Therapy students (under supervision) co-designed and delivered over 450 1:1 occupational therapy sessions to 75 individual participants. 20 group sessions, attended by 92 clients, were delivered. Six webinars were delivered to participants, supervisors, and peers from occupational therapy and other disciplines. A range of resources were produced including activity cards, handouts, videos and were shared with families and other therapeutic services. Pre and post assessments were undertaken with all 1:1 participants. Outcomes for participants included improvements in gross and fine motor skills, organisational skills, emotional regulation, improved sleep patterns, increased self-esteem, increased ability to manage stress and reduced anxiety. For DDCD access to therapeutic interventions for their membership and increased understanding of DDCD for a broad cohort of future occupational therapists has been a significantly important outcome. In August 2021, €50,000 funding was awarded by Rethink Ireland through their digital innovation fund. This funding was used to employ a full-time occupational therapist to continue the programme.

There were many implications and impacts from this innovate model of service delivery. Students gained valuable experience of using telehealth platforms to deliver an innovative occupational therapy service, ensuring work readiness in an ever-evolving health and social care landscape. Skills developed included the use of different platforms, design and adaptation of online interventions, development of high-level communication skills, articulation of clinical reasoning, reflective skills, and interprofessional liaison.

When comparing both telehealth and face-to-face placements, it is important to consider how student competencies will be met with both models of placement. Telehealth is recognised as an acceptable placement model (Twogood et al., 2020). The telehealth experience was planned to ensure that WFOT minimum standards (WFOT, 2016) and CORU standards of proficiency for occupational therapists (n.d.) and competencies were met. For example, when students were providing intervention to children and their families, they were supervised online by a qualified occupational therapist and they also had a peer occupational therapy student online. Students engaged in pre-session and post-session debriefs where they reflected on the sessions. Competencies in the areas of professional autonomy and accountability, communication, collaborative practice and teamworking, safety and quality, professional development, and professional knowledge and skills (CORU, n.d.) were embedded in the placement experience.

The optimal experience is to ensure that students are meeting all competency areas in ways that match contemporary occupational therapy practice. It is possible to achieve this through telehealth placements. Given that telehealth is a part of contemporary practice, it is important to have occupational therapy graduates who can be poised for action in this aspect of service delivery. Having a hybrid form of placement negates any risk of an expedient experience.

From the perspective of the children, adolescents, and adults who availed of the service, there was flexibility and choice, which contributed to the service being client and family centred. Greater ease of accessibility to the service was afforded through it being a free service. Additionally, it was accessible regardless of geographical location and was easier for families to incorporate into their daily routines. This aligns with the concept of removing barriers to accessing care through the use of telehealth as a service delivery model, within occupational therapy, thus leading to improved access to services (Cason, 2012) with telehealth being a crucial adjunct to in-person service for provision of occupational therapy, including post-pandemic (Hoel et al., 2021). The value of intervention that aligns with daily routines for parents and families is similar to the positive findings from a study on parent perspectives on telehealth intervention, where there was convenience and compatibility with daily life (Wallisch et al., 2019) reported, and supports the elements of ‘right care, right place, right time’ (Government of Ireland, 2021) which is a key feature of the Sláintecare, (Government of Ireland, 2021) current Irish health policy.

Conclusion with potential application to other places/countries

Contemporary practice is essential in the current world of occupational therapy and having skilled graduate entry level therapists is core to innovative, evolving practice. Having therapists who are skilled in the use of telehealth is an asset to the profession. This service provided this opportunity for the students. It is important to consider that the use of telehealth is within the purview of existing occupational therapy scopes of practice (Cason, 2014). There were several benefits to the client group where client goals were set and achieved. Positive feedback from the clients who availed of this service suggests that having accessible therapy, with an activity and occupation focus, occurring in the clients’ own homes, was sustainable. The outcomes of this study support continued use of telehealth by occupational therapists as an effective service delivery model, after emergency orders related to the COVID-19 crisis are lifted (Dahl-Popolizio et al., 2020).

Regarding student practice education placements, this service supports the option for continued remote working in addition to potential to develop an onsite telehealth clinic, thus future proofing against any future disruption to clinical placements. It embraces teaching in a digital world for practice education where this option would be less likely to be available in traditional sites. It also supports building the capacity of a future workforce of occupational therapists and their work capacity skills. It is important that universities, services providers, and organisations continue to embrace and utilise telehealth as a viable option for service delivery. Kwok and colleagues assert, in relation to the implementation of tele-practice by speech-language pathologists and assistants, the learning climate of the organisation and team approach to transitioning services were identified as main facilitators of implementation (Kwok et al., 2022).

In relation to sustainability and scale of the service, the OTPET, in conjunction with DDCD Ireland devised a submission for funding to Rethink Ireland and were successful in securing funding for an occupational therapist to further develop this telehealth service. Thus, POTTS was established, and this service is now embedded in the DDCD Ireland strategic plan. There is still scope for telehealth with the POTTS programme, and with the lifting of restrictions associated with Covid-19, the POTTS project has moved to a hybrid placement model (with a combination of telehealth and face-to-face placement). This move was to further ensure that students have a rich immersive experience with the client group, the practice educator and DDCD as an organisation. Having a hybrid option still allows families to access the service via telehealth or in person adding to a greater level of client centredness and services being provided within the home setting via telehealth if required. In conclusion, this hybrid telehealth service is currently viable and addresses the need for student practice education placements providing a much-needed service nationwide to children, adolescents, and adults with DCD in Ireland.