Telepractice in family support: What will it take?

Elly Robinson from the Parenting Research Centre looks at what the child and family services sector can learn from the transition to remote service delivery during the pandemic, and outlines five areas that provide a roadmap for change.

A wide range of social services moved to remote delivery following the emergence of the COVID-19 pandemic last year. This involved using online and phone-based technologies such as videoconferencing platforms and phone-based services to deliver supports that were traditionally delivered in-person. In the child and family services sector we’ve termed this type of delivery “telepractice”, noting the similarities with telehealth, but also the ways in which it is distinct.

COVID-related uncertainty, demonstrated by recent lockdowns, slow vaccination rates and ongoing issues with hotel quarantine, will continue to impact care and support for families for some time. But there is also growing recognition that a blended model of care that incorporates telepractice and in-person services can increase the availability of support to parents and children, including previously excluded or unengaged groups. Blended models of care, already prevalent in the health sector, would lead to service offerings that better suit the ways that families live and work in contemporary Australia. 

However, because technology-based approaches to service delivery in the child and family services sector have been underutilised compared to the health care sector, there’s the need to focus some energy, at both the policy and commissioning level and within delivery organisations, to build sector capacity in using telepractice modes. 

This is important because early experience with telepractice is showing us that, for some people, telepractice increases their engagement with services that in turn help facilitate better outcomes (eg. healthy coping mechanisms, parenting skills) for those participating. For example, service-level data that we have seen indicates that telepractice has yielded increased opportunities to connect with men and fathers, particularly in the service areas of family dispute resolution, anger management groups and parenting programs.

An article by Emma Thomas and colleagues from Journal of Telemedicine and Telecare outlined five priority areas for long-term sustainability of telehealth: 

1. Developing a skilled workforce 
2. Empowering consumers  
3. Reforming funding 
4. Improving the digital ecosystems 
5. Integrating telepractice into routine care  

Looking at these from the perspective of “telepractice”, we see several key areas of focus that would help to advance the use of a blended model within child and family services. 

Area 1: Developing a skilled workforce 

This area focuses on building the additional skills and support needed to deliver care via telepractice. The more that telepractice is successfully used, the more likely practitioners will feel comfortable using it. However, due to the comparatively slow uptake of telepractice in comparison to telehealth, the focus of skill development in the social services sector may be different. Increasing digital literacy, ongoing technical support and staff training is needed, as well as implementation support that can help to increase consistent and sustainable practice. 

Area 2: Empowering clients 

There is work to be done to better understand client needs in relation to telepractice, and ways in which client-centred models can be adopted in this area. This includes collating information on client experiences and understanding their expectations or preferences in regard to access to care. Some clients may also need support to build digital literacy, and gain access to suitable devices and data plans that would facilitate remote access, especially in rural and remote areas. Particular client groups, such as people with a disability or culturally diverse families, may need tailored approaches that help to increase rates of engagement and attendance in child and family services. 

Area 3: Reforming funding 

Given the promising early signs of the impact of telepractice delivery, we believe greater exploration of the policy and funding implications is warranted. This exploration should also recognise that telepractice does not necessarily provide a cheaper option for service delivery and should not replace in-person services. However, more work needs to be done to understand if increased engagement in key prevention and early intervention services means that there are savings in reduced need for tertiary services later.   

Area 4: Improving digital ecosystems 

There needs to be greater consideration of how the national digital infrastructure could be improved in a way that facilitates a more digitally inclusive community. This could include setting targets for use of telepractice similar to those set in the UK prior to COVID-19. In the health sector in Australia, the government has funded a telehealth tech company (Healthdirect Australia) to provide a video consultation option for doctors. Similar partnerships between the social services sector and IT companies could be explored, as could ways to improve digital and device access among members of communities who currently experience digital exclusion.  

Area 5: Integrating telepractice into routine care  

There is a need to develop practices that reflect an integrated and consistent approach to blended models of care. These practices could be supported by clear implementation plans. Informed by implementation science, guidance and support could be provided to agencies on building staff capacity in telepractice, and targeting implementation drivers to support consistent and high-fidelity use in day-to-day practice. Support could include the development of a range of workforce capacity building resources, training and competency assessment tools to maximise the reach and sustainability of telepractice support.

Conclusion

There’s potential to significantly increase the reach and engagement of people in important social services, through telepractice delivery. In order to do this in a way that maximises positive outcomes for participants, a systems level approach that involves the policy and service delivery community is needed. The five areas outlined above provide a roadmap for change. Early leadership on this is already seeing great collective action from people across the sector, but the effort must continue past the pandemic so that telepractice becomes a regular component of the continuum of care for individuals and families needing support.