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Video conferencing

By Sunil Bhar, Mark Silver, Rebecca Collins, Deborah Koder, Jenny Linossier and Aida Brydon

Swinburne University of Technology, Australia

Sunil Bhar, PhD, is a member of the Beck Institute International Advisory Committee. We are pleased to share this blog about the important work he and his team of clinicians and trainees are doing to provide free telehealth services to older adults in care homes who are experiencing depression, anxiety and isolation due to restrictions on visitations during the COVID-19 pandemic.

There are nearly 3,000 long-term aged care facilities in Australia. More than a quarter of a million older adults live permanently in these facilities. These individuals are among the most vulnerable groups in our society, with more than 50% experiencing mental health issues. Just as in the United States and the UK, more than 50% of aged care residents in Australia have significant levels of depression, anxiety and loneliness.

The COVID-19 pandemic has amplified the stress, anxiety and isolation for many living in such facilities. In Australia, heavy restrictions have been placed on visitations and movement. In some facilities, families have been prevented from visiting their relatives, while in others, visits have been shortened and discouraged. Many residents feel trapped, cut off from their families, anxious and isolated. Many families and aged care staff understandably feel equally distressed and helpless.    

Video conferencing

We wanted to help.

Ten years ago, a group of us at Swinburne University in Melbourne started The Swinburne Wellbeing Clinic for Older Adults, a student-based mental health clinic for older adults living in long-term care settings. Over this time, we have mentored more than 300 students in providing psychological treatments and support to hundreds of aged residents and their families within the Melbourne region. Our services were always delivered in person at the facility, and our students learned to adapt Cognitive Behavior Therapy (CBT), reminiscence therapy and behavioral activation to suit residential aged care environments. We have also learned the importance of working systemically, involving families and staff. However, given the COVID-19 restrictions imposed on face-to-face visits, we decided to add to our clinic a national telehealth counseling and support service.  

On May 15 2020, we launched Australia’s National Telehealth Counseling and Support Service for Residential Aged Care Communities. This service is free for adults living in long term aged care facilities, their families and aged care staff. It aims to help them cope with the impact of COVID-19 on mental health issues.

All services are provided through telephone or video conferencing. Our clinicians are provisionally registered psychologists enrolled in postgraduate studies, social work students and counseling postgraduates. These trainees are under the guidance of clinical supervisors. We accept self-referrals or referrals by family, health care practitioners or aged care staff. Our clinicians conduct intake interviews and provide ongoing counseling and support to the aged care community – residents, their families and aged care staff.  

This service has two aims. First, we aim to assist the aged care community. Second, we aim to train mental health trainees to work effectively within the long-term aged care sector. In Australia, most students in health care courses, such as psychology and social work, do not get specialized training in late life mental health. The telehealth service offers placement opportunities for postgraduate students, thus educating the next generation of clinicians.

We are in the early days of this national program. Our experience so far is as follows:

First, contrary to stereotypes, telehealth is a feasible means of delivering counseling and psychological treatments to aged care residents. The success of telehealth depends on the willingness and availability of aged care staff to support the program, assist with setting up technology and arranging appointments. Telehealth appointments have worked best when there have been clear arrangements between our counselors and aged care staff in setting up the program.

Second, the phone is the most common medium of communication, although some residents prefer video calls (or as one client called it “phone with pictures”). Some residents consider it important to see their counselor. Video technology is still new for most Australian facilities, although many have begun purchasing electronic devices (such as iPads) to facilitate video conferencing between residents and their families and health care professionals.

Third, we have tended to adopt technology and video platforms that are most feasible and accessible to the resident. We have used Zoom, Skype, Microsoft Teams, FaceTime and purpose-built video conferencing platforms, amongst others. We have tried to use video platforms that ensure the greatest levels of privacy when possible.

Finally, we have learned that telehealth has offered unique opportunities for cognitive restructuring. One client began her first Skype call on an iPad exclaiming that she would “never be able to learn how to use that technology.” By the end of the call, she proudly declared that she had “got it,” feeling that she had now “mastered” this strange device. In one call, she moved from feeling defeated to feeling accomplished.

We are excited about the initial findings about the feasibility and value of telehealth services for long-term residential aged care communities.