Systems Change

Creativity key to adapting

This is part of a series where we explore systems change in action – what drives it, how it happens and its outcomes. At the centre of the series is the question – what can we do to create lasting social change?

The Kids Plus Foundation operates out of Geelong in Victoria, providing a range of health services to infants, children and young adults with cerebral palsy and similar neurodevelopment conditions. The Foundation offers physiotherapy, occupational therapy, speech pathology, music therapy and social work programs and supports, with the focus of working in partnership with families. When the COVID-19 pandemic struck, Kids Plus had to change how it delivered its services. The challenges were significant – not just from a service delivery perspective but also the practical burden on families. But in the aftermath, some of those innovations have been built into the Foundation’s operations.

In this Q and A, Kelsey Jamieson, Executive General Manager of Therapy Services at Kids Plus Foundation and Kristy Waugh, Social Worker and Senior Support Coordinator at the Foundation, reflect on what changed during the pandemic.

 

Photo credit: The Kids Plus Foundation

Kelsey: In the pre-Covid world we’d provide face-to-face therapy and hands-on support for children and their families. For us that might mean sometimes they’re accessing services at our centre but it also might mean we’re visiting them at their home, kinder[garten], community settings, schools, different settings like that. Certainly, we provide a very hands-on intervention. It’s a very personal, face-to-face interaction that we provide that really got flipped on its head when Covid impacted, and we had to work from home and then move to more of a telehealth service.

Kristy: Pre-Covid I could tap in to when a child and family were accessing the centre for a service. If they were coming in to see physio, I could pop in and see mum, I could get forms signed, I could do a general well-being check in with the family…A lot of my work is with home visits and in the community and when Covid came along that put a halt to all of those opportunities and I was in my office at home attempting to do similar sort of work but without any of those face to face interactions.
 

So, what happened when COVID-19 arrived?

Kelsey:  We’re fortunate to be part of a very supportive organization. Ideas started from the top down – we have a very decisive leader, [Kids Plus Foundation CEO] Shaun Cannon, and we moved quite quickly around our decision-making to adapt to a telehealth model – and looking at what were going to be the barriers or facilitators for this? What did we need as a team to enable this to occur? First and foremost, we needed resources to do that – did we have the IT set up, did we have what we needed to work from our home offices, but not only did we have the resources, but did the families have them as well? That was a big eye-opener for us – that a lot of our families did not have access to devices or even internet to be able to access telehealth services. So that was something Kristy and her team really actioned quite quickly to ensure the families had access those resources.

Kristy: Each child who accesses Kids Plus has a key worker, somebody who is the main contact for that child’s therapy team, so we reached out to the key worker and said is there anybody you are supporting who would probably have challenges with accessing telehealth given this is the only opportunity we can be engaging them in a really meaningful way. And the list came back with over 20 families who definitely needed a device and some of them needed a device and an (internet) dongle to be able to connect. And we were in the same queue as everybody else who was scrambling for all those computers and IT systems, so we needed one of our main support people to contact JB HiFi etc. and the other providers to try to get their hands on whatever was left. In later times, NDIS came along to provide funding, through the child’s NDIS plan to be able to access those laptops and such but we were months ahead of that directive, so that was really awesome for our families.
 

How did you devise the content for the telehealth programs?

Kelsey: In a clinical setting, we are hands-on. We use our hands to support their bodies, to assist their bodies to move and participate in tasks. And all of a sudden that ability is taken away from us and we’re suddenly having to facilitate the same activities or tasks via a screen. Essentially it involved us moving to a more consultative or coaching role with the parents. It really required the families doing a lot from their end to really step into that space…we were really coaching them in what they could do to help their child be successful as part of these activities and goals we’re working on. But when you think about it, these families are also juggling their working from home, homeschooling needs and we have our whole therapy team doing the same thing – it’s not just one role anymore, suddenly we’ve got all three or four different hats on. The team embraced that and what really assisted it was their creativity – they had to really think differently – how can we engage online? How can we use songs, how do we use other visuals, how do we use toys on our screen to engage a child on their screen? We often commented that we felt more like Play School presenters some days, jumping around, using our puppets and toys and things like that. It really made us think differently and outside the box and I think as part of that, we’ve developed a richer set of tools to engage our children and families with.
 

What about the level the engagement with the kids?

Kelsey: It was really individual. For some kids it was more working through their parents primarily, providing their parents support and guidance. Whereas for other kids it was us directly engaging with them, so it really depended on the individual child’s abilities and what they were able to do. I have some kids who have quite complex physical needs and need to be supported to sit up and [some] have severe vision impairment – for them, they’re not going to get a lot out of looking at me on the screen, so it’s then about supporting that parent to be the lead player and lead supporter in those moments.

Photo of Kristy Waugh
 

The working day definitely felt harder – I think we’ve learnt that we are people people – we love being with people, we love that social engagement and having it on the screen was not the same: it was harder to connect with children and families over the screen compared to in person. Our appointment sessions started out at the same length – we would generally see families for an hour. On telehealth we would sometimes reduce that back to 30 or 45 minutes, just from a fatigue perspective for all involved.

Kristy: I didn’t necessarily see a lot of my participants on telehealth but the quality of the phone calls…it seemed to mean so much more to be able to engage a mum and dad in a phone call, whereas before it was quick 5 or 10 minutes check in, these phone calls could go on for 60 minutes, because it was possibly all we both had to hold on to, to unpack what was happening for them and their family and where they needed the extra supports.

As much as telehealth was awesome for some of our families – it cut out travel time, empowered parents to do more on their end in terms of that hands-on stuff but for other families, it didn’t work. There were some families for whom it was an extra task they couldn’t manage: their child wasn’t necessarily participating in the way they wanted them to…they just had to call it. There were even some lovely opportunities for families to finally find their voices and say, actually I’ve got to let you know this isn’t working for us and we just have to put therapy on hold, or we need to reduce the sessions, or we need it to look differently because this is not benefitting our family.

Some of the families I supported were already struggling and then to layer this extra level of complexity and challenges… it was really tricky stuff. Increased use of alcohol and drugs, increased family violence, increased mental health concerns, less access to resources they needed in a timely way – nappies and wipes, and PPE – they couldn’t get access to things: they didn’t have the supports in place to able to put their children in school initially and they had care responsibilities 24 hours a day of their children at home. It was a very challenging time.
 

What were the consequences for you when you considered those circumstances?

Kelsey: It really encouraged us to think holistically about the child and their family: it was more than their therapy goals were at this point in time. It was about them as a family and their well-being and whatever supports we could offer or whatever we could do from our end to help them get through this period of time, when we were all in time, no one knew how long it was going to last for, when we were going to return to face-to-face sessions again and when kids would be back at school and I think it really encouraged us to look at the bigger holistic picture which we’re really passionate about as an organisation.
 

How did parents respond to the coaching role? Did some parents become even more engaged?

Kelsey: Absolutely. Our role is about empowering parents – they’re with their children 24/7. If we can support them to have the skills to work with them to help them achieve their goals, ultimately that’s going to have a better outcome for everybody. So, it’s about us having hands-on to get hands-off and eventually step back – they’re the drivers, they’re the ones doing these things. Certainly, for some families it was an easier step in to take that role over whereas for others, they’re juggling an awful lot and the reality was that it was pretty challenging in some instances.
 

Photo of Kelsey Jamieson
Photo credit: The Kids Plus Foundation

What was the impact of the different way of working?

Kelsey: Just being able to be there with our families in whatever shape we could had I think created stronger connections and bonds with all of us and stronger bonds within the team. I feel that we’re still able to offer really positive supports…the families saw us as people too. My clients have seen my kids run in and out of the camera shot, in their ‘jarmies or whatever else they’re doing…they saw our lives as well. I think we connected as people, first and foremost.

Kristy: I think there was so much loss in the pandemic – [with] some of our families their child lost connection with school for a period of time, they may have lost access to their community support if they were participating in something, they’ve lost access potentially to their disability support workers when they were coming in assisting parents with those care-giving tasks, but we were there, we maintained, we responded in a way to see them on a weekly or fortnightly or as needed. If they wanted to give us a call Monday to Friday because I was available, I was keen to engage with them, so I don’t think we were lumped in that same space as that loss.
 

How has it changed the job you do?

Kelsey: It’s encouraged us to think differently about ways of delivering services and we’re back in the centre now, happily seeing clients face to face and out in their homes and in the community. We have now developed a telehealth branch of our service and this is something that we will continue to grow and develop over time. Right now, it means that if families can’t come in or we can’t see them face to face for whatever reason, we can just switch that session to an online video chat and still provide that support. And we can also start to support families who live further away from where we are. So regional families or families who can’t access their services close to where they live. So, I think it’s really encouraged us to develop the skills to deliver effective services online but also, to continue to explore what that could look like big picture wise.

Kristy: I’m very happy to be back seeing people face to face – there’s something about a quality connection in that. And the practical stuff – Mum being able to sign a document and not being held up by the delay of the signature because she doesn’t have the technology to do it quickly or easily online. It’s nice to be doing those things in the community even if we’re still wearing a mask and that looks a little bit different.
 

Some kids prospered? Some stayed the same? Did outcomes differ much?

Kelsey: Some kids that excelled and they did really well under that model of service provision whereas sadly some did change and perhaps not [to] be as developed as we’d hoped in terms of losing some of their skills or losing some of their range of movement. Particularly for a lot of our kids, they lost strength – it wasn’t just therapy they were missing. They weren’t able to go swimming, they weren’t able to do any of their general activities or participation in so many activities that impact their strength and their well-being overall.   But in our first week back, seeing people again, everyone was lit up – it was just such a powerful moment to be able to connect together, to see their faces and be in their spaces. And that’s where we still want to be.    
 

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