Telehealth in the spotlight

by Lisa Clausen

New research has charted the early impacts on Gambler’s Help counsellors of the forced move to phone and video-conferencing sessions, known as telehealth, as COVID-19 hit.

The COVID-19: Telehealth in Practice survey, conducted by Foundation senior adviser Dr Gabriele (Gabi) Byrne, surveyed 49 financial and therapeutic counsellors from 11 Gambler’s Help agencies across Victoria.

The findings highlight significant benefits of telehealth for counselling, but also pinpoint issues to be addressed to improve the experience of both counsellors and clients.

The survey found:

• only 40 per cent of counsellors felt ‘moderately or extremely confident’ using telehealth in February/March 2020, but this doubled by April 2020
• more than 90 per cent of counsellors thought the greatest benefit of telehealth counselling was the reduced travel time
• other benefits included clients being able to access counselling more often or from remote locations, fewer cancellations and missed appointments, and more flexible working hours for counsellors.

Anastasia Sagris-Desmond, a therapeutic counsellor at Connect Health & Community, says the majority of her 20 clients quickly embraced telehealth.

Research shows how crucial social connection is for people who experience problem gambling to avoid relapse. Anastasia says the ability to keep sessions going during the COVID-19 restrictions was critical, especially for those living alone.

‘Before COVID we used to dance around the edges of telehealth.’ - Anastasia Sagris-Desmond, Connect Health & Community

‘Clients were extremely grateful to be able to continue with the support, especially during lockdown, when they couldn’t get to us,’ she says.

Using video platforms such as Zoom to speak to her clients in their own homes, where one showed Anastasia her family photos and another her knitting, also strengthened therapeutic relationships.

‘Before COVID we used to dance around the edges of telehealth then, bang, we had to do it,’ says Anastasia. ‘I would now love to see it rolled into the suite of services that we offer clients from the get-go.’

The survey results are instructive on the current limitations of telehealth, which will need to be addressed if that’s to happen.

The most significant relates to technology, with 65 per cent of counsellors surveyed hampered by technical difficulties such as connectivity issues during counselling sessions.

Some counsellors were also concerned about engagement levels among clients who lacked privacy during sessions or were swamped by the demands of home life.

One counsellor, says Gabi, described attempting a mindfulness session with a client who was holding her baby while her toddler ran in circles around her. Another client did the dishes during a session, while others were interrupted by family members.

‘Building a rapport with someone who is just a voice on the phone is very difficult.’ - Annette Devereaux, Bethany Community Support

Building rapport with new clients and supporting distressed clients remotely also created challenges. For example, a third of counsellors said they had to employ different therapeutic strategies in the absence of visual cues and body language.

‘I do prefer initial consultations to have face-to-face engagement,’ said one respondent, ‘as body language speaks volumes and is definitely a missed element in an electronic world.’

Team leader and financial counsellor Annette Devereaux from Bethany Community Support is proud of her team’s rapid adaptation to a new way of supporting vulnerable clients, noting that some clients struggled to scan, text or email essential financial documents to their financial counsellor. Presenting them in person is easier.

‘Building a rapport with someone who is just a voice on the phone is very difficult – for both the counsellor and the client,’ Annette says.

With all staff working from home, the ability to debrief in the office with colleagues, particularly after a complex session, was also mourned by some counsellors.

‘Being able to turn your chair around and have a chat with someone about a conversation you’ve just had with a client is really valuable. We certainly missed that.’

Despite the obstacles, this early snapshot of telehealth uptake tells mostly positive news, with half of the counsellors surveyed last April keen to use telehealth post-COVID.

Tellingly, another third of counsellors also supported its continued use – but on the condition they receive specialised training and/or technical upgrades.

‘Telehealth really opens up a world of opportunity.’ - Dr Gabriele Byrne, Foundation senior adviser

Gabi says the goal now should be to build on gains of the past year and a Community of Practice has been established to share experiences and best practice. She says a shared commitment to both specialised training and the promotion of telehealth is critical if it is to be a viable option.

‘Telehealth really opens up a world of opportunity. The more we improve and address the issues that are negative, the more we can embrace the technology. But we need to ride the momentum and we need to be proactive,’ Gabi says.