Confidence rising among rehab clinicians – but tech concerns remain

A study has laid bare the pressures facing paediatric neuro-rehab professionals at the height of the pandemic, and how they were able to quickly adapt to new working practices.

It also highlights the need for greater support for families affected by neurological conditions in accessing technology; and for more research into the efficacy of remote interventions.

The Paediatric Neuro-rehabilitation Special Interest Group (PNR-SIG) charted the experiences of professionals from the start of the first lockdown and throughout subsequent months. Respondents were largely clinical or educational psychologists involved in paediatric neuro-rehab.

The research shows that confidence and competence in the delivery of remote care grew among practitioners as the crisis continued.

While families also became more competent, however, concerns remain that some still need more support in accessing technology.

Participants also underlined the necessity to continually monitor the impact of remote working on service delivery – including in terms of cost-effectiveness, commissioning services and services access.

The findings also show an enthusiasm for new possibilities within community rehab on the back of the COVID-fuelled remote revolution.

Eighty per cent of respondents felt confident in their ability to deliver interventions and rehabilitation remotely.

Respondents reported that 78 per cent of their clients/patients had responded well to working remotely.

The majority (89 per cent) of respondents had access to necessary technology, however for families, access to technology was less, with only 17 per cent ‘definitely’ having access and 50 per cent ‘probably’ having access.

Most respondents indicated that they would continue to offer remote interventions post-pandemic (42 per cent definitely; 42 per cent probably).

Overall 36 PNR-SIG members from a range of care settings responded to the survey. They included 31 clinical psychologists, four educational psychologists and a researcher/academic.

Prior to the pandemic, almost all respondents reported that assessments and interventions were only offered face-to-face.

Some respondents used remote methods (usually phone) for delivering psychoeducation with schools (47 per cent), families (39 per cent) and for wider team liaison (36-53 per cent, depending on type of liaison).

Psychologists reported a shift from working mainly face-to-face and via a phone call, to a range of remote methods during lockdown.

These included phone (69 per cent), video link (80 per cent) and online (22 per cent).

Some face-to-face working continued (22 per cent). These methods were maintained after lockdown and into the autumn 2020 period, with a ‘blended’ approach of face-to-face and remote delivery.

The ability to offer comprehensive neuropsychological assessment during lockdown reduced for most respondents with a minority reporting delivery of face-to-face neuropsychological assessments (25 per cent).

Approximately half of respondents offered assessment remotely (53 per cent).

After the first lockdown, face-to-face assessments reverted to almost pre-COVID levels (29 respondents post-lockdown compared to 35 pre-lockdown) and many described trying to clear the backlog of assessments.

Recalling the impact of the first lockdown, co-author of the study, Dr Emily Bennett, a consultant clinical psychologist at Nottingham Children’s Hospital, tells NR Times: “It was a very difficult time for everybody.

“There was a real genuine anxiety about how we were going to deliver assessments and how we’re going to continue doing the work that we were doing as we just didn’t have the technology.

“Adapting to the lockdown had its really challenging weeks. But actually, the way it panned out is we now have more access to different ways of working than we have ever had.

“COVID in some ways has given us opportunities that we may not have had before.”

In the report, clinicians voice concerns about the exclusion of vulnerable families with fewer resources and children who found remote interventions too difficult due to their level of functioning.

Dr Bennett says: “We know from the news, this is a huge problem nationally. Technology poverty isn’t something that’s just unique to the situation we’re dealing with. Schools are facing this all the time.

“There are different ways of working around it but it’s definitely a question mark as to how we make that access more equitable, because it doesn’t feel very equitable at the moment.”

Fellow author of the report, Dr Sophie Gosling, clinical lead and consultant clinical psychologist at Recolo UK Ltd, agrees that technology access is a pressing matter in neuro-rehab.

“I know there’s stuff that has been done through schools to get laptops into homes,” she says. “But, there are also things like having a decent internet connection.

“I would say this is something that has to happen at a much higher level if there’s going to be equity of access for everybody.

“Certainly, in my experience, some of my colleagues have found that there are children who didn’t have laptops before who now do, because they’ve been provided with them from school.”

The PNR-SIG was launched in 2018 in response to a lack of opportunities for clinicians to get together and share ideas.

“Paediatric neuropsychology is a relatively new area of work for many psychologists. It’s not something that’s been funded very much in the UK until recently,” Dr Bennett says.

“We’ve seen a big rise in the numbers of people who are actually getting the chance to do this sort of work, so we felt like it would be really important to have a place where people could collaborate to make sense of the world we’re all working in.”

The group now has over 100 members and is looking to conduct further research into the impact of COVID-driven restrictions and issues related to the impending easing of such measures.

Other authors of the report were Dr Suzanna Watson, consultant clinical psychologist, Cambridge and Peterborough NHS Foundation Trust and Cambridge University Hospitals; and Dr Catherine Harter, clinical paediatric neuropsychologist, The Cambridge Centre for Paediatric Neuropsychological Rehabilitation.