Digital occupational therapy

In order to ensure the profession is fit for the 21st Century, all occupational therapists should have the digital literacy skills required to capitalise on the benefits digital brings to their workplaces and areas of practice.

The COVID-19 pandemic has placed pressure on health and care services to rapidly implement remote working practices with an increased reliance on digital tools.

The term “remote working” can encompass approaches/modalities such as telehealth, telemedicine, virtual therapy and NHS England’s ‘Digital First’, among others. Remote working can be defined as the use of information and communication technologies (ICT) to deliver health and care related services when the provider and client are in different physical locations. As restrictions lift, health and care professionals will be reviewing and embedding new ways of working and this is likely to include a blend of face to face and remote working practices.

A universal, targeted and specialist approach to digital technologies

There are a range of everyday digital tools within our workplaces and the homes of people who access our services that can be easily used to enhance our practice.

Universal tools

Around 95% of the UK population have a mobile phone.
National rollout of communication tools like Microsoft Teams and Attend Anywhere enable safe and secure remote working.
A service webpage that provides essential information on occupational therapy and how to access a service is useful for both people and other professionals.
Social media tools like Twitter and LinkedIn can widen our professional network and support professional learning.

Targeted tools

There may be specific groups of people who would benefit from targeted digital tools e.g. a platform that supports therapeutic groups or an app that captures activity levels. These types of tools may be used to overcome difficulties such as accessing a physical location, e.g. if they are a full time carer or do not drive, whereas other targeted digital tools may be offered due to the preference of your client group and are a method of offering choice. When deciding whether a targeted tool is appropriate, consider the needs of those who access the service.

An example of this is facilitating virtual communities. This Alzheimer’s Scotland resource creates a space for people with dementia and their family members as well as supporters to come together and explore ways of living well with dementia.

Specialist tools

Some digital tools could be classified as specialist if they are needed by people with the most complex needs or circumstances. A good example of this is selecting an appropriate video-call tool for people with cognitive impairment or neurodevelopmental conditions.

Service example

A specialist technology enabled care service in Edinburgh has been trialling video-call systems that enable staff to securely make contact with people who have a cognitive impairment. The team have been looking at tools that don’t rely on a person having to go into an email address, download an app or web-browser, access a link to consultation or wait in a lobby.

Where to start with digital

These questions are a good starting point when exploring how digital can enhance practice:

Are there guidelines on delivering remote services?

Start with collecting information that helps you to explain the problem your service is facing and what you might need from a digital tool.

Locate your organisations digital, data and technology strategy and local policies and procedures. Some organisations have AHP digital leaders and digital working groups which you can tap into for local support.

Look at national guidance specific to your context of practice as well as national AHP guidance. The resource section is a helpful place to start.

Connect with your local RCOT regional group and/or Specialist section to access peer support. You may also find online AHP forums such as the FutureNHS Collaboration Platform a useful place to connect with others and share resources.

How can the public access information about your service and occupational therapy?

A webpage can be used to promote the benefits of occupational therapy and how to access it. Information like top tips and links to useful sites can support self-management, enabling people to take control of their own health and care.

Service Example

A Children’s Occupational Therapy Service in Cambridgeshire has produced this video to demonstrate how they worked with families and their organisations communication team to develop their webpages.

The Impact

Hits in the first 3 months were higher than the entire three years previously.

The website has become a useful resource as part of the teams triage with children and families being able to get going with activities before their first appointment with an occupational therapist. Referrers such as school SENCos are also signposted to the website to help them to support the child whilst waiting for further input from the service.

I’m concerned that some people cannot access our service if we rely on digital tools

A personalised offer is one that acknowledges that no one person is the same and digital ways of working should be offered as a choice. It’s important that you understand your local population by considering what you know about the digital readiness of the people who access your service? You need to test your assumptions by asking people how they use digital technologies in their everyday life as well as gathering feedback on their experiences of accessing your service.

Use of digital in practice

The following sections detail some examples of digital technologies that support the occupational therapy process in a variety of settings.

Digital referral and triage

Digital technologies provide opportunities to deliver triage in new ways. In addition to supporting decision making and signposting, digital triage tools can support assessment and provide information as well as collecting outcomes that support service improvement.

The article published in Mays OTN "Five Steps to a big impact" describes the process and different tools that were used to manage referrals to an adult social care team. The Reigate and Banstead team share their five step process and tips on conducting virtual assessments.

Additional resources

Digital assessment

Occupational therapy assessments vary across contexts and specialisms and therefore the range of digital tools that could enhance practice is broad.

Resources

Sefton_Moving_with_Dignity_Videoconference_assessment_service_exampleSefton_Moving_with_Dignity_Videoconference_assessment_service_example.pdf (PDF, 83.59KB)

Sefton Local Authority "Moving with Dignity" team describe the processes they have put in place to embed videoconferencing assessments within their service.

Examples from RCOT’s Small Change, Big Impact Campaign:

Digital interventions

Occupational therapists may recommend specific apps or use digital technologies to deliver interventions, such as virtual therapeutic groups. They may also work with a person to use everyday technologies that support participation in daily life e.g. Amazon Alexa.

Resources

Service Example

The Acute Day Service within Sussex Partnership NHS foundation Trust share their experiences of moving their 4-week mental health group treatment programme online.

Delivering remote groups (PDF, 81.23KB)

News article

A technology enabled care team shares current projects and the positive impact of digital tools on people receiving services.

OTnews - Doing things differently (PDF, 1.88MB)

Evidence Spotlight: Assistive and everyday technologies

Remote outpatient appointments

There are a range of benefits to offering non face-to-face appointments, such as improving access to occupational therapy as well as reducing travel time and the impact on the environment.

Resources

University College London (UCL) has produced a useful resource for starting out with non-face-to-face clinics. UCL How-to guide: non face-to-face clinics

The NHS Education for Scotland (NES) has a toolkit of resources for implementing AttendAnywhere.

Video consultations: a guide for practice by Prof Trisha Greenhalgh

Digital discharge

There is a range of videoconferencing tools available; you should check which is recommended by your organisation’s information services.

Digital outcomes

It is important for all occupational therapists to collect data on the effectiveness of occupational therapy interventions and their services. Digital tools can support timely data collection often with added benefits e.g. information is collected outside of face-to-face time and at an appropriate interval that identifies whether change has occurred over time.

Resources

Research Project

Natalie Jones and Jennifer Read discuss their digital home visit research project led by occupational therapists.

In 2020, they published both an OTN article "Occupational Therapy in the Digital Age" and a BJOT research article “ Remote Home Visit: Exploring the feasibility, acceptability and potential benefits of using digital technology to undertake occupational therapy home assessments) that describes their ongoing research and development journey to implement home visits using video conferencing technology.

News Article

Angela Alty, Clinical lead stroke rehabilitation occupational therapist at Lancashire Teaching Hospital NHS Foundation Trust published "The digital solution: environmental assessment for acute hospital discharge" in June 2020s OTN.

042-044_OTnews_June_2020_The_Digital_Solution_to_environmental_assessment.pdf (PDF, 1.69MB)

Digital outcomes

It is important for all occupational therapists to collect meaningful data on the effectiveness of occupational therapy interventions and their services. Digital tools can support timely data collection often with added benefits e.g. information is collected outside of face-to-face time and at an appropriate interval that identifies whether change has occurred over time.

For more information on collecting data see RCOT’s Informatics Webpage.

Clinical safety and digital technologies

Whilst there are huge benefits attached to digital technologies, all occupational therapists are required to assess the safety and risk of implementing these tools in practice.

To better understand the opportunities and risks attached to digital technologies: technologies, see the OTNews article:

OTnews - Two sides to every story - digital opportunities and risk (PDF, 943.28KB)

When looking to introduce new digital technologies, you need to establish what your own organisation's digital strategy is as well as local processes and procedures for implementing technology. In addition to this, RCOTs publication Embracing risk; enabling choice may be a useful resource.

Developing digital skills

Digital literacy, as defined by Health Education England, is 'The capabilities that fit someone for living, learning, working, participating and thriving in a digital society'.

Occupational therapists are responsible for ensuring that they have the required digital literacy skills that are specific to their workplace, and that they keep up to date with the digital technologies specific to their area of practice.

Digital Fellowship Opportunities open to Occupational Therapists

The Topol Programme for Digital Fellowship

The DigitalHealth London Digital Pioneer Fellowship

NHS Digital Academy

NMAHP Digital Health and Care Leadership Programme (Scotland)

Resources

OTnews - Going digital for CPD (PDF, 1.62MB)

Health Education England’s Digital literacy programme

NHS Education for Scotland’s Digital Health and Care NHS Apps Library

Evaluation of digital projects

During the COVID Lockdown period, many occupational therapy services were required to rapidly roll out remote working solutions. Many teams have seen some unexpected benefits and challenges. It is important to capture this valuable learning so that health and care services can be redesigned to capitalise on the benefits of remote working and reconsider areas that require different approaches.

Resources

This GOV UK resource supports rapid evaluation of digital health products during the COVID-19 pandemic.

This NHS Providers resource pulls together some useful examples and targeted questions designed to help board members embed digital innovation at all levels of leadership.

The Digital innovation in adult social care: how we’ve been supporting communities during COVID-19 report (Sept 2020) covers factors which lead to success digital innovation as well as next steps.

Social Care Digital Innovation Programme publishes case studies of grant funded digital innovation projects in social care

Digital Inclusion

Digital inclusivity is not about disability but about universality and making something that can be used by as many people as possible. Whether you are developing a webpage or providing video consultations, occupational therapists need to consider ease of access and support participation in activities that occur in the digital environment.

Resources

NHS Digital’s The Digital Inclusion guide for Health and Social Care (2019)