Managing your video consultation

MANAGING RISK

It’s good to discuss this with your service user, for instance – how they should let you know if they are not feeling safe or need a break eg they could use a hand signal or ask your service user to use the chat function if they cannot speak aloud Check with your service user that they have a safe and comfortable space to undertake their video consultation and check if they will have access to this for any future session/s It’s important to reassure on interruptions and how these will be handled, eg – in the case of the clinician (eg called away for an emergency) – in the case of the service user (eg their partner or family relative walks in during the video consultation) Options could be to halt the call for a few minutes and redial in at an agreed pause of 5 or 10 minutes. There could be additional agreement that if the interruption extends beyond a certain amount of time, then the video consultation will be rescheduled due to lack of time

It may be that you wish to set up a code word to be used by your service user should they find themselves in an intimidating situation during their video consultation.

OTHER POINTS TO NOTE

Nonverbals can be a useful pointer when gauging the wellbeing of a service user, just as in a face to face consultation. Remember that the service user will be following your nonverbal pointers too, so be mindful when on screen with body language, tonality of voice, posture etc.

CLINICIAN TIP

Remember the three C’s; confidence, competence, and consent. Preparation is key so ensure you feel confident in holding a video consultation (eg by holding a simulation session beforehand with colleagues) and you feel competent in managing the technology. Ensure your service user feels at ease and is comfortable with the facilitation of an online session.

Pauses in conversation may be more frequent, depending on connection Using an online format for a meeting; it’s likely that you may talk over each other. This is to be expected The amount of eye contact may be a little different in an online setting Also remember that a lot of non-verbal information may be missing, due to the online nature of the session, eg image blurry, incomplete body on view, or no image at all, sound is delayed etc

DISINHIBITION

Disinhibition is a lack of restraint manifested in disregard of social conventions, impulsivity, and poor risk assessment. When handling disinhibition in a video consultation setting, this could be important in the context of setting the right conditions for the session to take place. This should be a conversation to have before a session, but may well be a conversation during a session, as well. Pointers could include:

Encouraging the service user to be dressed appropriately, (eg ensuring that they are dressed for the session and not in pyjamas or bathrobes), positioned appropriately and within a space where they can talk privately (where possible) without distractions – as if they were attending a session face to face

Having a direct conversation with the client about the boundaries of what is appropriate, i.e. is it ok for the client to: – smoke/vape during a session (for instance in some settings, but certainly not in the case of doing trauma work and dissociating, which could be a fire hazard if the cigarette falls somewhere) – drink during the session eg tea and coffee to calm their nerves but not consuming alcohol

SCREENSHARING

If you wish to share your screen during an Attend Anywhere video consultation, see our useful guide here

CHAT FUNCTION

You’ll know, from attending a Microsoft Teams meeting, that there is a ‘chat’ function on the right-hand side of the screen, which is visible during a meeting. There isn’t a ‘chat’ function in Attend Anywhere, but clinicians can send messages to service users waiting in the waiting rooms. See guide here.

INVITING ANOTHER COLLEAGUE TO JOIN AN ATTEND ANYWHERE VIDEO CONSULTATION

Here’s a useful guide on inviting a participant to your Attend Anywhere video consultation

CHECKING TO SEE PARTICIPANTS IN AN ATTEND ANYWHERE CONSULTATION

Before joining a call, please ensure you are entering the correct consultation, as there may be other on-going consultations or callers with the same name as your client in the shared waiting room. You can check who is currently in a consultation by clicking on the ‘Participants’ tab, as seen below.

John

John...

John Smith (Provider)...

TECH TROUBLESHOOTING

Here’s a useful guide for handling Attend Anywhere technical issues here If you still experience problems using Attend Anywhere, then please email the team at clinical.applications@Candi.nhs.uk

Options in case of technical difficulties

Give it 5 mins and redial into the call

Aim to telephone the service user if you experience persistent issues Suggest the service user emails you if they have any issues

SERVICE USER TRAUMA OR DISTRESS

If your service user becomes distressed, angry or confrontational during the video consultation, you will need to use the skills and training you’ve developed for handling those situations in a face to face ‘live’ consultation. Remember in a video format:

Your tone of voice can help de-escalate a distressed and angry service user. This is referred to as the ‘emotional contagion effect’, where your emotional state can affect how another person feels. If you approach a distressed and angry service user, raise your voice and use a forceful tone, you run the risk of escalating the service user distress and anger Remember to try and reassure by using their name in your responses Once you notice significant changes in your service user’s behaviour, it’s best to prepare by detaching yourself from the situation. Keeping cool will let you answer their questions as best as you can and can help avoid further comments or anger Practice active listening; sometimes, service users get angry because they feel like they’re not being heard or understood. The best way to combat this is through active listening, so for example, listening to what they have to say, and repeating it back to them to demonstrate that you do, indeed, hear and understand them Acknowledge rising frustration with verbal and non-verbal cues. On a video call, this will include the use of providing positive statements and encouragement Get support; dealing with difficult service users sometimes requires backup, and there may be instances where you need to ask a colleague to join you on the call Encourage the service user to ground themselves, e.g. Ask them to feel their feet on floor, where they are sitting. Ask them to describe their environment (e.g. the room they are in) Ask service users to name: 5 things you can see - 4 things you can touch - 3 things you can hear - 2 things you can smell - 1 thing you can taste

Breath with them by stating for example, ‘Let’s take some slow deep breaths together’ If service user sounds confused and disoriented remind the person that they are speaking to you, that they are safe and that nothing bad is happening. Remind them of the date e.g. ‘It’s Thursday the XX November 2020’ For more grounding strategies, see here

If the service user becomes angry

Remain calm and non-defensive – avoid confrontation

Let the client ventilate feelings (e.g. around technical difficulties or otherwise) and acknowledge their feelings: ‘I understand that you are feeling really frustrated’ Encourage problem solving and offer reassurance If service user becomes aggressive/abusive towards staff, explain that meeting can’t continue without cooperation If impossible to continue, end call and postpone in non-judgemental way

If you become concerned for the service user’s safety

Ask about client’s safety – is someone at home with you?

Encourage them to reach out for support at end of call. Ask: – Who/what makes you feel better when you’re upset? – What could you do after the session to calm down (e.g. engaging in a soothing ritual, go for a short walk, listen to a piece of music, watch a distracting video)?

Make sure service users are in possession of crisis numbers

Make a plan to call back and/or review crisis plan

Discuss any issues with your line manager/clinical supervisor

See section on managing risk page 8