Friday, 27 April 2012

Tick Box Telecare - its coming to you...

Tick boxes are a standard method used when undertaking large surveys.  In research, the tick box serves as a method of gaining quick opinion on a certain subject.  This opinion is then translated into some form of quantitative statistics and presented in a report.  Tick boxes are not the most reliable form of data but they are a quick form of gathering statistical data.
 
The tick box approach is really useful in other circumstances.  When undertaking a new task, a tick box or checklist is a useful memory aid to ensure you have completed everything you need to do.  Just as we use shopping lists to help us shop the checklist is a useful prompt.  The tick box also can be used as a form of evidence, demonstrating someone has completed all the stages of something, although it does not show the quality of how they completed it.

In a telecare assessment, the tick box can be really useful as a guide to the things you need to discuss and consider in the assessment.  It can serve as a memory jog or prompt as well as a tool to ensure you have covered all bases. 

The tick box is of course not without its limitations and problems. 

One clear issue is that the tick box will focus the assessor’s attention on the elements mentioned on the list and therefore the assessor could fail to think outside of these elements.

An OT colleague mentioned one of the benefits of the tick box assessment enables detailed information in a short format but it should always have the space to provide additional information to give a full picture. This is the qualitative material, such as the client has stairs but no stair rail or bannister.  These important factors could have significant bearing in an  assessment for telecare.

This is an interesting point.  A standard tick box approach often leaves little or no space for the extra information.  The rationale for this is that this information cannot be coded so it is best omitted. 

point 1 - This is the real core information that should be recorded, so any tick box approach to telecare must have boxes for providing extra information.

The recording of information is often based on ease of processing rather than ease of collection.  So although a tick box might have additional space for comments, there is no guarantee that these comments will be used at a later stage.

point 2all comments boxes should be given equal weight in the processing of the information. 

Thus, armed with a tick box telecare assessment which has space for comments, the assessor begins the assessment. Where are they? Are they in the office speaking to someone on the phone or are they are actually at the client’s house? 

I suggest that it is almost impossible to undertake a telecare assessment over the phone. No matter how detailed your questions are, you will never get the level of information required to complete a true full assessment.  You will not, for example,  be able to accurately determine if a person has difficulty walking – I accept that you can ask the person – but many people are unable to rate themselves accurately.  People tend to over or under exaggerate their abilities.   It is difficult for the most experienced OT or social worker to determine accurately whether someone does or does not have mobility issues over the phone.

I accept that the current culture suggests that the responses of the client are often all that is required as proof, so if a person does not have insight they require assistance with mobility then , according to this argument, they do not... until they are found in a heap on the floor, suffering from hypothermia. This attitude is similar to asking a person over the phone whether they attacked their partner – I doubt many social workers would be happy to accept the response over the phone.

point 3 Telecare assessments must be completed face to face, in the property the client resides. 

Face to face interviews must be at the client’s residence so the assessor can see how the person moves around their home and how they get in and out of bed or the bath etc.  Home visits allow the assessor to assess the client’s capacity and possible difficulties around their home.These assessments and observations could also trigger other referrals.

By face to face, I mean in visual contact, not staring at a person! I also mean not staring into a computer screen where the tick box form is being completed.  Eye contact, observation and listening are essential to any good assessment.

That ticks the box

The take away message is relatively simple, Use tick boxes sparingly and appropriately and with due caution. 

What we need to avoid are crass statements such as:

Have you fallen in the last 6 months?
If the answer is yes then consider a fall detector (which is one of the myriad of possibilities and does not get the assessor to consider other options). 

Have you left the bath tap on? .... ...consider a flood sensor

A good assessment would explore (amongst other things):
  • If a person has fallen, why and where have they fallen?  
  • What other factors contributed to the fall?   
  • A lapse in medication perhaps or sudden onset of dizziness etc?  
  • Has the person noticed a reduction in their general mobility? 
The reason why someone has fallen could be for a number of contributory reasons.  A full exploration could justify a number of other referrals to services such as GP, Physio, OT or falls clinic.

Telecare needs to be truly person-centred.

point 4 - Tick box telecare could be useful if used as part of a range of tools to assess a person but not as the assessment per se. 

It is clear that in the cost-saving culture, councils and health authorities will be advocating a tick box approach to telecare in the future, but in the long-term this is false economics.  A thorough assessment might trigger additional referrals to other services and might appear to cost more, but the saving is in the client, a person, actually getting the help they need to be able to respond to and manage their condition.

This post was spurred into life by an article in  Telecare Aware.

Update

Since this article was written gdewsbury, the consultancy I work for has produced a person centred telecare assessment tool called DTA: the Dependability Telecare Assessment tool manual. This is available from www.gdewsbury.com/dta only. It takes the user through the process of using the tool to ensure person centred telecare assessments. 
 
 



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