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 2 – all 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.
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.
