Video Assessments Pros/Cons: Reflection by Alex Wood

Introduction

In March 2020 the COVID-19 pandemic hit the UK and the government announced the first of several lockdowns. This lockdown saw the closure of non-essential shops and services with the aim of reducing contact between households and ultimately the spread of Covid-19.

At the time of the first lockdown, I was working as a brain injury rehab Occupational Therapist (OT) as well as an Expert OT. Neither of these roles required me to have essential/urgent face-to-face contact with my client’s and therefore, a review of how these services could be delivered was initiated.

Client contact was made via telephone or using video call in the first instance, with further data collection and assessment needs being identified following a risk assessment and discussion with the client. Various means of assessment were adopted, for example; completing outdoor assessment/ treatment sessions or gaining further video footage of the client completing functional tasks, which were then sent via WhatsApp or email.

For the purposes of this reflection, I have chosen to focus on the use of video footage in addition to, or instead of, face-to-face observation of function for assessment purposes.

Previous Experience

Prior to the pandemic, in my experience, most observations of function were completed on a face-to-face basis. These observations took place in a variety of settings. In the acute sector this was mostly in the hospital setting or if appropriate in the client’s own home, although this was becoming less due to the need to increase efficiency and those with more complex needs being referred for rehabilitation, rather than planning for discharge from an acute setting. When working with those already in their own home, the assessment was always within the client’s home environment or local community.

It has been widely accepted that individual’s environment can be appropriately adapted, often requiring the analytic skills of the therapist to make judgements following their observations. Little has been discussed however, in terms of alternative assessment methods such as video calls. I have had some brief conversations with other occupational therapists, regarding the various methods of assessments that have been available to us throughout the pandemic and the thoughts around these.

Pros vs Cons

I have explored the positive and negative aspects of the use of video for functional assessments below:

Pros regarding the use of video for functional assessments

1. The reduced need to travel to complete an assessment was one of the main positive’s; increasing the efficiency of a service and reducing the cost to a client should this service be provided privately.

2. The therapist’s ability to review videos more than once can assist with the assessment process and reduce the likelihood of the OT missing subtle but important information. I have found the ability to review videos useful within all of my OT roles.

3. For those with fatigue or poor exercise tolerance enabling a staggered assessment process can be useful.

Cons regarding the use of video for functional assessments

1. Video did not always provide the therapist with the information they required which resulted in a visit being completed anyway. Should this be the case, a multi stage assessment process was initiated which could be argued to be less efficient.

2. As previously mentioned those with fatigue or poor exercise tolerance enabling a staggered assessment process can be useful. Although from a therapist’s perspective it is also useful to understand how quickly a client becomes fatigued and what effect this has on their function which may only become apparent should more than one aspect of function be assessed in one go, as per usual face-to-face assessments. Again, this is something to be aware of and managed by the OT as required.

3. There is also the need to consider how video evidence is documented and stored. This has implications for IT, GDPR and confidentiality. Videos take up a large amount of hard drive space and for example as part of my local authority role photographs but not videos are stored on the central system.

Further considerations 

 With regard to increasing efficiency I think that there are some instances where video assessment can assist but is very dependent upon the needs of the individual which are not always evident prior to assessment. It is also important to acknowledge that efficiency is important in health and social care. However, being able to build a rapport with the client in order to gain a deeper understanding is also important and in some roles essential.

Face to face assessments help therapists to understand a client’s level of function within their home environment and how they manage this on a daily basis. This, I consider both a positive and a negative. For example, a client may be more natural, with a video capturing a client’s usual patterns rather than what they think the OT wants to see. On the other hand, they have more time to plan, even practice what is videoed and ultimately sent to the OT for assessment purposes. This needs to be considered during the assessment process and a judgement made as to whether a face to face visit is required consequent to this.

To Conclude

I view that video assessments will always have a place and will be used in conjunction with other assessment methods into the future. It will reduce the need for face-to-face visits in some cases but not replace it completely and these cases will become more evident as experience is gained.

Alex Wood.