Occupational Therapy News OTnews May 2020 | Page 49

COVID-19 FEATURE
and have proved invaluable in maintaining a service for vulnerable
members of the community, at this difficult time.’
There are a number of processes and considerations that
SHA has used and has found successful in adapting to ‘virtual
assessment’ methods in line with social distancing rules.
Draw up a process chart
First, draw up a process chart to identify which elements of the usual
process need to change in line with social distancing measures.
It is important to consult with the local authority lead and relevant
team members for each of the process tasks that need amending,
to ensure that the new process results in valid outcomes and is
practical, achievable, and agreeable to all.
Robust screening
The local authority may need to review and develop its screening
tool to ensure that the team can make more decisions with greater
confidence regarding eligibility at the point of initial desk-based
screening.
Telephone calls to applicants can be made at the point of initial
desk-based screening to verify or clarify any information. Some local
authorities may decide that this screening model is the only mode
of assessment that will be used while social distancing measures
are in place and that they can remain confident making eligibility
decisions based on this approach.
Other local authorities may still opt for further in-depth assessment
using a ‘virtual assessment’ approach if they feel that desk-based
screening is not allowing them to make confident decisions.
Guidance notes for virtual assessments
So that the clinicians felt supported to carry out the virtual
assessments in a consistent manner that achieved robust
outcomes, SHA produced guidance notes, which included how to
use investigative questioning and useful hints to help applicants give
the most accurate responses.
SHA assessors have found that specific probing questions
needed to be targeted towards the issue of ‘breathlessness’
and ‘recovery time’, as this is where there were quite a few
inconsistencies in the information the applicant provided.
Choosing a communication platform
There are various user-friendly video calling options that applicants
can access free of charge. Security implications of the various video
calling platforms, such as the level of encryption and privacy must be
considered. From our experience, the most popular and agreeable
forms of video calling for applicants are What’s app and Face Time.
SHA assessors have found that the video calling versus phone
call approach made the assessment process much easier for these
cases in terms of making decisions on eligibility, as observations
could be taken into account as supporting evidence.
Making discretionary decisions
Assessors need to be supported to feel confident to make
discretionary decisions. This is most relevant where the assessment
tool is based on use of a scoring matrix, and where the final totalled
score needs to reach a certain threshold to determine eligibility.
The assessment tools used by SHA involve this method of scoring
to determine eligibility. As expected, with the telephone assessment
approach, SHA assessors have found that applicants score higher
than that if they were completing face-to-face assessments.
For those applicants who do not have access to video calling,
all information obtained is essentially ‘subjective’. Even where
video calling is used, it is not possible to make the same detailed
observations of the applicant’s gait, speed, recovery time and
distances that they can manage walking.
Investigative questioning and cross-checking answers are
used, but where the applicant score is not supported by sufficient
corroborating evidence, the assessor should recommend to the
local authority how to make the best decision regarding eligibility.
There are various options: check for further supporting evidence;
issue the badge for one year instead of the usual three years and
ensure that the applicant is assessed face-to-face in one year
prior to renewal; issue the badge for the usual three-year period
regardless of any gaps in corroborating evidence; or do not issue
the badge (or other travel concession) if the assessor reports
insufficient corroborating evidence, despite the final score reaching
the threshold for eligibility.
The local authority will need to weigh up how heavily they
demand sufficient supporting evidence where this would usually
be attained via a face-to-face observational assessment. This is
because of the costs involved in dealing with multiple appeals.
These costs include not only money, but also the time and effort
from local authority staff to deal with complaints.
Availability of supporting evidence
Where local authorities have IT systems that allow assessors to
access supporting evidence, this can be beneficial. However, this
increases the time required for each appointment slot.
‘We wanted to keep our service going, so that those vulnerable
customers that may need a Blue Badge for their necessary
appointments and supplies were still able to receive them,’ adds Sue
Lack, mobility services manager at the London Borough of Havering.
‘The only option open to everyone really was via telephone and
to adapt our service to work as well as possible given the situation.
‘There will of course be some cases that may need to be seen face
to face at a later date, but they will be in the minority and most
applicants are understanding and happy that we are still providing a
service.’
In summary, the keys to success of implementing a virtual
assessment service are flexibility, collaborative engagement with
all relevant parties – this motivates and encourages change to
adapt while managing levels of anxiety and confidence to work in a
different way – and regular review.
Domenica Russo, occupational therapist and Nick Stone, director,
SHA Disability Consultancy Ltd. Visit: www.shadisability.com
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