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Covid-19 HSE Clinical Guidance and Evidence

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COVID-19 Contingency Planning - Guidance for Alternative Models of Care (Non-Residential)

COVID-19 Contingency Planning - Guidance for Alternative Models of Care (Non-Residential) (CD19-133 / 22.04.20)


  • Note: as with all service provision during Covid-19, all proposed supports below must be provided with strict adherence to National Public Health Guidance (www.hpsc.ie), including
    • maintaining social distancing
    • hand hygiene
    • cough etiquette
    • Personal Protection Equipment (PPE)   
Overall Contingency Planning
  • In the context of the current Covid-19 pandemic, all Community Healthcare Organisations (CHOs) should continue to proactively engage with disability service providers to ensure that appropriate contingency arrangements are made so that the necessary supports are put in place for persons with disabilities and their families. As the circumstances, risks and availability of staff will vary as the situation progresses, all contingency plans must be subject to on-going review and updating.
Developing Alternative Support Models
  • In the absence of regular, scheduled day services, respite supports and multidisciplinary supports, CHOs and their service providers are encouraged to use creative and innovative models of care to support service users, both adults and children. Each CHO should endeavour to
    • Establish a process using a key point of contact approach to assess support needs and co-ordinate responses. The priority will be to identify those service users and/or families that require support in the short or mid term
    • Implement an alternative model of support pathway
    • Develop a plan that takes into account appropriate use of available locations and staff.
Determining Priority Needs

A short questionnaire conducted by staff with service users or carers over the telephone may be helpful in identifying who requires support and the most appropriate approach to provide it.

Factors to consider in prioritizing those requiring support should include:

  • Behaviours that challenge
  • Safeguarding concerns, including those identified by the CHO’s Safeguarding Team, and Trust in Care concerns where known
  • Additional family vulnerabilities e.g.
    • single parents
    • carer with ID who may not be able to follow Public Health Covid-19 guidance
    • One carer hospitalised and the other unable to manage their person with a disability and behaviour that challenges alone
    • Young carers providing care for a single parent
    • Households with 2 parents with disabilities
  • More than one person with additional needs in the household
  • Limited external supports
  • Service users living alone
  • Complex medical needs
  • Carers who are elderly or otherwise vulnerable

Service providers should contact their Safeguarding Team for advice if they are concerned that a home living arrangement is becoming high risk for the potential of abuse and/or neglect.

Key Point of Contact
  • Service users, including those on waiting lists and their families, who are prioritised as needing critical support should be allocated a key point of contact who will initiate and maintain contact (pending service prioritisation demands and staff resources available) during Covid-19, and co-ordinate the required supports for their assigned service users and families. Back up arrangements should be in place in the event that a key point of contact is unavailable.
  • The key point of contact should initially contact their assigned service users/main carer, or their carer in the case of children, to identify and prioritise their current critical needs during Covid-19 (See Appendix 1 Sample St Gabriel’s Telephone Support Record).  This will enable the service to continue to prioritise provision of critical services throughout this public health emergency when staffing resources may also be reduced. Following the contact call, the key point of contact can coordinate the required discipline specific supports in collaboration with the team (where in place) or individual disciplines. The following adapted models of service are already being explored and implemented in many areas around the country:
Sample Support Pathways for Alternative Models of Service during COVID-19
  • Pathways should provide for a stepped approach as shown in the following sample pathway (figure 1 Pathways for Alternative Models of Service during Covid-19). The range of supports available may include:
Online supports
  • Provision of parent support groups, parenting programmes or similar interventions through platforms such as “Zoom” (free up to maximum of 40 minutes) or “Facetime”
  • General advice and suggestions, such as activities, use of social stories
  • Signposting of appropriate online resources, bibliotherapy etc.

See Appendix 2 Enable Ireland’s paper on use of technology to support people with disabilities and their families which will be updated regularly on Enable Ireland’s website. This paper will continue to be updated as new information becomes available. Please check www.enableireland.ie. Note: All agencies using any of the suggested technology need as always to comply fully with their own organisation’s GDPR policy.

Direct one on one contact by phone/video link e.g. What’s App, Facetime, Viber

The key point of contact will coordinate the required discipline specific initial phone calls for one on one support identified in the ‘Contact Call’. These may include:

  • Regular, scheduled telephone sessions with service users and / or families by an agreed “key point of contact” to provide advice, reassurance, training, demonstration or support
  • Provision of 1:1 targeted interventions  to include:
    • General advice and support
    • Home Programmes
    • Contingency planning support and advice in line with Public Health guidance
  • Dedicated nursing support provision across 2-3 self-isolating houses (thereby, reducing risk of infection) where deemed critical to families managing safely during Covid-19
Face to face interventions
  • Where a face to face contact is deemed critical to supporting a service user, and where a service user (and if a child, their carer,) are willing and able to attend a clinic, or for the clinician to provide a home visit, a face to face intervention may be provided. Again, strict adherence to Public Health guidance on Covid-19 must be maintained at all times (see www.hpsc.ie ).
  • It is essential that a preliminary phone questionnaire is completed in advance of this visit (see Appendix 3 St Gabriel’s phone questionnaire in advance of direct contact sample) and again, on meeting the service user or carer, to ensure the optimal safety of staff, service users and their families.
Use of Existing Facilities and Resources
  • CHOs and service providers, working collaboratively, should take cognizance of existing accommodation capacity in the area (e.g. day centres, special schools, clinical or office accommodation etc) and human resource capacity whilst ensuring that any solutions support adherence to  Public Health guidance including social distancing, hand hygiene, cough etiquette and PPEs.
Further considerations for CHOs
  • Use of existing facilities to provide targeted respite interventions for small numbers of service users who cannot be supported in their home on a 24/7 basis. Consideration should be given to equipment needs in this case.
  • Use of existing staff to provide “out of home” support hours for short excursions
  • Use of existing volunteer base with appropriate controls
Ongoing Review of Public Health Guidance/Requirements
  • As the impact of Covid-19 continues to evolve daily, it is essential that staff working with service users and families continue to review updated Public Health guidance to ensure all alternative models of service offered are in full adherence to this guidance. All support plans must be subject to on-going risk assessment and the use of appropriate controls to address such risks.
Sample Pathway for Alternative Models of Care during COVID-19

Fig.1 

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Possible Use of SNA Support within Disability Services – Under Discussion
  • Possible usage of SNA personnel with Disability Service is under active discussion, given the clear benefits in maintaining continuity and relationship with existing children and families, as well as benefits arising from specialist support skill capabilities of many SNAs.
  • To be further scoped subject to ongoing discussions.
Appendix 1: SAMPLE - St Gabriel’s Telephone Support Record Form

app1
app1.2

 

Appendix 2 -Using technology to support people with disabilities, their families and those who support them during the COVID-19 pandemic

Eireland

Some initial suggestions

  • Note: This is the first draft of an ideas document which we encourage you to contribute to: together we can be creative in how we use technology to support people with disabilities who may be feeling isolated and worried, and we can also consider innovative ways of remote working to benefit all.
  • This is already a very worrying time for people with disabilities, being constantly reminded that they are in a high risk group when it comes to Covid-19. With schools and services shut down how can we use technology to facilitate communication, prevent people feeling isolated and maybe provide some kind of distraction?

WhatsApp or Viber Groups

  • This is something most of us use and find very useful. Disability services could set up a group/groups and use them as a way to keep communication open while people are at home.
  • WhatsApp is very accessible as it allows people to contribute to a group chat using recorded Video or Audio or text. It’s a good way to share jokes and funny stories and keep morale up. It supports individual and groups (up to 4) video and audio calls.

Advantages    

  • Accessible (to many)
  • Familiar

Disadvantages

  • Needs a smartphone, computer or tablet. This might be difficult for some people
  • Only supports groups up to 4 in real-time calls or video

Echo Dot or Echo Show

  • For some people, speech is the easiest way for them to access technology. The Amazon Alexa powered devices can be a very intuitive way of getting information, entertainment (music, radio, audiobooks adventure games). They also support a feature called “Drop in”. When setting up a device you can add friends or contacts who also have Echo devices and allow them to “Drop in”. This could provide a good means of keeping contact with people who may not be comfortable enough with technology to use a smartphone or WhatsApp. It works basically like an intercom. The person being dropped in on does not have to do anything other than answer, no buttons to press or commands are needed. It’s like talking to them if they were in the room with you. The Echo Show (only £50 on Amazon at the moment) has a screen and camera also. We are not sure if you can Drop in with video of if you need to use a video calling service. (Maybe someone reading this already knows the answer?)

Advantages

  • Very easy to use natural speech interface.
  • Lots of entertainment options
  • Can open communication channels in a natural way with user input

Disadvantages

  • GDPR/Privacy/Consent considerations

Video Conferencing

Microsoft Teams

  • Microsoft Teams is a hub for teamwork in Office 365. It is currently free to download and use, during this Covid 19 pandemic. It is most likely to be initially at least, most useful to staff, as there is a degree of learning and familiarization involved: Here’s an introductory video illustrating how Teams works.

Skype

  • Skype should be familiar being the original voice and video calling service. Perhaps not as popular as it once was it is still used by many people. Once someone is set up and signed in it should be easy enough to navigate. Skype is keyboard accessible, which will allow us use alternative input methods or create a simplified interface using software like the Grid 3. Unfortunately, Skype no longer supports games like checkers and chess but it is still a good option especially if people are already using it.

Zoom

  • Currently free, the video conferencing tool Zoom is a great way of bringing larger groups together via video. It supports all the main platforms (Windows iOS, Android and MacOS). It’s quite an easy app to use and is free to install and use for up to 40 minutes. This could be used to bring everyone together at a certain time every day and would be probably the best way of simulating the atmosphere people would be familiar with within the services they normally attend. When hosting a meeting, you can select ‘share screen only’ to ensure that the there is no potential for making any changes to attendees’ own devices. Without selecting this feature, it would be possible to remotely access devices, and this is something that would require written/recorded consent.

Note: Corporate IT Departments may have concerns re: this solution as they may not have any prior agreement with them. So for service providers, best to check with IT before considering it.

Advantages

  • Free and relatively easy to use
  • Supports large group video calls
  • Great casting tool

Disadvantage

  • GDPR concerns
  • Requires a computer or mobile device
  • Will be new and unfamiliar to most (all)

Set up an Internet Radio Station

  • There are services that allow you create an online radio station (for example https://radio.co/). This would be a great way of keeping people in touch with news and entertainment custom made for a specific audience. Rotate DJs between services, have chats, play music, share news. Bit of a mad idea but could be fun for everyone. If a live radio channel is a bit of a stretch we could maybe produce a daily podcast. Get people to record introduction to songs on their phones and send us the audio. Record thoughts, news, jokes, and we can try to put it all together and send out a link for everyone to listen. Video could also be used and make private links on YouTube.

Advantages

  • Accessible to (almost) all as listeners
  • Offers opportunity to be producer as well as consumer of news/entertainment
  • All content curated by surface users

Disadvantages

  • Totally new to us, not sure of the requirements for setting it up but happy to hear from others more familiar, and happy to try it out.

Watch Together

Online Games

  • There are lots of games available online that allow you invite friends to play remotely. Why not curate and manage a range? Suited to Draughts, Battleship, Ludo, Scrabble, Chess although younger players might be more interested in Fortnite

Advantages

  • Many of these games will be familiar to people already
  • Great distraction; Start a league!

Disadvantages

  • Many of the sites that offer these games are funded by advertising and can be difficult to navigate (auto playing videos, links to products, flashing ads designed to trick people into clicking on them. This is not an insurmountable problem but it would be a good bit of work identifying appropriate platforms. iOS might be better.

Virtual Photo Walks

https://youtu.be/y1Uv7as5ZmI: This is a lovely idea we came across. The original uses Google Hangouts but any video conferencing app would work.

Watch out for some free online content on Assistive Technology for Creative Expression: being launched later this week on enableirelandat.com

Stay safe and well,

Siobhan, Karl, Juliann, Sean and Shirley: The Enable Ireland AT Team

HSE Note: All agencies using any of the above technology need as always to comply fully with their own GDPR policy.

Appendix 3: Sample St Gabriel’s Phone Questionnaire in advance of direct contact
Questionnaire for families prior to appointment or home visit

Question 1:

  • Is anyone in your household experiencing any of the following presently or in the past month:
    • High Temperature
    • Cough
    • Sore Throat
    • Shortness of Breath
    • Runny Nose

Question 2:

  • Has anyone in the household been in contact with COVID 19 or diagnosed with COVID 19?

Question 3:

  • Has anyone in the household travelled from any high risk country in the past month?

Question 4:

  • Is anyone in the household immune compromised?

If the answer to any of the above questions is yes, please contact your line manager as the appointment may be cancelled and/or home visit.


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