How did we respond to the restrictions due to the Covid-19 Pandemic?
Prior to Covid-19 lockdown restrictions, families brought their babies for sessions with our speech therapist, occupational therapist and physiotherapist once a month. As soon as we realised that we would not be able to offer face to face therapy safely for some time due to the Covid-19 pandemic, we started exploring telehealth options to mitigate the negative impact of loss of support and interdisciplinary therapy for our babies and their families. Offering telehealth was especially important due to a reduction of services in the state health system during the pandemic, the only other option for babies and their families from low socio-economic homes. The state health care workers were all focusing on managing the Covid-19 crisis in the state health system.
From April 2020 to September 2020, we were able to successfully meet the needs of our beneficiaries, including past and new beneficiaries, through a quick transition to telehealth. Non-synchronous WhatsApp chats were chosen due to low data usage and end-to-end encryption. Once a month, families were invited to send video clips and written feedback about progress and concerns. An individualised interdisciplinary home programme with 3 – 5 ideas and / or video demonstrations giving guidance around communication, movement, play, positioning, sensory stimulation or activities of daily living was sent back to families after WhatsApp discussion amongst one of our therapy teams. Families in need were also provided with monetary support, data and resources for their babies as we realised that having babies at high risk of developmental delay or disability was only one of the many challenges they faced.
An unexpected advantage of telehealth is that therapists have gotten a glimpse into the real environments in which the babies live and the space, furniture, people and toys that they have available, which allows us to give more relevant advice. The babies are also more relaxed at home and we get to be led by the families as they choose what to show us and what concerns they wish to raise.
Parents were very receptive and have spontaneously sent messages of appreciation and shared milestone videos throughout lockdown:
My son is so lucky to be part of such a warm family and team, you are doing more than enough and we really appreciate everything that you are doing for us.
Thank you thank you for those guidelines and reassurance!! Wow! A massive thank you for the great videos. This will help so much and I cannot express my gratitude to you all for the support. We will send some videos once we start with all the great ideas, so that you can see the progress. Stay safe and thanks again.
Good day, we are all doing well. Baby is also developing; I have realized that talking to him more has made him more active when we bath and eat. He interacts when I talk to him.
Thanks for asking, baby is doing really well, he is responding to the exercises. We are doing that all the time and we can see he is changing.
More formal feedback questionnaires sent to families after 3 months of telehealth asking what has worked well and what can be improved revealed:
All the advice given has helped our boy develop, the support received has helped us as a family to understand that in order for him to develop we need to work as a team, and that has helped our boy, the team effort between us and the lovely Bhabhisana team has yielded positive results.
Personally, I don’t see anything that needs to be done differently, you have been a support structure for our family financially and emotionally. All I can say is thank you from the bottom of my heart, please do not change, those good hearts make people’s lives better. You are all awesome!
The therapy via WhatsApp is very helpful, we see lots of change in our baby, like his arms are starting to loosen up they not as stiff like before, he can touch my face now and that’s the greatest feeling ever all thanks to Bhabhisana!
The things they suggested for us to do with the baby, the videos we received from them on how to massage your baby, stimulating his brain and for him being able to open his hands and hold a toy on his own, being able to lift his head while on his tummy, they are working especially for us.
I quite like the WhatsApp correspondence, I feel like it creates ongoing support, there is no need to wait and wonder for a next appointment to improve or exclude a particular exercise or advise. The fact that help is at my fingertips and the response turn-around time is comforting.
For me to receive therapy through WhatsApp has helped me a lot financially because it helps me to save transport money going for therapy.
Two families requested synchronous and more regular sessions and two were anxious for return to face to face sessions as soon as possible.
Outcomes
Six months of delivering only telehealth services has convinced us that positive outcomes for the development of at-risk babies and support of their families can be achieved through this method. However, face to face therapy also has advantages, especially the option to discuss and demonstrate handling and explain suggestions in a more nuanced and interactive way. From October 2020 we converted to a hybrid service where we see some babies face to face and others through telehealth to get the benefits of both methods and reduce the negatives of both methods. Face to face sessions are prioritised for babies new to the service and those whose family request it or who we feel will benefit from it. Thanks to our sharp telehealth learning curve, necessitated by Covid-19 restrictions, we are proud to now offer a more flexible and family-friendly service endorsed by our beneficiaries.
