Remote consultation in Deaf CYPMHS as a result of COVID-19 measures

The effects of the COVID-19 pandemic have prompted a necessary change in the way that the NHS provides care for its service users. Under NHS guidance, remote video consultation has been rapidly introduced to replace face-to-face consultation.

National Deaf Children and Young People Mental Health Services (CYPMHS) is a highly specialised mental health service for deaf children and young people with mental health issues.

Leeds and York Partnership NHS Foundation Trust hosts the York-based Deaf CYPMHS for the north of England, with other bases in Manchester and Newcastle.

The service operates a team around the child and family model, employing deaf and hearing staff (including psychiatrists, psychologists, specialist deaf outreach workers, nurses, social workers and British Sign Language/English interpreters). This ensures that the child and family can work in their first or preferred language in a culturally sensitive way to address their mental health needs holistically and effectively.

Situation

Deaf children and young people are at a higher risk of developing mental health difficulties than their hearing counterparts. They are also particularly affected by the isolation and use of face masks during lockdown as it brings additional communication barriers.

Infection control guidance as a result of the COVID-19 pandemic was clear that any non-urgent face-to-face appointments and travel should be stopped. Even when the York-based Deaf CYPMHS was able to do some limited face-to-face work, NHS England did not fully approve any of the existing clear face masks from an infection control perspective. This severely limited how the service could work in terms of communication.

Aspiration

The aspiration was to introduce a remote working model that enables continuation of service in the absence of face-to-face contacts that takes into consideration the unique Deaf CYPMHS service-user, carer, and professional team’s communication, engagement and interaction needs.

Solution and impact

Clinical work

As a regional service Deaf CYPMHS was already used to using some video-technology (such as whatsapp video) to offer follow-up sessions and some parent-based interventions. This meant they were well placed to adapt their existing policies to widen this mechanism of service delivery to include assessments and more complex interventions.

Their service users have been welcoming of this approach and flexibility. It has been particularly helpful for the BSL-using deaf children and young people who are no longer accessing school to be able to have remote one-to-one sessions with a deaf professional who is a native BSL user.

Therapy has continued where there was a pre-existing relationship and the feedback has been very useful about connection to the deaf community for their advice and support.

As well as delivering work around care plans (anxiety management, identity work, and emotional regulation packages) staff have been able to signpost to BSL resources around the current pandemic.

Teamwork

Like many other teams, most Deaf CYPMHS staff have been working from home during the pandemic. They have used video technology to have daily team huddles and ongoing weekly clinical meetings, supervision and governance meetings. This has enabled ongoing connectedness and a sharing of risk around clinical work, as well as support for individuals’ wellbeing.

Staff have gained confidence in using technology and they have found that having some of their meetings in this way works well.

Next steps

The plan is to embed the use of technology to enable a regional team to work more closely together on quality improvement (QI) projects, clinical pathway work, as well as supervision with subject matter experts.

Functionality

Zoom is an online application that can be used to run video conferences.

Within the York-based Deaf CYPMHS service, a range of platforms for clinical and professional work were trialled. While the service was able to be flexible and use different platforms if schools and other organisations could not use Zoom, there was a clear preference for Zoom.

The clear feedback from deaf staff was that the video quality is superior on Zoom for their work with deaf young people and children who rely on visual communication, lip reading and facial expressions. Furthermore, using split screens (not available on all video conferencing platforms) enables equal access to deaf and hearing staff and allows interpreters to be visible. The information governance lead at Leeds and York Partnership NHS Foundation Trust agreed that with the appropriate security safeguards in place, Zoom can be used clinically.

While Zoom has not been assured nationally by NHS Digital as a secure video conferencing tool, their guidance is that this does not mean it should not be used. However, it is important to note that it is an organisation’s own responsibility to perform risk assessments on any products that are used.

Guidance issued by the National Cyber Security Centre (NCSC) may be used to support decision making.

Capabilities

The introduction of video consultation across the service has enabled continuation of clinical work and professional teamwork.

Clinical work

• Remote home visits to observe parent-child interactions
• School videos to observe the child in an educational environment
• Virtual multi-disciplinary meetings to plan, implement and review joined-up care. The service was more able to attend and contribute to professionals, EHCP and other meetings as a result of them taking place virtually

The service has also delivered a therapeutic group through Zoom for deaf and hearing parents of deaf and hearing children/young people with an autism diagnosis. They had tried to run this before as a face-to-face programme, however people struggled to attend due to distance.

Professional teamwork

Each team has Zoom huddles to remain connected and the focus has increasingly been on staff wellbeing and strategies to help with remote working and isolation. Their weekly clinical meetings have continued through Zoom, as have service clinical governance meetings.

Clinical and managerial supervision also takes place through Zoom.

Scope

Remote working tough video consultations has enabled the Deaf CYPMHS to engage with the child/young person, their parents, carers, and relevant professionals in order to continue offering their service across multiple settings during the COVID-19 pandemic.

Key learning points

Service user involvement in the design

Engagement with staff including the services’ deaf staff was crucial in identifying what was needed for an effective transition to remote working. The service is also undertaking service user feedback to write a care pathway, which will allow service user-centred discussions around using video technology in therapy.

Key figures/quotes

“Even though I was shielding, the fact that I could have sessions every week from the team through Zoom to help me manage my child’s behaviour difficulties was brilliant. My child really enjoyed playing games online with the specialist deaf outreach worker to help him feel more positive about being deaf and control his behaviour better.”
Quote from anonymised parent, taken from ‘Experience of Service Survey’ which is sent out routinely

Key contact

Sophie Roberts, consultant child and adolescent psychiatrist, National Deaf CYPMHS clinical lead, National Specialist Mental Health Clinical Reference Group member

Sophie.roberts@nhs.net