The Role of the OT in Caregiver Coaching over Telehealth

caregiver coaching

Due to the COVID-19 pandemic, many occupational therapy practitioners have turned to the telehealth service delivery model. But many practitioners are new to providing services using this model, leading to questions about how to make the best use of the platform.

The American Occupational Therapy Association (AOTA) defines telehealth as the application of evaluative, consultative, preventative and therapeutic services delivered through information and communication technology.1 Telehealth is a natural fit for delivering occupational therapy services because it offers a window into the client’s natural environment. In addition, providing services in this context creates opportunities to coach caregivers—including family members—who are involved in direct care.

An estimated 53 million Americans serve as informal caregivers for adult relatives or friends.2 Caregivers are valuable members of the intervention team, and occupational therapy practitioners can and should promote caregiver self-efficacy and active participation in the therapy process.

Coaching Caregivers

The telehealth service delivery model allows occupational therapy practitioners to provide coaching within a family-centered framework. Coaching may be provided in collaboration with the client, or indirectly on behalf of the client through consultation.3

Coaching is characterized by the coach (in this case, the occupational therapist) who shares specialized knowledge, skills, and intervention strategies, and the learner (the caregiver), who provides intimate knowledge on the client’s abilities, daily routines, and barriers to occupational performance.4

Telehealth allows the occupational therapist to observe the client and caregiver in their natural environment and provide feedback and instruction on therapeutic techniques. Together, the caregiver and practitioner problem solve and discover solutions to improve the match between the client’s abilities, the activity demands, and the performance context.5

Instructional Materials and Methods

The success of the coaching process is dependent on the communication and collaboration between the occupational therapist and caregivers.

When coaching, a wide range of media is available to reinforce learning. Develop materials specifically for the client or caregiver. Select the format (visual, auditory, or written) that will align with the learning needs of the audience. Visual cues and auditory prompts may be provided to the caregiver in real time through a video communication service. As an example, MedBridge’s Telehealth Virtual Visits platform allows clinicians to share HEP and patient educational resources during the online appointment, allowing for discussion and helping to ensure that the patient and caregiver understand the information that is being shared.

It may also be necessary to provide clients and caregivers with education and training on the use of technology and setting up the environment for telehealth. Auditory instructions can be recorded and played back at a later date. When providing written information, consider the match between the reading level of text and the reading proficiency of the client and the caregivers. To reach the largest audience, the American Medical Association recommends patient education materials be written below the sixth-grade reading level.6 For people with low literacy skills, the National Institutes of Health (NIH) suggests writing between the third- and sixth-grade reading level.7

For Further Professional Guidance

The AOTA’s Caregiver Toolkit provides additional information and resources for caregivers and clients of different ages, stages, and conditions. Additional resources include MedBridge courses discussing telehealth such as:

  1. American Occupational Therapy Association [AOTA]. (2018, updated April 2020). AOTA position paper: Telehealth in occupational therapy. The Americal Journal of Occupational Therapy, 72(Suppl. 2). Retrieved 7/10/2020 from https://ajot.aota.org/article.aspx?articleid=2719223
  2. American Association of Retired People & National Alliance for Caregiving. (2020). 2020 Report: Caregiving in the U.S. Retrieved 7/10/2020 from https://www.caregiving.org/wp-content/uploads/2020/06/AARP1316_RPT_CaregivingintheUS_WEB.pdf
  3. American Occupational Therapy Association [AOTA]. (2018). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 768(Supplement 1), 1-48.
  4. Rush, D. D., Shelden, M. L., & Hanft, B. E. (2003). Coaching families and colleagues: A process for collaboration in natural settings. Infants and Young Children, 16, 33-47.
  5. American Occupational Therapy Association [AOTA]. (2018). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 768(Supplement 1), 1-48.
  6. Weiss, B. D. (2007). Health Literacy: A Manual for Clinicians. Chicago, IL: American Medical Association Foundation and American Medical Association.
  7. National Institutes of Health [NIH]. (2018). Clear Communication: Clear & Simple. Retrieved 7/10/2020 from https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/clear-simple