virtual home visits occupational therapy

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Identifying Benefits, Concerns Around Virtual Home Assessments

This UK study looked at the use of telehealth to deliver virtual home assessments for occupational therapy services; the authors also created guidelines to support additional work in this area.

A recent study examined attitudes, barriers, and other factors that increase the chances of success of virtual assessment visits .

Most work around the user acceptance of telehealth comes from the patient or the health care provider perspective, as telehealth has mostly focused on clinical uses. Telehealth also could be used for assessment visits for patients who are discharged from facilities and are returning home, the authors noted.

The current study was carried out in the United Kingdom and looked at telehealth to deliver virtual home assessments for occupational therapy services. The authors also created guidelines to support additional work in this area.

Home visits are linked with a significant investment in cost and time, including arranging the visits, other logistics, the actual visit itself, travel time, and time spent writing reports.

In this study, the prototype technology for video consultation was simplified. It was not necessary to install an application or to register on a website; the patient clicked on a link sent via text message or email to start the visit. The link could also be shared with a caregiver if the patient need assistance.

On the occupational therapist side, they would see an interface that allowed them to see the patient's video feed, record audio or video, take screenshots, save digital notes, and control the patient's camera in order to fine-tune the images.

The researchers gathered various stakeholders, including occupational therapists, physical therapists, dieticians, nurses, and others, for workshops and a demonstration of a mock visit. Participants were asked for their thoughts about potential barriers to introducing the technology, potential benefits of using the technology, other ideas for the technology long-term to provide or enhance care, and ideas to further develop the technology to fill their needs.

Several barriers were identified, both for the technology used for the demonstration as well as broader concerns. The primary barrier related to security, including video connection, data storage, levels of access to the information, and sharing purposes. While a virtual, recorded assessment avoided duplication efforts and allow other providers and caregivers to view the data, concerns were raised about patient confidentiality and information governance.

Staff training was cited as another barrier; other barriers included the cost of the system, availability of information technology resources, and network reliability. Variability in any of these areas could exacerbate health inequalities, participants noted.

One social worker pointed out that many of the oldest adults are frail and may struggle with technology. In addition, not all patients have smartphones or a sufficient data plan.

Providers noted that even virtual visits conducted on a computer still require a private consultation room, as a group office setting with multiple staff members on multiple computers would not be appropriate and would violate patient confidentiality.

The lack of in-person contact would prevent therapists from checking furniture and other physical dimensions of the patients home. One participant was even worried that the patient on the other end of the connection might not even be in their actual home.

However, benefits were also recognized, including efficiency, reduced costs, and safety for the provider, as some pointed out they had visited dangerous or unclean homes in the past. For patients, a wider number in a larger geographic region could theoretically be served, and virtual assessments could also be helpful to patients with mobility issues.

If the idea of conducting virtual home assessments were to advance, certain guidelines would need to be in place, the authors noted. They proposed several, including ones related to security, guidance and help features, and offering more control to patients by deciding if they want to participate. In addition, the technology should enable multiple users and an ability to verify identity and location.

Lanfranchi V, Jones N, Read J, et al. User attitudes towards virtual home assessment technologies. J Med Eng Technol . Published online June 22, 2022. doi:10.1080/03091902.2022.2089250

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• Practice resources
• Occupational therapy topics

Digital occupational therapy

In order to ensure the profession is fit for the 21st Century , all occupational therapists should have the digital literacy skills required to capitalise on the benefits digital brings to their workplaces and areas of practice.

The COVID-19 pandemic has placed pressure on health and care services to rapidly implement remote working practices with an increased reliance on digital tools.

The term “remote working” can encompass approaches/modalities such as telehealth, telemedicine, virtual therapy and NHS England’s ‘ Digital First ’, among others. Remote working can be defined as the use of information and communication technologies (ICT) to deliver health and care related services when the provider and client are in different physical locations. As restrictions lift, health and care professionals will be reviewing and embedding new ways of working and this is likely to include a blend of face to face and remote working practices.

A universal, targeted and specialist approach to digital technologies

There are a range of everyday digital tools within our workplaces and the homes of people who access our services that can be easily used to enhance our practice.

Universal tools

• Around 95% of the UK population have a mobile phone.
• National rollout of communication tools like Microsoft Teams and Attend Anywhere enable safe and secure remote working.
• A service webpage that provides essential information on occupational therapy and how to access a service is useful for both people and other professionals.
•   Social media  tools like Twitter and LinkedIn can widen our professional network and support professional learning.

Targeted tools

There may be specific groups of people who would benefit from targeted digital tools e.g. a platform that supports therapeutic groups or an app that captures activity levels. These types of tools may be used to overcome difficulties such as accessing a physical location, e.g. if they are a full time carer or do not drive, whereas other targeted digital tools may be offered due to the preference of your client group and are a method of offering choice. When deciding whether a targeted tool is appropriate, consider the needs of those who access the service.

An example of this is facilitating virtual communities. This Alzheimer’s Scotland resource creates a space for people with dementia and their family members as well as supporters to come together and explore ways of living well with dementia.

Specialist tools

Some digital tools could be classified as specialist if they are needed by people with the most complex needs or circumstances. A good example of this is selecting an appropriate video-call tool for people with cognitive impairment or neurodevelopmental conditions.

Service example

A specialist technology enabled care service in Edinburgh has been trialling video-call systems that enable staff to securely make contact with people who have a cognitive impairment. The team have been looking at tools that don’t rely on a person having to go into an email address, download an app or web-browser, access a link to consultation or wait in a lobby.

Where to start with digital

These questions are a good starting point when exploring how digital can enhance practice:

Are there guidelines on delivering remote services?

Start with collecting information that helps you to explain the problem your service is facing and what you might need from a digital tool.

Locate your organisations digital, data and technology strategy and local policies and procedures. Some organisations have AHP digital leaders and digital working groups which you can tap into for local support.

Look at national guidance specific to your context of practice as well as national AHP guidance. The resource section is a helpful place to start.  

Connect with your local RCOT regional group and/or Specialist section to access peer support. You may also find online AHP forums such as the FutureNHS Collaboration Platform a useful place to connect with others and share resources.

How can the public access information about your service and occupational therapy?  

A webpage can be used to promote the benefits of occupational therapy and how to access it. Information like top tips and links to useful sites can support self-management, enabling people to take control of their own health and care.

Service Example

A Children’s Occupational Therapy Service in Cambridgeshire has produced this video to demonstrate how they worked with families and their organisations communication team to develop their webpages.

Hits in the first 3 months were higher than the entire three years previously.

The website has become a useful resource as part of the teams triage with children and families being able to get going with activities before their first appointment with an occupational therapist.    Referrers such as school SENCos are also signposted to the website to help them to support the child whilst waiting for further input from the service.

I’m concerned that some people cannot access our service if we rely on digital tools

A personalised offer is one that acknowledges that no one person is the same and digital ways of working should be offered as a choice. It’s important that you understand your local population by considering what you know about the digital readiness of the people who access your service? You need to test your assumptions by asking people how they use digital technologies in their everyday life as well as gathering feedback on their experiences of accessing your service. 

Use of digital in practice

The following sections detail some examples of digital technologies that support the occupational therapy process in a variety of settings.

Digital referral and triage

Digital technologies provide opportunities to deliver triage in new ways. In addition to supporting decision making and signposting, digital triage tools can support assessment and provide information as well as collecting outcomes that support service improvement.

The article published in Mays OTN "Five Steps to a big impact" describes the process and different tools that were used to manage referrals to an adult social care team.  The Reigate and Banstead team share their five step process and tips on conducting virtual assessments.  

• May_OTNews_P25-27.pdf (PDF, 1.37MB)
• Virtual_assessments_V3_(1).pdf (PDF, 553.62KB)

Additional resources

• Care Quality Commission: Getting to the right care in the right way - digital triage in health services.
• NHS England: Advice on how to establish a remote ‘total triage’ model in general practice
• Webinar How to establish a remote Total Triage model in general practice using online consultations

Digital assessment

Occupational therapy assessments vary across contexts and specialisms and therefore the range of digital tools that could enhance practice is broad.

• Sefton_Moving_with_Dignity_Videoconference_assessment_service_exampleSefton_Moving_with_Dignity_Videoconference_assessment_service_example.pdf (PDF, 83.59KB)

Sefton Local Authority "Moving with Dignity" team describe the processes they have put in place to embed videoconferencing assessments within their service. 

Examples from RCOT’s  Small Change, Big Impact Campaign:

• Jane Ritchie
• Diana Turner
• Leanne Rouse
• Bella Dhariwal
• Sarah Remnant
• Tiffany Spicer
• Kim Griffin
• Annabel Williams

Digital interventions

Occupational therapists may recommend specific apps or use digital technologies to deliver interventions, such as virtual therapeutic groups. They may also work with a person to use everyday technologies that support participation in daily life e.g. Amazon Alexa.

The Acute Day Service within Sussex Partnership NHS foundation Trust share their experiences of moving their 4-week mental health group treatment programme online.

• Delivering remote groups (PDF, 81.23KB)

News article

A technology enabled care team shares current projects and the positive impact of digital tools on people receiving services.

• OTnews - Doing things differently (PDF, 1.88MB)

Evidence Spotlight: Assistive and everyday technologies  

Remote outpatient appointments

There are a range of benefits to offering non face-to-face appointments, such as improving access to occupational therapy as well as reducing travel time and the impact on the environment.

University College London (UCL) has produced a useful resource for starting out with non-face-to-face clinics. UCL How-to guide: non face-to-face clinics  

The NHS Education for Scotland (NES) has a toolkit of resources for implementing AttendAnywhere.

Video consultations : a guide for practice by Prof Trisha Greenhalgh

Digital discharge  

There is a range of videoconferencing tools available; you should check which is recommended by your organisation’s information services.

Digital outcomes

It is important for all occupational therapists to collect data on the effectiveness of occupational therapy interventions and their services. Digital tools can support timely data collection often with added benefits e.g. information is collected outside of face-to-face time and at an appropriate interval that identifies whether change has occurred over time.

Research Project

Natalie Jones and Jennifer Read discuss their digital home visit research project led by occupational therapists. 

In 2020, they published both an OTN article "Occupational Therapy in the Digital Age" and a BJOT research article “ Remote Home Visit: Exploring the feasibility, acceptability and potential benefits of using digital technology to undertake occupational therapy home assessments) that describes their ongoing research and development journey to implement home visits using video conferencing technology.  

• OT news June 2020 (PDF, 8.01MB)
• Remote visits BJOT 2020 (PDF, 678.94KB)

News Article

Angela Alty, Clinical lead stroke rehabilitation occupational therapist at Lancashire Teaching Hospital NHS Foundation Trust published "The digital solution: environmental assessment for acute hospital discharge" in June 2020s OTN.

• 042-044_OTnews_June_2020_The_Digital_Solution_to_environmental_assessment.pdf (PDF, 1.69MB)

It is important for all occupational therapists to collect meaningful data on the effectiveness of occupational therapy interventions and their services. Digital tools can support timely data collection often with added benefits e.g. information is collected outside of face-to-face time and at an appropriate interval that identifies whether change has occurred over time.

For more information on collecting data see RCOT’s Informatics Webpage .

Clinical safety and digital technologies

Whilst there are huge benefits attached to digital technologies, all occupational therapists are required to assess the safety and risk of implementing these tools in practice.

To better understand the opportunities and risks attached to digital technologies: technologies, see the OTNews article:

• OTnews - Two sides to every story - digital opportunities and risk (PDF, 943.28KB)

When looking to introduce new digital technologies, you need to establish what your own organisation's digital strategy is as well as local processes and procedures for implementing technology. In addition to this, RCOTs publication Embracing risk; enabling choice   may be a useful resource.

Developing digital skills

Digital literacy, as defined by Health Education England ,  is 'The capabilities that fit someone for living, learning, working, participating and thriving in a digital society'.

Occupational therapists are responsible for ensuring that they have the required digital literacy skills that are specific to their workplace, and that they keep up to date with the digital technologies specific to their area of practice.

Digital Fellowship Opportunities open to Occupational Therapists

The Topol Programme for Digital Fellowship

The DigitalHealth London Digital Pioneer Fellowship

NHS Digital Academy

NMAHP Digital Health and Care Leadership Programme (Scotland)

• OTnews - Going digital for CPD (PDF, 1.62MB)

Health Education England’s Digital literacy programme

NHS Education for Scotland’s Digital Health and Care   NHS Apps Library  

Evaluation of digital projects

During the COVID Lockdown period, many occupational therapy services were required to rapidly roll out remote working solutions.  Many teams have seen some unexpected benefits and challenges. It is important to capture this valuable learning so that health and care services can be redesigned to capitalise on the benefits of remote working and reconsider areas that require different approaches.

This GOV UK resource supports rapid evaluation of digital health products during the COVID-19 pandemic. 

This NHS Providers resource pulls together some useful examples and targeted questions designed to help board members embed digital innovation at all levels of leadership.

The Digital innovation in adult social care: how we’ve been supporting communities during COVID-19 report (Sept 2020) covers factors which lead to success digital innovation as well as next steps.

Social Care Digital Innovation Programme publishes case studies of grant funded digital innovation projects in social care

Digital Inclusion

Digital inclusivity is not about disability but about universality and making something that can be used by as many people as possible. Whether you are developing a webpage or providing video consultations, occupational therapists need to consider ease of access and support participation in activities that occur in the digital environment.

NHS Digital’s The Digital Inclusion guide for Health and Social Care (2019)

• Digital_Inclusion_July_2020.pdf (PDF, 1.22MB)

Autistica -  tips to make online events/meetings/webinars more accessible for autistic people and those with additional needs

National Autism Implementation Team – Guidance on digital consultations

Improving digital inclusivity for specific needs can be found through charities such as AbilityNet

The Good Things Foundation is a social change charity, helping people to improve their lives through digital.

Further resources

The Department of Health and Social Care “The future of healthcare: our vision for digital, data and technology in health and care” (2018)

Kings Fund Report “Technology and innovation for long-term conditions” (2020)

National Voices Insight Report “The Dr will zoom you now: getting the most out of the virtual health and care experience (2020)

Socitm Advisory “Getting the most out of video-calling applications: sharing best practice” report

Health and Care Professions Council guidance on adapting your practice.

NHSX are leading on digital transformation of the NHS and social care in England.

Health Education England “The Topol Review: Preparing the healthcare workforce to deliver the digital future”

Digital Social Care working in partnership with NHS Digital

Scotland’s Digital Health and Care Strategy: enabling, connecting and empowering

Informed Health and Care: A Digital Health and Social care Strategy for Wales.

Northern Ireland

Department of Health eHealth and Care Strategy 2016

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Virtual Home Visiting Strategies that Support All Children and Families

Roselia Ramirez: Welcome to the Home Visitors' webinar series.  We are so happy that you have joined us today.  My name is Roselia, and I am one of your host presenters for this series.  I'm here with my colleague, Adriana.  Hi, Adriana.  It's so good to see you today.

Adriana Bernal: Hi, Roselia.  It's good to see you, too.  Hi, everyone. As Roselia mentioned, we are so glad that you joined us today.  We are with the National Center on Early Childhood Development Teaching and Learning, known as DTL.  We have an exciting topic for you today to kick off our series, Virtual Home Visiting Strategies that Support All Children and Families.  You are in for a special treat.  We will be hearing from Dr. Brenda Jones Harden during our presentation.

Roselia: You are so right.  We have a great topic lined up for you today, and it's so exciting that we get to hear from Dr. Harden.  But before we jump in, we want to take a moment to recognize and acknowledge that home-visiting programs continue to be flexible in their approach to supporting families during this time.  We know that many of you have gone from virtual back to in person and then back to virtual, as well as a combination of these two options.  We also know that families, as well as program staff, continue to balance work and education for children as well as their own wellbeing.  So, throughout our time together today, we will talk about strategies to deliver home-visiting services virtually, but keep in mind that many of these ideas and resources can support in-home, in-person visiting as well.  OK, so with that said, let us review the key topics for our session today.  We will begin by first setting the stage.  Then, we will focus on exploring strategies and methods that support virtual home visits, and we're excited that we get to highlight some new resources that are now available on the ECLKC, or ECLKC, as well as identify some oldies but goodies to help support the work that you do with all children and families.  But one more thing that we really want to emphasize before we move into today's topic is that now more than ever we need to take time to take care of ourselves.  To be the best version of ourselves, we must make this a priority. I remember when I was doing home visits, I had my day carved out with chunks of time for each of my families, and then in between those visits, my mind was already working through the next visit and thinking about resources and all the things that I needed to do for my families.  It can become overwhelming really quickly.  So, one of the things that I found that was very helpful was taking even just a few seconds to take some deep breaths and commit and focus to one task at a time, so clearing our minds or having a mindful moment can really help alleviate that stress of the busy days that we have.  So, let us try this out.  Let's practice.  So, take a few deep breaths with me and Adriana and commit to focusing on this hour with us.  Think about what you would like to take away from our time together today, and we ask that you turn off the many thoughts that are running through your head and just focus on your breathing here.  OK, so let's try this out, and we're going to call this the take five method.  OK, are we ready?  Let's take that first breath.  [Inhaling and exhaling deeply] In.  [Inhaling] Out.  [Exhaling] In.  [Inhaling] And out.  [Exhaling] In.  [Inhaling] And out.  [Exhaling] And one more time.  In [Inhaling] and out.  [Exhaling] Alright, so that's just one strategy.  In your participant's guide, we'd like to invite you to jot down at least three things that you're going to commit to doing to help take care of yourself during these times.

Adriana: Wow, that was a great exercise.  Thanks so much, Roselia, for reminding us how easy it can be to take a few moments to work for ourselves, to focus and decompress.  We now can move into some of the content that includes great strategies and resources that we want to share with you.  And to set the stage for the connections we will be making, we want to start with Head Start Program Performance Standards.  We are not going to spend a lot of time here as we know that you are familiar with these and you can revisit them any time.  We just wanted to highlight a couple of things to emphasize the why of the work we do as home visitors.  So, our standards tell us that a home-based program must promote secure parent-child relationships and help parents to provide high-quality early learning experiences.  So, in addition, programs are designed to partner with the family, so we are planning jointly and using assessment data and we are scheduling enough time to serve all children enrolled, and of course, delivering comprehensive services in promoting positive outcomes.  So, we mentioned that we have a guest speaker today.  Roselia, do you want to tell us a little bit more about her?

Roselia: I most certainly will.  It is such an honor to tell you about Dr. Brenda Jones Harden.  Dr. Harden is the Richman professor for children and families at the University of Maryland School of Social Work.  She is the co-chair of DTL's Research to Equitable Practice Advisory Group.  This is a group of researchers and grantee representatives who help to inform the work of our center.  Dr. Harden is also the vice president of the Zero to Three board of directors.  And for more than 35 years, she has focused her work on the developmental and mental health needs of young children who are at risk, and she's interested in using her research to inform practice that promotes positive outcomes for children and home visitation in Head Start.  In this first clip, listen in as Dr. Harden was asked about the unique opportunities that home visiting provides, and also, what are some of the challenges at home visitors are facing.  We invite you to pull out in your participant guide and jot down some thoughts or key takeaways that come to you as you listen to what Dr. Harden shares.

Brenda Harden: Hello, everyone.  My name is Brenda Jones Harden.  I'm Alison Richman, professor for children and families at the University of Maryland School of Social Work.

Roselia: What are some of the unique opportunities that home visiting provides?

Brenda: You get an opportunity to observe a family and their interactions in an informal setting.  Very different than in an office or a clinic or in a lab, so you're much more likely to get a sense of how family members interact with each other, but also the family's broader context, like the kind of environment that they live in, so the stresses that might affect them because of community violence, for example, but also what happens in their residence.  Is this a stable, calm place or is this a place full of chaos?  But also, I really believe you get a better sense of the needs of a family so you can sort of adapt that intervention to meet the family's particular needs.

Roselia: What are some of the challenges home visitors face?

Brenda: We know from the research that families who tend to be in home-based programs -- like home-based Early Head Start, for example -- are much more likely to be high risk than families who attend center-based.  And if you think about it, families who are able to organize themselves enough to get a job and get their children to center-based, you can imagine that they are probably at lower risk than families who tend to be in home-based, but we have the data on this.  So, they have many more concrete and psychological needs often.  So, the burden on the home visitor is fairly high.  But the other thing that I think is related to that is it's incumbent upon the home visitor to kind of balance case management with promotion of parent-child interaction and child development.  I would argue that home visitors are so stressed, not only because of the kinds of risk factors that their parents bring, but also the fact that they're going out  into these communities: there's nobody with them, they're on their own, their car might break down -- all kinds of other things.  They're literally putting their lives on the line with their jobs.  The other thing I think is important is to help the home visitor focus on the moment.  I think what happens, whether we're parents or home visitors or clinicians and other kinds of ways or even teachers in the Head Start classroom is we get overwhelmed with the breadth of what we have to do instead of taking each moment at a time and celebrating each moment and trying to make each moment as effective as you can be.

Adriana: I don't know about all of you, but there are a few takeaways for me.  I really appreciate that Dr. Harden talked about the primary population home visitors' partner with are those that tend to be high risk, as well as highlighting on the fact that home visitors must balance case management with the promotion of the parent-child relationship.  So now, take a moment and share your key takeaways in that Q&A.  So, we know that one of the biggest differences between home-visiting and center-based programs is that home visitors are working to promote positive parenting through effecting home-visiting practices that in turn impact child development.  Because of these dynamic, we do have a unique opportunity, as Dr. Harden mentioned, as home visitors, we get a better sense of sort of a big picture view of the child's and family's strengths as well as their needs that we can then use to frame activities to better support learning experiences.

Roselia: I do believe that our audience today would agree that home visitors do have a unique opportunity.  For me, listening to Dr. Harden, something that resonated was focusing on the moment, which made me hone in on remembering our home-visiting purpose which aligns with the Head Start Program Performance Standards that we began our discussion with.  Our purpose as home visitors is centered around these two things.  So, first is promoting secure parent-child relationships and supporting or facilitating high-quality early learning experiences.  Take a moment now and reflect in your participant guide and jot down some additional things that come to your mind when you think about your purpose as a home visitor.  And while folks are doing that, we want to move along and we want to explore each of these components just a little bit more.  OK, so let's start with the parent-child interactions or relationships.  How do we define what we mean by this process?  So, for me as a visual learner, this image helped me to put it all together when we think about this as a process.  In the resource widget, you have a tip sheet from rapid response virtual home visiting, and they have defined parent-child interaction as "any moment of shared attention between a parent and child and then how a child experiences the parent, how the parent experiences the child, and how these experiences impact the relationship."  So, this process takes place during playtime as well as during daily routines.  So, in your participant guide, we invite you to take some time and jot down some key words that really resonate with you when you think about how we define that parent-child interaction.  So, take a couple of moments to just kind of jot down some of those key things that you look for.

Adriana: Thank you, Roselia.  Now that we have defined what we mean by parent-child interaction, the second part of our purpose as home visitors is facilitating high-quality early learning experiences.  We want to think about how we are supporting parents using daily routines as well as everyday materials in the home as learning opportunities.  Take a look at the two photos here and in your participant's guide.  Write down some notes about what you think these children are learning as they engage in these activities.  And as you do that, I want to share some thoughts that I have.  The first thing that comes to my mind is the opportunity here for language development, introducing new words, and asking open-ended questions to see what the children are thinking.  Young children playing with blocks are developing their fine motor skills in exploring early math concepts as well as problem-solving.  And cause and effect, of course.  So, many opportunities to a daily routine.  Hope you came up with some other great learning opportunities and noted them in your participant's guide.

Roselia: When we began our time together, I took a moment to acknowledge the flexible approaches of home-visiting programs, and we know that many programs continue to support their work with families virtually.  As we begin to talk about some strategies, methods and resources to support families virtually, let us keep a few things in mind.  First, providing information and sustaining relationships with our families is really key during this time.  We need that relationship to build our partnership and to engage our families.  This helps to promote security and confidence in the families’ skills to facilitate learning experiences for their children.  Hearing from Dr. Harden, we are reminded that our families are high risk and they may be encountering additional stressors during this time.  Our goal is to support skill building by identifying strengths and capitalizing on those strengths to support facilitation, of facilitation, of learning experiences for all children.

Adriana: So, Roselia, how about we pause here and take a moment to see how our participants are feeling about their current engagement with virtual home visits.  So, now if you can just take a moment, and respond to this poll and we have a few answers for you to respond to.  How would you rate your engagement with virtual home visits?  So, we have A, I am engaging with all families.  B, I am engaging with most of the families.  C, I am engaging with some of the families, and D, it is difficult to engage families virtually.  We will wait a minute to hear about your experiences and what responses do you have.

Roselia: Alright, well, it appears that most of our folks are engaging with most of their families, which is good, but we've got some work to do in that area.  So far, let's review a little bit.  We've spent our time focusing on our purpose and what guides the work we do with children and families, as well as acknowledging the flexibility of programs to reach families.  We're going to shift gears now and dive into exploring some strategies and methods, as well as sharing some new resources that we mentioned, are now available on the ECLKC.  And that will help in connecting these concepts to your daily work.  OK, so as we heard from Dr. Harden, we fully recognize that home visitors face some unique challenges in their work.  We know that our work as home visitors focuses on supporting parent child interactions to promote positive outcomes.  So, here are some strategies to consider when planning for a virtual home visits.  First is where.  So, encourage families to set up the visit where the child is comfortable.  Before the visit, work with the family to decide where they and their child feel most comfortable with their virtual visit.  And then next is when.  So, when is the best time for that virtual visit to take place.  Schedule times around play time interactions, both previous and real time.  And this helps to promote parents reflection of their child's development and skills and their own behaviors and skills as parents.  Remember to consider routines and everyday life activities and adapt to the family's schedule when possible.  And then you have the who.  So, who is on camera?  Of course, if this is an option.  And we know that this can be difficult, especially when working with very young children.  But as you saw in our video example, working with young children on camera can be possible.  But we want you to consider the importance of using that camera to help you feel connected, which ultimately supports building that relationship with the parents and the children.  And then lastly, we have the why.  This is really about directing the visit toward the parent child interaction.  We're going to talk a little more about this in a minute.  But right now, we invite you to jot down some additional considerations for the families that you serve in your participation guide.  And what folks are doing that, Adriana, do you want to share some suggestions about the use of cameras with families?

Adriana: Sure, Roselia.  There are a few easy strategies that I have found to be helpful.  First, have the parent adjust that device and camera angles so you can capture everyone on the screen or at least for part of the time.  Remind the parent to move that device as needed, positioning that camera four to five feet away from the parent and child interaction.  That can provide a broader view and relieve the tension a child might experience.  So, encourage the parent to take-me-with-you kind of approach, which means take the device if the child moves or leaves the room.  Give gentle reminders to the parent at the start of the call or even at other times during the call that other family members are welcome to join or rejoin the station.  And remember that your own personal and family needs may occur during visits as we know that many of us are working from our homes, so we have to be flexible.  Think to the what steps might take place and share those possibilities with the family.  That makes us more relatable families see that we ourselves are managing work-life balance, so it sometimes can be helpful for the family to observe your own family interactions and see that that flexibility exists.

Roselia: Those are some great suggestions, and I really appreciate you talking about how our own personal and family needs may occur.  I can't even begin to tell you how many times I've been interacting virtually and folks really get to see a glimpse into my personal reality.  I've got a needy cat that will decide to jump in out of nowhere, or my little dog decides to start barking uncontrollably.  Or I have my 7-year-old who suddenly decides that he has an emergency, there's some type of crisis, or he just wants to pop in and see what's happening on camera.  We know that life is not on pause during our virtual visits.  We talked about our families and how they may be experiencing additional stressors during this time, and we heard from Dr. Harden that home visitors are balancing case management with promoting the parent-child relationship.  As we're working through that balance, we want to focus on our purpose as home visitors, whether it is virtually or in person.  Adriana, can you share why it's important to direct those visits toward the parent child interaction?

Adriana: Absolutely.  Development and relationship patterns continue regardless of family circumstances and ongoing situations.  Redirecting discussion towards parent-child interactions and child development is important to do without disrespecting or disregarding the context and content of the family's story.  As we build relationships with the families, they will want to share with us, of course.  So, listening to the content and context of the family's story is our first step.  Then, asking questions such as, "How do you think the situation is affecting Jose?"  or "Have you noticed any changes in Maria since this happened?"  are ways to bring that child into conversation so parenting can be supported.  You can also connect a goal to bring the focus to interactions.  For instance, you can say something like, "It sounds like the week has been a very busy time for you and your family.  You and Jose seem to be getting a lot of organizing done together."  Even when families might think that they didn't have time to focus on specific skill, children are getting some great fine motor skills practice when they help you.  You can ask them, "What else have you two been doing together?"  Those are some ideas to ask the families.

Roselia: The ability to ask those reflective questions does take practice so that it becomes natural and just kind of part of your routine and interaction with the family.  This is a great lead in to us sharing the new resources that have been created to support your work.  So, first, we have virtual learning at home in Early Head Start and Head Start.  This resource offers guidance from the office of Head Start when determining best practices for virtual learning.  The resource helps to validate the importance of intentional partnering with families, nurturing the parent-child relationship, as well as the intentionality that is needed when planning for those child-family activities.  As a reminder, these resources are available in the resource widget and we invite you to explore them, and then utilize your participant guide to jot down some ideas on how you might use them with your families.  So, it's kind of allowing you to kind of start to put together a little resource library for yourself.

Adriana: Yeah, great information, Roselia.  Resource that we want to share with you is whole ideas to help education staff plan for virtual learning.  These resource contains some great suggestions and considerations.  When we think about virtual learning, we just selected a few that we want to share with you today.  So, let's now talk about communication and its importance.  First and foremost, establish regular communication with families, determine the how and when, what means of communication they prefer, and honor their preference.  So, discuss your availability to communicate with families such as days, hours of the week that you are available and anticipate a timing for response.  I think this is an important one because sometimes we have different ideas of how fast people have to respond to us.  So, we remember that not all families have access to electronic devices, and some might have limitations to data plans or not have access to internet or phone services at all.  So, you can use multiple ways to keep families engaged in their child's learning and supported during this process.  Also to communicate effectively with families with limited English proficiency in children who are dual language learners.  Ideally, the home visitor will speak the family's home language.  We know that it's not always possible, so make sure to plan and tap into community resources, interpretation services, or software or maybe other family members to support communication.

Roselia: Adriana, this resource also shares some tips on virtual learning events.  So, typically when we meet with families in person, our visits are at least 90 minutes, but for virtual meetings, we want to keep them short, so a maximum of 30 minutes.  We want to give children and families resources and ideas to foster learning at home and work with them to determine the best approach for their household, so really individualizing, and we need to know that what works for one family may not work for another.  The frequency should be manageable for children and families.  Make a plan that will work for the family, and then also remember that we're partnering with the family and we want to be sensitive to their unique circumstances.  Continue to follow the child's lead.  This is really important.  They're in their homes, they're playing, they're exploring and they're learning, so we may not get to see them on camera.  Also, we know that virtually, we're getting a very limited glimpse, so one idea, if feasible of course, is to ask families to share pictures or maybe videos of their child during your virtual visit.  This can help you to plan for activities or determine what resources may be helpful to encourage continued development.  We're going to hear more about videotaping in just a bit, so let's pause here for a minute and we have a video clip that we want you to watch in this virtual visit example.  As you're watching, in your participant's guide, we want you to jot down some examples or some reflections of some key components that you see or hear during this virtual visit.

Woman: And are you still seeing him doing some nice, purposeful reaching.  I know you said last time he was reaching for Dad's face.

Mother: Actually, he's doing more.  We're seeing, what was it?  Oh, he actually -- so, this little thing.  He actually grabbed this the other day.  He was on -- I don't remember if he was on his side.  We're seeing a lot more side rolling -- 

Woman: Fully to the side.

Mother: Yeah.  So, he ended up grabbing this, and he had pulled it up to his mouth and everything.  Yeah, we've got one of these things, too.  I've been having him go on his side, and then he likes this side in particular, and the one that has the buttons, too.

Woman: And you can activate the buttons?

Mother: Yeah, so we've been trying to work on him learning how to push.

Woman: Uh-huh.

Mother: I guess...  And is he rolling to both sides pretty equally or is it at once?

Mother: I'm seeing both sides.  It's almost like he'll do one and come back to center and then go to another.

Woman: OK.  There we go.

Mother: Say hi.

Woman: So, if you want to tuck his shoulders just a little bit more underneath or his elbows.  Sorry, right. Yeah, perfect.

Mother: We'll bring you back.  Oh, good.

Woman: Very nice.  Look at that little hand opening up a little bit, huh?  Now let's see if you can.  Uh-oh.  Where'd your baby go?  Hello. That's good, a smile.

Mother: Hi.

Woman: So, if you kind of back your support off just a little bit, let's see.  Do you think he'll try to reach a little bit for anything in front of him yet or is that still really tough?

Mother: You like Yowie.  Let's see. You want to -- Ah, and there he goes.  You going to your side?  You going to climb around?

Woman: I think there's a little bit of spit up, too, so maybe if you want to...

Father: No, that was just bubbles.

Woman: Bubbles. OK.  Hard to tell on video.

Adriana: You know, Roselia, when I watched the video, it made me think of some additional considerations when it comes to virtual visits, and they all relate to self-awareness.  In a virtual environment, our pace of listening and sharing is different.  We want to be aware of our own breathing and tone as well as our body language.  Our tone is very important, particularly if interacting via phone.  The family and child cannot see us in by text or mail.  Our tone can be misunderstood and can impact that relationship.  We want to be intentional with our process to give the parent-child time to respond and join the conversation, so be sure to summarize so that everyone is on the same page with the same understanding, and plan for the next steps to set up the next appointment and develop a follow-up plan if possible.

Roselia: Self-awareness is definitely something that we need to consider as we're interacting with families virtually, so thank you for bringing that up.  Particularly in a virtual environment, some of the things that you talked about can really impact how the relationship moves forward.  Be sure to check out this resource, Ideas to Help Education Staff for Virtual Learning, for some additional ideas and suggestions, such as those that you see on your screen now.  I did want to take a moment and talk a little more about supporting the families whose children have an IEP or an IFSP.  In a moment, we're going to hear from Dr. Harden on the use of videotaping, but I wanted to share an example with you on how you might incorporate videotaping to support children with special needs.  Work with the parent to videotape at different times during the day, during natural routines, during play, and then during the virtual visit, utilize the video to talk through ideas and suggestions to reinforce skills and learning.  It's also an opportunity to bring together other service providers that are working with the families, those such as the speech therapist, occupational therapist or physical therapist.  Oftentimes we know that the frequency of service providers is much less than what you may be providing.  So, connecting with service providers in this way allows you to support the parent on the overall desired outcomes, and that everyone is working together on the same goals.  OK, so these next set of new resources, I was really excited about.  I can tell you from my own experience that having a daily schedule really helped me as a working parent with two young children.  Supporting parents to organize their day with a daily schedule that works for them, and that it also builds in opportunities for learning within those daily routines can really move you into superhero home visitor status.  In your resource widget, there are three draft daily schedule examples that are broken down by developmental age.  So, you have one for children under 12 months, and then there's one for children 12 to 18 months, and then there's one for children 2 to 4 years of age.  These are resources that you can use and share with your families so that they can visualize what their day could look like.  And then it can help you to build in those opportunities to work on the goals that the family has established, so be sure and check them out.  In addition, you can use the link on the slide to the ECLKC for some additional information regarding the importance of schedules and routines.  Sometimes this is really a great place to start to empower our families in understanding and seeing how a daily schedule can really be a powerful tool for them.

Adriana: I appreciate that you mentioned goals, Roselia, because there is a new resource called Using the Family Partnership Process to Support Virtual Learning in the Home that it can support home visitors through the process of developing goals with the family.  In this resource, you can learn more about the seven-step process for goal setting with families.  The resource highlights reflective questions home visitors can use in each of the steps, and it helps us to ensure that we are valuing different perspectives and contributions.

Roselia: So, talking about different perspectives, in a time in which we are spending a lot of time in the virtual world, a common question that may arise is, "What about screen time?"  Know that we are living in circumstances we've never experienced before, and it's important to acknowledge that many of us have relaxed the rules that we have established for screen time right now.  It's important for us to talk with parents about the guidelines that have been established by the American Academy of Pediatrics, and these are highlighted on your screen for you by age groups.  We want to have these conversations with parents, share the information, the research, but we want parents to understand that when it comes to learning in the home, limited and planned screen time with face-to-face interactions can provide some learning opportunities.  So, we're not saying no screen time, and right now, it's the reality that we're -- that we're living in.  And so, credible media for young children is a new resource that you can use and share with families to support parents, to select interactive experiences that support learning in multiple domains.  When we say credible, we're referring to technology that is dynamic; it's real time; it's interactive media that encourages active exploration and social interaction.  So, kind of working on that parent-child relationship.

Adriana: [Laughter] Great information, Roselia.  We have covered a lot of information so far and have highlighted some great new resources which will support the strategies and methods to serving your families for sure.  Earlier, we mentioned the use of videotaping.  Videotaping can be a really great strategy when we think about how to be more effective as home visitors, particularly right now in these virtual environments.  So, Roselia, you talked about how videotaping can be used to support parents who have children with special needs.  So, let's hear what our guest expert speaker, Dr. Harden, has to say about the use of videotaping and how we can use our education managers established resource to help support our growth.

Roselia: How can education managers help home visitors increase the effectiveness of their visits?

Brenda: So, one of the things that I really believe in is the use of videotape, and more and more as we do parenting interventions in the field, we are borrowing from evidence-based parenting interventions that use videotape.  So, I would argue, and I always   say this to Head Start programs: If you got a little extra money and you want to spend it before the budget year is over, get some video cameras.  And I think what you can do is teach home visitors how to video themselves, and we've done this.  You just put the camera in a corner of the room and you pretend like it's not there.  Families often forget about it; home visitors forget about it.  And then bring it back to the office and have the ed manager look at that videotape with the home visitor to see, for example, like a 12-monther.  Are they pulling up to stand?  So, here's an opportunity to say to mom, pull that little ball a little farther and see if he'll cruise, or you got a 24-monther who says, "Cookie, cookie, cookie."  You can say to the home visitor, and the ed manager knows child development like the back of their hands, of course.  Look, the child is doing a single word.  Let's see if we can expand the child's language and have them say, "Mommy, cookie, please."  So, mom can say, "Cookie, please."  So, I think really looking at the child and using what the child does in the context of the home visit is the best way.  Certainly ed managers can go out with home visitors and do the coaching in Vivo.  But I know that's really hard for them with the kind of workload they have, so I think using a video is a prime way to kind of get this work started.

Adriana: Yeah, videotaping can definitely be intimidating, and just like being on camera, it is sometimes something that takes time and practice to get comfortable with.  So, now we are quickly coming to the end of our time together.  And before we get to some questions, we wanted to mention a few oldies but goodies that we want to be sure you are connected to for your work with children and families.  So, we have learned that what happens during the first five years of life is critical to healthy child development.  That ELOF is a resource that supports how we approach children's growth and development in all learning domains.  Anywhere you can use a ELOF@Home application that serves as a tool for home visitors to get on the go access to the ELOF goals and effective teaching practices.  We also want to mention the effective practice guides.  They provide information about domain-specific teaching practices that support children's development.  They offer information for guidance on teaching in-home visiting practices within early learning settings and in-home environments.  The Know, See, Do, Improve structure is helpful for home visitors and families to use in their planning of home visits and socialization activities.

Roselia: In addition to that, we also have the Connecting Research to Practice briefs that are available on the ECLKC.  These briefs were developed to support home visitors in their work with children and families.  Each brief is topic specific and reviews the latest research that is important to child development, and it helps to inform effective practices.  The briefs also provide home visitors with strategies to talk with families about research on child development.  And then here are some additional resources that are available to home visitors to help you stay connected and expand your knowledge.  So, first we have the MyPeers home-visiting community, and this is a place to connect and collaborate with your peers.  Members share thoughts and strategies on staying connected with families, as well as intentional planning for home visits and socialization activities.  The individualized professional development portfolio, or the IPD, this offers self-paced courses, including the effective practice guides for infants, toddlers and preschoolers, and then the beginning home visitor series.  And then there's the Text4HomeVisitors.  Sign up to receive text messages with information, tips, research, and resources to strengthen and support your home-visiting practices.  And then lastly, we want to encourage you to continue to visit the ECLKC Coronavirus Prevention and Response page for the latest news and updates and resources.  We know that things are quickly changing.  And then this is -- this is a great resource for you to stay connected as those changes are happening.  OK, so let's take a breath here.  Adriana and I, I feel like we've covered a lot of information in a short amount of time.  We hope that you will take these new resources and share them with your families, with your teens, reflect with your education managers, but ultimately utilize them to support your virtual home-visiting practices.  We want to use the final minutes of our time together to respond to your questions.  So, Adriana and I are going to go off camera so that we can sort through questions and look for some themes.  And so, right now, what we want is, want to encourage you to enter any questions related to today's topic into the Q&A.  And we're going to, as I mentioned, we're going to go in there, we're going to sort through, and we want to take some time to answer your questions.  So, let's get started with that.  OK, so before we get started, as a reminder, we do want to let you know that if we do not get to your question, our plan is to put together a document with questions as well as those responses and then post that in the MyPeers home-visiting community.  So, be sure to submit your questions.  And again, if we don't get to them today, please don't feel that we didn't see your question, but we just want to make sure that we capture all the questions and then put those in a document with the responses in the MyPeers community.  Alright, so our first question...  This is actually a question that we saw that came up in the MyPeers home-visiting community as well.  And so, the question was asking for ideas on how to make home visits more inviting.  Adriana, do you have some suggestions based on your experience?

Adriana: Sure, I have a few ideas.  One of the things that we need to remember is that regardless of the type of home visit, either in person or virtual, the foundation for success is still the same -- relationships.  We need to do whatever possible to sustain those strong partnerships with families and keep the communication flowing.  We know that needs have changed, and families as well as programs, need more support than ever.  So, home visitors need to respond genuinely to each family needs to reinforce those partnerships.  We have discussed different strategies throughout the webinar to highlight the importance of learning experiences to promote positive outcomes.  So, remember to keep your enthusiasm and energy high by taking care of yourself.  And of course, it is essential to be prepared and to be flexible keeping in mind that life will happen during those visits, and we need to relax and go with the flow.  Now, I have an example.  We need to be aware that many families might feel isolated as they maintain some distance from their friends and extended family members and many of the activities they have been part of or their routines have changed.  Some programs are trying new strategies to minimize the sense of isolation by facilitating brief extracurricular activities according to the family's interest, such as cooking, gardening, meditation and yoga, dancing.  So, home visitors can still be supportive by providing information about any groups in their communities that might have activities focused on the family's changing needs and interests.  So, basically, we need to maintain those strong relationships with families, and home visitors are experts on that.  We know that, and to be responsive more than ever to their changing needs and challenges.  So, remember that all families want the best for the children, which includes effective learning, and we need to keep going back to that major goal.  Always connect your activities to that goal and facilitate activities that are exciting with accessible materials, highlighting what the child will be learning and how those skills are aligned with the learning outcomes.  On the other hand, home visitors also need to be supported with resources and strategies are the ones we highlighted, and also by networking with their colleagues to get fresh ideas about new strategies and activities to keep the engagement going.  There is a lot of creativity out on the field.  I can never stop surprising myself about the things the programs are doing, and we always learn something new and exciting when we network.  So, Roselia, is there something else you would like to add?

Roselia: Yeah, just a couple of things.  I agree with everything that you have shared here.  When I think about making the home visiting or the experience inviting for the family, whether it's a virtual or in person, this is really based on our ability to meet the family where they are, so to speak.  And I really want to emphasize the importance of that joint planning.  When we're joint planning with the family, they feel a part of that process, and we want the agenda for that visit to really be based on the family needs.  And then within that process, our work comes in with weaving in those opportunities for promoting parent-child interactions and then facilitating those high-quality learning experiences.  So, we always want to wrap around, as we mentioned earlier in the presentation, we want to make it about the child.  And then remember some of the things that we talked about regarding self-awareness, particularly if you are conducting those virtual home visits.  Self-awareness is really important.  The visit can seem uninviting if our approach is overbearing, and then the parents are feeling like we're not listening to them.  So, just kind of be mindful of our self-awareness, and then also just kind of looping back and making it about the child.  OK, so I'll turn it back over to you, Adriana.

Adriana: Yeah, I totally agree.  Those are great points that we need to keep in mind.  We can now move into the next question that came up that I thought will be good to share some feedback with everyone.  The question is how to maintain a healthy balance while supporting families virtually.  What can you tell us about that, Roselia?

Roselia: That is a really great question, and we're talking about that balance.  Dr. Harden talked about the fact that, as case managers, we're not -- Not case managers, but as home visitors, we're having to maintain that balance between promoting those parent-child interactions as well as case management.  So, this really lends itself to the commitment that we talked about at the beginning of our session today, and that is self-care.  We really need to make this a priority.  Now, I hope that I'm understanding what the individual was asking, but I would think that this is an indication that staff themselves are experiencing additional stressors during this time, right?  I mean, we just can't ignore that.  So, we talked a little bit about this during the presentation, but I would reiterate the importance of establishing boundaries and then committing to time for yourself.  If we schedule it, then we can make that a priority.  Try the deep breathing before each of the visits to kind of help clear your mind and then focus on that task at hand.  And then lastly, I would also say that we need to learn to relax during the virtual visits.  We are learning through this process.  I mean, it's kind of one of those things that we're flying the plane as we're building it, and so we have to accept that it's not going to be perfect.  And we're working with technology.  I mean, there's many things around technology -- limited technology, no technology, getting comfortable ourselves, as well as getting the family comfortable with technology.  And ultimately, we can sometimes create unnecessary stress for ourselves because we get caught up in all the details that we miss the bigger picture, and that is connecting with the family.  So, I would say that maintaining a healthy balance is really about making a commitment to take care of ourselves so that we can then focus on and then also have energy for the families that we serve.  So, with that, let's explore another question that came up, and it's related to cancelations or parents not showing up at the time of the appointment.  So, what can be done to support families in these situations?  Adriana, what can you say about this situation?

Adriana: Yes, Roselia, there is a lot to say because that is certainly a big one.  First of all, remember to keep your partnerships strong.  As we mentioned before, the stronger we sustain those relationships, the more commitment we could see from the families.  Also, to set a good example, we need to keep our schedule visits agreed unless we do have a real emergency.  I have found in my experience that after I canceled a visit, it will be more common for families to do so as well.  So, we have to be very careful with that.  So, now on the technical side, we need to prepare families for visits and ensure that they have everything they need.  We know that families are experiencing challenges more than ever, and more than ever, they need our support too.  So, we can start by checking in briefly via text or phone call to remind them of the visit, discussing and deciding the space in the home where the visit could take place.  So, also preparing the family for what you have planned for the visit, such as we will be doing the sorting activity today and these are the skills that your child will be practicing so they can have an idea of how important each visit is and what the children are going to be learning.  We also need to confirm the video and the internet access to provide if we need to provide it when it's possible, and remember to allow the parents to drive the session.  Be proactive also by anticipating some issues that may occur.  If the technology is not connecting, agree on a backup plan and strategies so you both know what's going to happen if things don't work out how you have planned.  And finally, support set up with video for families, set clear expectations, and keep open communication.  For more information, you can review one of the handouts that we have.  It's called Serving in a Virtual Environment Cheat Sheet.

Roselia: Thanks, Adriana.  Those were some great strategies, and I'm really glad that you remember to mention that particular resource.  I think there's a lot of good information in there.  So, here's a question regarding strategy, asking about strategies again.  So, this one is, what are the best practices when it comes to virtual learning?  And the office of Head Start has offered some guidance for best practices that come to my mind.  And so, the first one is, again, stopping, taking a breath and just really focusing.  We can very easily get overwhelmed, and so we want to -- we want to take that breath and focus.  We know that we are all worried about families and children during these times, and we know that parents want what is best for their children, right?  And we want to help them achieve their goals.  So, it's important to remember guidelines that are established by your programs as well as the Head Start Program Performance Standards.  With these in mind we're already starting from a good place.  And then there are so many unknowns, but we know that you are working hard to make the best decisions for children and families.  Also, we need to remember that we want to rely on our skills and our knowledge.  We know how to do this.  Partnering with families to achieve children's school-readiness goals is a core principle of Head Start, and so utilize data that's available to you.  Look for guidance from the office of Head Start, local information and good common sense judgment when making decisions about how to approach virtual learning with families.  So, when we think about this, here's a few guidelines to keep in mind.  Virtual learning approaches must be individualized for each family situation.  We know that every family is impacted by the current crisis differently.  We have some parents that are working full time outside of their homes.  We have some that are working staggered hours or working multiple jobs.  Some are working from home, while others are out of work.  And then we could also have instances of multiple families that are living in one home.  These are all going to impact our ability to connect with these families virtually.  So, conduct individual planning with each family to determine what their visit will look like, how long it will be, and then who will be involved, as well as languages that they prefer.  And then lastly, I want to mention, because I know we're running out of time here quickly.  There's many resources and supports on the ECLKC, so connect with those resources, and then also check in with your supervisors and your managers to explore what resources are available to make those connections for the individual needs that your families have.  So, the ECLKC, your MyPeers community, there's resources that are available to help support your work.  OK, Adriana, I'm going to turn it back over to you.

Adriana: Yeah, thank you, Roselia.  It's great to know that we have all those great resources to support programs.  So, well, that concludes the time we have together today.  We encourage you to visit the MyPeers community to continue the conversation.  Roselia and I are your new facilitators for that community, and we look forward to engaging with you there.  So, thank you for joining us today, and we also want to send a thank you to Dr. Brenda Jones Harden for sharing her insights.  And we look forward to hearing more from her in future sessions.  So, we appreciate very much your participation, and have a great afternoon.

Home visitors value the diversity and unique contributions each family brings to creating learning opportunities within the home environment. Partnering with and engaging families virtually can bring some unique challenges that require adapting practices in meaningful and relevant ways.

In this webinar, explore strategies and resources to plan individualized virtual home visits for all children and families. Learn about new resources available to assist with virtual learning and engagement. Note: The evaluation, certificate, and engagement tools mentioned in the video were for the participants of the live webinar and are no longer available. For information about webinars that will soon be broadcast live, visit the Upcoming Events section.

Video Attachments

• Webinar Slides (1.74 MB)
• Participant's Guide (729.18 KB)

Additional Resources for Virtual Home Visiting Strategies that Support All Children and Families

• Tips for Virtual Support of Parent-Child Interaction
• Observing in the Virtual Environment Tip Sheet

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Use of Virtual Reality Technology to Support the Home Modification Process: A Scoping Review

Na-kyoung hwang.

1 Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul 02062, Korea; moc.liamg@18noitapucco

Sun-Hwa Shim

2 Department of Occupational Therapy, College of Medical Science, Jeonju University, Jeonju 55101, Korea

Associated Data

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Healthcare is a field in which the benefits of virtual reality (VR), such as risk-taking without consequences, direct experience, and service outcome prediction, can be utilized. VR technology has been used to help clients face environmental barriers by implementing a home environment in virtual reality without a home visit by an expert. This scoping review was conducted to identify the areas and implementation methods of the home modification process supported by VR technology. Twelve studies met the research criteria. The following three types of tools supported by VR technology for the home modification process were identified: educational tools for clients or specialists, home environment measurement tools, and intermediaries for decision making and collaboration between clients and specialists. Most of the studies reported positive results regarding the usability and acceptability of the technology, but barriers have also been reported, such as technical problems, inappropriate population groups for technical use, cost-related issues, the need for training, and fear that the technology could replace home visits. Thus, VR technology has potential value in the home modification process. However, for future clinical applications, additional studies to maximize the benefits of these VR technologies and address the identified problems are required.

1. Introduction

Home modification, as part of occupational therapy (OT) interventions, is a general compensatory strategy used to improve occupational performance and reduce environmental barriers in the home environment of clients with functional limitations [ 1 , 2 ]. It has traditionally been implemented based on the “Person–Environment–Occupation” model, which is a conceptual framework for OT [ 3 ]. Occupational therapists provide a home environment suitable for individuals by supporting a virtuous cycle in which people, activities, and spaces are mutually supported and utilized [ 4 ]. OT-led environmental assessment and modification generally comprise comprehensive assessments of the individual, their activities of daily living, and their environment and strategic interventions focused on these areas. Strategic interventions include the prescription of assistive technology and adaptive training, material adaptation such as applying non-slip strips on stairs, behavioral adaptation such as refraining from hazardous activities, and structural modifications such as installing stair lifts [ 5 ]. Home modification services reduce the caregiver burden of client care [ 6 ], delay the admission of the client to a facility [ 7 ], and contribute to the reduction in falls [ 8 ]. Studies have also reported that home modification by occupational therapists increases clients’ self-awareness of activity performance [ 9 ] and their acceptance of the results of home modification [ 10 ].

Home modification services are organized in various ways in different countries; however, they share the involvement of multiple stakeholders such as paying authorities, builders, and interdisciplinary healthcare team members [ 2 ]. To modify the home environment optimally, it is necessary understand the environmental barriers in the home and the structural changes required to solve them, the use of assistive technology, and changes in the client’s occupational performance, and to collaborate with stakeholders to address these areas [ 11 ]. The lack of communication between stakeholders involved in the home modification process can impede the smooth progress of the process and result in environmental modifications that do not reflect the client’s needs and desires, leading to the client’s maladjustment to the environment and a decrease in their satisfaction [ 12 , 13 ]. In addition, 2D drawings of spatial design, photos, or online image prints of assistive equipment, which have been primarily used for coordination and collaboration with stakeholders during the home modification process, are limited in their ability to help the stakeholders fully understand the environmental modification. In particular, it may be difficult for clients to imagine or surmise the application of assistive equipment when only image materials are provided, without a demonstrative experience [ 14 ].

Virtual reality (VR) is an immersive and interactive technology that marks new milestones in the ways people interact with their environment and envision new approaches in their relationship to reality [ 15 ]. The immersive environments created by VR technology, such as 3D virtual worlds or games, are interesting because of their potential to enhance learning through situational experiences, various perspectives, or knowledge transfer [ 16 ]. VR has been gradually expanded and applied to various fields, such as defense, medical care, architecture, and education, and related content is being actively developed [ 17 ]. In healthcare, attempts to actively introduce VR to rehabilitation treatment, surgery/treatment/medical training, and emotional management have increased remarkably [ 17 ]. The value of VR lies in enabling users to directly experience the targeted situation without experiencing the risks or errors that may occur in real situations [ 18 ]. In particular, the healthcare field is an area where the advantages of VR, such as opportunities for risk-taking and direct experience, are usefully applied [ 19 ]. Simulation is considered a standard method in healthcare education, and technology-enhanced simulation (TES) can be implemented using VR [ 20 ]. TES enables majors in healthcare-related fields to acquire knowledge and skills without harming clients or being in high-risk situations and to apply and practice the theory learned [ 21 ]. Moreover, instructors can provide feedback on practice in a safe and controlled setting [ 17 ].

E-health technologies, such as VR, enable user-centric access to healthcare. Clients receiving healthcare services can practice and experience target behaviors, and VR is useful in predicting service outcomes [ 19 ]. Recently, VR technologies have been used to help clients face environmental barriers by realizing the home environment without home visits. VR-based home modification software facilitates the cooperation between the client and expert in the home modification process by enabling the client to interact with various virtual home environments. It further increases the client’s insight into modification and helps home adaptation [ 22 ]. Moreover, these technologies offer the potential to increase access to home modification services for people in rural areas, reduce home assessment costs, and improve the quality of the process by supporting home assessment [ 1 ].

Ninnis et al. [ 23 ] reviewed existing technologies, such as digital photos and teleconferencing equipment, and new applications to support home assessments, but areas of home modification process supported by VR technology and the ways the technology is used have not yet been synthesized. The purpose of this study is to examine the areas and implementation methods of home modification processes supported by VR technology and explore the outcomes and barriers to VR technology application in home modification.

2. Materials and Methods

This review of VR technology use for home modification has applied a scoping review approach. According to the Arksey and O’Malley framework [ 24 ], scoping review has the following logical flow stages: (1) identifying research questions; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) an optional consultation stage. The final step of the framework was not performed in this review because of the exploratory nature of the review and lack of stakeholder involvement.

2.1. Stage 1: Identifying Research Questions

The following three research questions present a broad scope of VR technology use for the home modification process:

• Which areas of the home modification process are supported by VR technology and how is the technology implemented?
• How are the VR technologies evaluated in terms of usability, acceptability, and participant outcomes?
• What barriers to using the identified VR technologies were identified?

2.2. Stages 2 and 3: Identifying Relevant Studies and Study Selection

Related studies were identified according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 25 ] ( Figure 1 ). We searched four databases (MedlineComplete, Embase, CINAHL, and PsycINFO) to identify relevant studies on the use of VR technology for the home modification process published between 2000 and 2021. Moreover, the reference lists of the studies were searched to identify additional relevant studies. We also considered grey literature, which may be published in non-scientific journals, such as technology developments and case studies. Our basic search included search terms related to “virtual reality”, “home modification”, and “occupational therapy”. The following keywords were used: “virtual reality”, “mixed reality”, “augmented reality”, “3D” and “home modification”, “residential modification”, “environmental modification”, “home adaptation”, “home visit”, “pre-discharge home visit” and “occupational therapy”, “assessment”, “evaluation”, “assistive technology”, “education”, and “collaboration”.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. VR: virtual reality; HM: home modification.

The inclusion criteria for the research articles included research emphasis on the use of VR technology for home modification and availability of quantitative or qualitative data in full-text English. We excluded protocol studies, dissertations, theses, conference abstracts, and viewpoints. We did not limit the subjects of the study (e.g., to the elderly and patients) or the specific purposes of the use of VR technology (e.g., compensatory approach for home adaptation of clients with functional impairment), and we included studies in which VR technology was used in the home modification process. This review also included interventions using VR technology that are considered perspectives of OT practice in the home modification process, even if the technology developer or provider was not an occupational therapist.

The study titles and abstracts were examined after the initial search, and full texts of eligible studies were obtained. The manuscripts were searched for the presence of inclusion and exclusion criteria. A consensus to include each study in the scoping review was reached between the authors.

2.3. Stages 4 and 5: Charting the Data and Collating, Summarizing, and Reporting the Results

Data on the author, publication date, study design, home modification area, purpose, method, participants, main outcomes, and barriers were extracted from each article. One of the two authors performed data extraction, and the other verified that the data synthesis strategy was followed. A qualitative synthesis of the studies selected for this review was conducted. A tabular form was organized to compare the thematic information extracted from each study, and after analyzing the themes and barriers, textual descriptions were created for each study. The identification and extraction of thematic information was undertaken based upon areas of the home modification process supported by VR technology and the barriers in practice. Textual descriptions of each study are followed by the tabulation of results, grouping studies according to areas of VR technology use for home modification, the purpose and results of each study, how the technology was implemented, and VR technology barriers in practice. In Section 3 , the themes and summaries of the studies are organized by their research questions, and the findings related to each question are discussed.

The research literature on the use of VR technology for home modification was sparse at the time of this review, with only 12 articles meeting the inclusion criteria ( Table 1 ). Figure 1 shows a PRISMA chart illustrating the search results and review selection.

Summary of included studies.

HM: home modification, OT: occupational therapy, PT: physical therapy, VR: virtual reality, app: application, 3D: 3 dimensions, VR: virtual reality, SUS: systems usability scale, FP: floor plan, DEM: durable medical equipment, MPMA: MagicPlan mobile application, LDM: laser distance measurer, AR: augmented reality, AT: assistive technology, PSSUQ: Post-Study System Usability Questionnaire, MapIt: Mobile App, CIDAs: 3D Interior Design Applications, TAM: Technology Acceptance Model.

3.1. Characteristics of the Included Studies

A total of 297 participants were included in the 12 studies. Sample sizes varied across the studies, ranging from 3 [ 26 ] to 69 participants [ 19 ]. In most studies, except for one [ 26 ], occupational therapists were involved as technology developers or providers. Most of the included studies investigated participant perspectives, such as usability, acceptability, and use of VR technology, and the data collection tools used were specifically designed for the studies but were not verified. A summary of the characteristics of the included studies is presented in Table 1 .

3.2. Areas of the Home Modification Process Supported by VR Technology

Three VR-supported areas of the home modification process were identified from these studies. Four studies [ 19 , 27 , 28 , 29 ] used VR technology as an educational tool for clients or students of home modification, and three studies [ 22 , 30 , 31 ] used it as a tool to evaluate the home environment. The remaining five studies [ 26 , 32 , 33 , 34 , 35 ] used it as a tool to assist with optimal decision making and collaboration with clients in the home modification process.

3.3. VR as an Educational Tool for Clients (Stroke Survivors, People with Physical Disabilities, and the Elderly) and OT, PT Students

Threapleton et al. [ 27 ] applied a VR program designed as an educational tool that identified potential safety issues in the general home environment of stroke patients before they are discharged and informed of the need for assistive equipment and adaptations in the home. The study explored the acceptability, potential utility, and limitations of the VR program to occupational therapists and stroke survivors. The participants reported software-related technical issues, but they perceived the virtual home program as an effective visual means for the preparation and discussion of discharge planning.

Palmon et al. [ 28 ] evaluated the usability of the Habi-Test, which was designed to facilitate the planning, design, and assessment of optimal home and work settings for people with physical disabilities. Habi-Test addresses the need for environmental modifications by identifying barriers that limit the performance of tasks in the home environment, while the user navigates in a virtual home environment. Eight occupational therapists did not complete the task on the first attempt using the software, but after a few alternations, five out of the eight completed the task. The occupational therapists recommended continuous improvement and testing of the Habi-Test to address the frustration of the narrow field of view, difficulty navigating in the environment because of the narrow space, and difficulty in recognizing the current location.

Falls Sensei is a first-person 3D exploration game aimed at educating the elderly on external fall risk factors within the home environment. Users play a game to find all the risk factors present in each of the four areas (kitchen, bathroom, bedroom, and lounge and stairs) in the home. If they find a risk factor successfully, they are congratulated and a confirmation with an explanation of the risk factor is displayed on the screen. Money et al. [ 29 ] conducted usability tests for the program and investigated older adults’ perceptions and attitudes toward using the game in practice through a post-task interview. The participants reported “Good” levels of usability (systems usability scale score: 77.5/100) and positive attitudes in most items ( p ≤ 0.05 for 9/10 items). In addition, the participants improved their awareness of home hazard detection and became more aware of future modifications required in their own homes.

Second Life ® is a web-based virtual environment used as an educational tool for clinical evaluation and intervention in the home environment. It provides undergraduate students with educational opportunities for home modification interventions outside of the classic classroom environment. Sabus et al. [ 19 ] applied the VR program to OT and physical therapy (PT) undergraduate students and investigated the utility of the program and the achievement of decision-making learning goals for home modification. As a result, the participants reported that the VR program supported learning about home modification and promoted collaboration between majors: PT students focused on functional movements during a client’s daily activities, OT students focused on compensatory approaches, such as installing contrasting stairs for clients with reduced vision, and environmental modification recommendations were derived through the collaboration between majors. In addition, the participants showed high levels of achievement in learning goals for home modification decision making, such as a client-centered approach, consideration of context factors, and appreciation of unintended consequences.

3.4. VR as a Tool for Home Environment Measurement

In other studies, VR programs were used to measure and evaluate the home environment, such as room size, furniture, and door width, for structural change to improve the accessibility of the client’s home and the selection of suitable assistive equipment. The potential for home measurement using an adapted commercial MagicPlan mobile application (MPMA) and laser distance measurer (LDM) was explored by Tsai et al. [ 30 ]. They investigated the feasibility and usability of the MPMA and LDM with lay participants and clinicians. MPMA allows users to create floor plans that can contain virtually inserted pieces of durable medical equipment (DME). MPMA with an LDM allows users to virtually determine whether the ordered DME will fit in the measured environment. The results showed that 77% of lay participants spent less than 60 min completing floor plans, and clinician participants completed virtual home evaluations within 5 min in 73% of the cases. In addition, both participant groups felt that using MPMA for home evaluations was useful and recommended it. However, the ease of use of the MPMA was scored as neutral by both groups.

The 3D measurement aid prototype (3D-MAP) proposed by Hamm et al. [ 31 ] was designed to support the elderly in directly measuring and recording installations in their homes as part of the process of providing assistive equipment. For accurate measurement, an audio guide and 3D visual model, which guided the measurement of five installations (bed, bathtub, toilet, chair, and stairs) related to external factors of falls in the home environment, were provided. Although the need for some changes to the use of 3D-MAP was identified, most participants perceived this app as a useful tool to help with the measurement and reduce the time for the auxiliary equipment provision process. Moreover, the app showed good levels of usability and strong agreement among the participants, especially in terms of usability and learnability.

MapIt, developed by Guay et al. [ 22 ], allows a room to be scanned quickly and simply, produces a 3D representation of a person’s home, and explores home adaptations to enhance a person’s occupational engagement. Guay et al. documented the development of the app prototype and investigated the stakeholder views of the app’s acceptability. The results of the investigation of acceptability indicate that occupational therapists and relatives of individuals with disabilities found MapIt to be useful because it provided a global view and supported joint understanding of the environment. However, some concerns have also been raised: the need for a person to scan and provide technical support at a low cost for persons with major mobility or cognitive impairments, residual usability issues (complex software installation, low intuitiveness), and scan rendering (image quality and validity of measurements).

3.5. Intermediary for Collaboration and Decision Making between Clients and Occupational Therapists

In five of the twelve studies, the virtual environment was used as a tool to help clients understand home modification choices and facilitate communication with practitioners in the home modification process.

In three studies, 3D interior design applications were used. They supported the process of exploring a variety of potential interior designs and home modifications and allowed users to evaluate the relative benefits and challenges of these modifications before their implementation. Atwal et al. [ 34 ] explored the perceptions of occupational therapists with regard to using a VR interior design app as an assistive tool in the pre-discharge home visit process. Occupational therapists felt that the VR app had the potential to enhance clients’ understanding of home modification and enrich communication and client involvement. Although there were several suggestions for technical fine-tuning and modifications, such as adding equipment items, occupational therapists showed a positive response overall in the ease of use and the actual use of the application across a range of clinical settings. Money et al. [ 32 ] explored the perceptions of community-dwelling older adults of a 3D interior design application. The participants believed that the application served as a useful visual tool and had a clear potential to facilitate a shared understanding and partnership in care delivery. They were able to create 3D home environments; however, many issues were identified: interface considerations, size and scale, and the need to redesign the interface/functions to require less dexterity/motor skills. They also suggested that the most valuable usage scenario involved clients and practitioners jointly using a customized 3D interior design application in a face-to-face setting. In a previous study investigating occupational therapists’ perceptions in relation to 3D interior design software, the participants saw it as a useful tool that could enhance the status of OT within the healthcare profession and improve communication [ 33 ]. Although concerns have been raised, such as the need for training for familiarity with some 3D techniques and fears that it may replace home visits, most occupational therapists found the software useful as an additional tool for home visits. Furthermore, they considered that the software had the potential to facilitate home visits rather than replace them.

Aoyama et al. [ 35 ] investigated the usefulness and usability of a tablet-based augmented reality (AR) app that supports the home modification process by superimposing 3D assistive technology (AT) items onto real home environments. The participating occupational therapists reported the usefulness of the app, which facilitates client participation and collaboration in decision making for home modifications by providing visual cues (size, function, shape, etc.) about AT to be installed in the future. However, the occupational therapists also identified technical issues, such as the need to improve the fit, look, and functions of ATs in the home environment.

Unlike studies investigating cooperation and decision-making facilitation among stakeholders in the home modification process, Chandrasekera et al. [ 26 ] used AR technology as an assistive tool of a compensatory approach in client home adaptation. They developed a hybrid space within the participant’s living environment using an AR object location and information system based on visual and spatial organization. Then, they evaluated the user perceptions of older adults who had physical impairments and mild memory loss. The technology used simultaneous localization and mapping-based AR to create a hybrid space by superimposing information on the living environment to help the elderly live independently. The participants mentioned that the technology was easy to use, useful for organizing objects within the home environment, and if available, they would certainly use it to help them with their daily activities.

3.6. Barriers in Practice Using VR Technology

Most studies reported technical problems, such as difficulty with the navigation controls [ 27 , 28 ]; a lack of household objects or equipment items [ 27 , 28 ]; a need to improve the fit, look, and functions of assistive devices [ 35 ]; scan rendering [ 22 ]; and a need for clearer visual prompts and an alternative keyboard interface [ 31 ]. Other reported barriers were that the technology is not suitable for use by some population groups, such as the elderly [ 32 ], a lack of low-cost software support [ 22 ], a need for sufficient training to become familiar with the 3D technology, and a fear that the technology could replace home visits [ 33 ].

4. Discussion

This scoping review was conducted to examine the areas of the home modification process supported by VR technology, the areas of VR technology that support the home modification process, use of VR technology, perceptions of outcomes such as usability and acceptability by users, and the manifestations of barriers in practice.

The studies included in this review were either qualitative or descriptive studies to identify the problems and explore the feasibility of VR technology in the home modification process. It can be seen that VR currently requires further preparation for widespread use and future studies. The following three primary areas of VR technology for home modification support have been identified: educational tools for clients receiving home modification services and students learning home modification, tools for home environment assessment, and intermediaries for collaboration between the client and specialist. Home modification specialists in rehabilitation include an occupational therapist, physical therapist, and rehabilitation teacher responsible for determining home modification requirements and counsel throughout the environmental modification process, and a rehabilitation engineer, an architect with sufficient knowledge of disability-related accommodation and construction to develop bid-ready specifications, a contractor, or other individuals [ 36 ].

Home modification VR for educational purposes was primarily implemented as computer simulation presenting a scenario in which the user experiences environmental barriers in a virtual home environment through an avatar and solves problems by trying potential solutions. Such computer simulation software makes it possible to transfer and apply the learned information to the physical environment and to predict dangerous situations or unintended consequences that may exist in the real environment [ 37 ]. The occupational therapists and clients that participated in the study recognized the VR software as a useful tool to confirm the safety risks of the home environment and deliver information about home modification [ 27 , 28 , 29 ]. In addition, studies examining the usability of VR software for the purpose of educating students have reported that VR software promotes learning and collaboration among experts on home modification and achievement of learning goals [ 19 ]. Although many elderly and disabled people experience barriers in the home environment, the lack of clients’ awareness of home modification, and of information or media to help decision making are also factors that complicate access to home modification and the smoothness of the process [ 38 ]. In addition, education and training for home modification are not usually part of the accreditation curriculum in construction, design, rehabilitation, or OT programs, thus, learning opportunities for home modification experts are limited [ 38 ]. Therefore, VR technology has the potential to improve client awareness of the current home environment, provide key information regarding home modification, and holds sufficient value as a tool to provide innovative solutions for learning and training for home modification experts.

VR-based home measurement software is used to measure and evaluate the environment for structural changes to improve the accessibility of the client’s home and to select suitable assistive devices. In particular, the measurement of the client’s space is one of the processes necessary for the prescription and application of assistive devices, such as mobility aids (e.g., walkers and wheelchairs) or commodes. This provides a justification for the need to purchase assistive devices to clients and related parties involved in financial supporting the health and welfare systems [ 39 ]. The participants found that VR-based home measurement technology helped home measurement and potentially reduced waiting times for home visits [ 22 , 31 ]. Moreover, the global view supported by VR is a useful tool for enhancing the understanding of a person’s environment [ 22 ]. The key to the home improvement process is for the client to identify the environmental barriers with a professional to implement change, add assistive technology use, and promote occupational engagement [ 11 ]. Home visits are unavoidable to ensure the smooth progress of the home remediation process and to obtain optimal results, but they are a challenge for professionals and clients. Multiple home visits can lead to an inefficient use of resources, such as funds and time [ 40 , 41 ], and for some clients, home visits by experts can cause stress and anxiety. In addition, clients may have a negative perception of home modification as they consider that their mobility abilities are being evaluated [ 34 , 42 ]. Although some technical difficulties related to 3D reconstruction remain, environment measurement software using VR presents a possibility as an alternative or complement to in-person measurement of the environment through home visits.

VR can be a useful tool to help clients understand their environment modification choices and improve communication with specialists in the home modification process. A key task in the integration of healthcare and technology is to create opportunities for healthcare providers and clients to collaborate in the decision-making processes. To realize this, it is necessary for healthcare professionals to integrate and apply new technologies and services [ 43 , 44 ]. The three studies included in this review suggested the possibility of using a VR interior design app, which enabled the adjustments to the space to be shared and assistive devices to be prescribed with the client, as a tool to support home modification [ 32 , 33 , 34 ]. AR is a field of VR and is a computer graphic technique that synthesizes information from the real and virtual environments to create a virtual object that seems to exist in the original environment [ 45 ]. In relation to rehabilitation and home adaptation, AR programs support assistive devices or smart homes for people with physical disabilities [ 46 ]. Moreover, a mock-up AR program for cooperation and decision making in the home modification process has been developed and used [ 47 ]. Two of the studies included in this review considered AR technology. One study used tablet-based AR software to superimpose 3D assistive device items on the real home environment [ 35 ], and the other used an AR object location and information system for home adaptation and independent living of elderly clients with memory loss [ 26 ]. The participants in those studies found that AR technology enhances shared understanding and partnership between stakeholders [ 35 ] and has value as an auxiliary tool for decision making about home adaptation and independent daily activities for clients with memory loss [ 26 ]. The participants in these studies also suggested the need for fine-tuning software operations.

Most of the studies included in this review described the development of software to support home modification and investigated the usability of the software. The studies reported the need for improvement and additional studies on the technical problems of the software. Thus, VR software requires further preparation and testing before it can be implemented in the home process in general. Although the studies included in this review reported positive results in usability evaluations, a number of technical problems and modification recommendations have been raised in studies that applied software to support home modification. Many technologies that have been developed in the healthcare field are not adopted or are abandoned for various reasons [ 48 ]. While technological innovation is widely recognized as a key contributor to health, the lack of capacity of healthcare systems to support technology programs, abandonment of technology use by individuals, and difficulties with scale-up and spread are major barriers to technology non-adoption [ 49 ]. Therefore, to achieve a widespread use of the VR software for education, home measurement, and collaboration and decision making in the home modification process, it must be ensured that it meets the needs and values of users as well as solving the current technical problems, and that the software is more convenient than the existing methods and practices. In addition, it must be ensured that it provides advantages, such as increasing the value of home modification and efficient use of resources (e.g., time and funds).

Limitations

Only 12 studies were included in this review, and although some included quantitative data such as surveys, most studies were qualitative and focused on exploring the feasibility or usability of VR technology to support home modification. Therefore, it is not possible to demonstrate broad and general aspects of the usability or the effectiveness of VR technology for this purpose. Further studies on usability, feasibility, and the effectiveness of VR technology in the current home modification support system are also required. Furthermore, as the study sample was limited to the selection strategies described in the materials and methods section, it is possible that relevant studies were missed. Future research could extend the search to include additional databases or map the field over time.

5. Conclusions

This review primarily explored findings in the area of VR technology applications in the home modification process and their aspects, such as usability and acceptability. VR technology has the potential to improve client awareness of home safety, provide important information on home modification, and could be used as a useful educational tool in training home modification specialists. VR-based home measurement software can be used as an alternative or complement to in-person measurements through home visits. It also has the potential to be utilized as a tool to help clients understand their home modification choices and improve communication with specialists in the home modification process. Although most of the studies showed positive responses in the usability evaluations, perceived usefulness, and acceptability, technical problems and correction recommendations were also identified according to the VR application area. Further studies on VR technologies that effectively support the home modification process by maximizing the usability and benefits of software and addressing the identified technical problems of the software should be considered.

Author Contributions

Conceptualization, N.-K.H. and S.-H.S.; data curation, N.-K.H. and S.-H.S.; investigation, N.-K.H.; methodology, S.-H.S.; project administration, N.-K.H. and S.-H.S.; resources, N.-K.H.; supervision, S.-H.S.; visualization, N.-K.H.; writing—original draft, N.-K.H. and S.-H.S.; writing—review and editing, S.-H.S. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Accessibility options:

Guidelines for virtual home assessment tools

Health and Social Care Services Research

doi: 10.3310/nihrevidence_56294

This is a plain English summary of an original research article . The views expressed are those of the author(s) and reviewer(s) at the time of publication.

Virtual home assessments could reduce the need for in-person visits. New guidelines could help people develop and use the tools they need to carry out these assessments.

Home assessments are for people who struggle to do everyday activities because of disabilities, for example, after having a stroke. These people may require handrails or other adjustments to their home.

Researchers in Sheffield worked with service users and local healthcare professionals (including occupational therapists and social workers) to evaluate the pros and cons of virtual home assessments. The service users and allied health professionals gave feedback on virtual assessments in general, and also on a new video conferencing tool. They provided insights into how the assessments and the tool could be improved.

Virtual home assessments are faster than in-person visits and may allow people to be discharged from hospital more quickly. They also cut down on staff travel time and costs. However, key concerns included the safety of personal information, the availability of devices for service users and professionals, and verification of people’s identity.

The guidelines cover security, privacy and service user choice, among other issues. They are intended to help professionals create services that are practical, effective, and secure.

More information on home assessments is available on the NHS website.

The issue: home assessments are time consuming and expensive

Home assessments can take up to 4 hours and cost roughly £208 per visit. Conducting virtual home assessments could cut down on both time and cost.

Video consultations minimise face-to-face contact (important during the pandemic), and remove the need for travel. Remote consultations are cheap, short, and can allow relatives to join from elsewhere. They are being used increasingly. However, disadvantages include people being reluctant or unable to use new technology.  

Home Quick is a new virtual home assessment tool for video consultations. It allows a professional to control a service user’s smartphone and capture real-time notes. Researchers explored allied health professionals’ and service users’ views on the tool, and on virtual home assessments in general.

What’s new?

Researchers explored the pros and cons of the tool at 6 focus groups with service users and relevant professionals. They included occupational therapists, physiotherapists, dieticians, speech and language therapists, as well as workers from local authorities and the voluntary sector.  

The focus groups described the many benefits of virtual home assessments. They save time and money. They are faster than in-person visits, which means that people could be discharged from hospital more quickly. Recordings of visits could be shared with other bodies and reduce the need for multiple home visits. Virtual visits are safer for professionals because some homes can be hazardous or unhygienic.

Virtual visits also allow family members and carers to attend assessments from a distance. There is no need to travel, which means the same hospital could support more patients over a wider area.

However, key concerns with virtual assessments were:

• security; service users’ personal information should not be shared without their permission
• the availability of devices and stable Internet; a lack of technology could exclude certain service users (elderly people, for example) and widen health inequalities for those who could not afford the data to join a virtual assessment
• the need for professional training to use the tool and a lack of private consultation rooms for online assessments
• the impossibility of conducting some assessments remotely, such as checking for bad smells that indicate hygiene problems, or measuring room size and height to plan adjustments to someone’s home
• verification of whether the correct patient is being assessed in the correct property.  

Why is this important?

Based on insights from the focus groups, a literature review, and real-life case studies of virtual home assessments, the researchers developed guidelines for virtual home assessment tools.

• Visible security: service users should have easy access to security information (such as who can view the recording) and be able to opt how long their data, including the recording, can be stored. Professionals should be reminded of security protocols within an app or programme.
• Accessible help features should be provided in multiple formats (such as voice and touch activation).
• Service user choice: people should be helped to decide for themselves if they want virtual home assessments (except when an in-person visit is essential).
• Privacy: photos and videos taken during the assessment must be saved securely.
• Professional environment: professionals should carry out assessments in private, formal settings with minimal background noise, and ensure the microphone and camera work before starting the assessment.
• Support multiple users: assessment tools should accommodate multiple users so that family or carers can join calls (with the service user's permission).
• Identity and location checks should be carried out, such as location tracking or patients showing identification on screen.

What’s next?

These guidelines are intended to help developers and other allied health professionals create virtual home assessment tools that are practical, effective, and secure. They comply with existing health technology guidelines, such as NHS Digital Design Principles and the Topol review .

Virtual home assessments will never totally replace home visits. For example, where a close inspection of housing conditions is required to assess the person and their environment in context, in-person visits will still be needed. In addition, some service users may lack access to technology and internet or prefer face-to-face contact. There will be an ongoing need for in-person visits to avoid widening health inequalities. However, virtual home assessments could replace some in-person visits, avoiding unnecessary travel and the associated time and cost.

Future research could investigate whether home assessment tools need to be adapted for people with specific needs, such as blindness. In addition, whether video conferencing could be used for specific assessments, such as memory tests or examining issues with people’s wheelchairs.  

The focus groups were carried out in Sheffield, so future studies could investigate whether the findings are relevant in other cultural and geographical areas.

You may be interested to read

This Alert is based on: Lanfranchi V, Jones, N, Read, J, and others. User attitudes towards virtual home assessment technologies . Journal of Medical Engineering and Technology 2022;46:536–546.

An article summarising some of the preliminary studies that lead to this research.

A researcher blog about creating a human connection with service users via telehealth services.

A video demonstration of how virtual home assessment tools could be used.  

NIHR Evidence Alert: Hospital at home is a good option for many older people

Funding:  This study was supported by the NIHR Devices for Dignity MedTech Co-operative .

Conflicts of Interest:  The authors declared no conflicts of interest.

Disclaimer:  NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

Privacy Overview

Remote home visits: Exploring the concept and applications of remote home visits within health and social care settings

--> Jones, N. orcid.org/0000-0002-6177-1808 , Read, J. , Field, R. orcid.org/0000-0003-3502-2691 et al. (5 more authors) (2022) Remote home visits: Exploring the concept and applications of remote home visits within health and social care settings. British Journal of Occupational Therapy, 85 (1). pp. 50-61. ISSN 1477-6006

Introduction:

This study consulted intended users and adopters of technology about a remote home visit application called Virtual Visit Approach. Participants were shown a video of a ‘mock’ remote home visit and asked to discuss the potential benefits, barriers and uses they could envisage.

Methods:

Purposive sampling brought together stakeholders, patients and public representatives to capture thoughts, feelings and views in co-design workshops. Primary qualitative data were collected in real time. Post workshop, they were analysed and categorised into key themes and subthemes.

Findings:

The opportunity to conduct remote home visits was regarded as a positive adjunct to usual practice. However, concerns about the quality of remote assessments were expressed by participants in the workshops.

Conclusion:

The NHS response to COVID-19 sparked a national roll out of the use of video conferencing technology. The opportunity to access technology to conduct remote visits and consultations, has instigated a seismic change in the way healthcare is delivered now and for the future. However, there is much we do not yet know about the impact on the intended adopters and users of remote visits and consultations. This study demonstrated the importance of involving intended adopters and users in the co-design of technology to explore potential benefits, barriers and uses providing valuable insights to inform future design and development.

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40 facts about elektrostal.

Written by Lanette Mayes

Modified & Updated: 02 Mar 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

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Our commitment to delivering trustworthy and engaging content is at the heart of what we do. Each fact on our site is contributed by real users like you, bringing a wealth of diverse insights and information. To ensure the highest standards of accuracy and reliability, our dedicated editors meticulously review each submission. This process guarantees that the facts we share are not only fascinating but also credible. Trust in our commitment to quality and authenticity as you explore and learn with us.

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Victor Mukhin

• Scientific Program

Title : Active carbons as nanoporous materials for solving of environmental problems

However, up to now, the main carriers of catalytic additives have been mineral sorbents: silica gels, alumogels. This is obviously due to the fact that they consist of pure homogeneous components SiO2 and Al2O3, respectively. It is generally known that impurities, especially the ash elements, are catalytic poisons that reduce the effectiveness of the catalyst. Therefore, carbon sorbents with 5-15% by weight of ash elements in their composition are not used in the above mentioned technologies. However, in such an important field as a gas-mask technique, carbon sorbents (active carbons) are carriers of catalytic additives, providing effective protection of a person against any types of potent poisonous substances (PPS). In ESPE “JSC "Neorganika" there has been developed the technology of unique ashless spherical carbon carrier-catalysts by the method of liquid forming of furfural copolymers with subsequent gas-vapor activation, brand PAC. Active carbons PAC have 100% qualitative characteristics of the three main properties of carbon sorbents: strength - 100%, the proportion of sorbing pores in the pore space – 100%, purity - 100% (ash content is close to zero). A particularly outstanding feature of active PAC carbons is their uniquely high mechanical compressive strength of 740 ± 40 MPa, which is 3-7 times larger than that of  such materials as granite, quartzite, electric coal, and is comparable to the value for cast iron - 400-1000 MPa. This allows the PAC to operate under severe conditions in moving and fluidized beds.  Obviously, it is time to actively develop catalysts based on PAC sorbents for oil refining, petrochemicals, gas processing and various technologies of organic synthesis.

Victor M. Mukhin was born in 1946 in the town of Orsk, Russia. In 1970 he graduated the Technological Institute in Leningrad. Victor M. Mukhin was directed to work to the scientific-industrial organization "Neorganika" (Elektrostal, Moscow region) where he is working during 47 years, at present as the head of the laboratory of carbon sorbents.     Victor M. Mukhin defended a Ph. D. thesis and a doctoral thesis at the Mendeleev University of Chemical Technology of Russia (in 1979 and 1997 accordingly). Professor of Mendeleev University of Chemical Technology of Russia. Scientific interests: production, investigation and application of active carbons, technological and ecological carbon-adsorptive processes, environmental protection, production of ecologically clean food.   

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