This blog was written by Kate Fennell. Kate is a professional doctorate candidate, Fellow of the Higher Education Academy, and social work lecturer on the integrated Allied Health Professions and Social Work Masters programme at Edinburgh Napier University.
Whilst information and communication technologies had been adopted in health & social care (H&SC) practice long before the pandemic, the abrupt need to close non-essential workplaces accelerated the use of digital platforms for health consultations and interprofessional meetings. For many services, these online meetings have continued beyond the pandemic. Teleconference, MS Teams etc are convenient for collaborative meetings as a means to manage limited resources and reduce travel for both H&SC staff and people who use services, especially in geographically remote areas. Across the UK and Scotland, tribunal hearings were conducted using audio and video technologies, which helped to avoid significant delays (Byrom & Beardon, 2021) during the pandemic. However, there are also many disadvantages associated with Telecare and other remote IT use, as reported by the Covid Public Inquiry (McKay et al, 2024), with particular groups of people being digitally excluded.
My particular interest in this topic relates to research being conducted as part of a professional doctorate. As many of you will know, I’m undertaking an in-depth system level analysis of meaningful participation within the Adult Support and Protection Case Conferences (ASPCCs). As a reminder, the Adult Support and Protection (Scotland) Act 2007 mandates public bodies to investigate situations of harm and to support and protect adults at risk. One of the fundamental principles of the legislation is to involve the person in the adult protection process. The ASPCC is an interprofessional, multi-agency meeting which is convened to explore risk and develop a support and protection plan. It is now customary practice for the individual at risk to attend these meetings. But attendance does not necessarily equate to meaningful participation and attendance can be tokenistic.
Thirty-one research participants contributed to focus groups and semi-structured interviews conducted across Scotland. The research sample comprised adults at risk of harm, social workers, independent advocacy workers, ASPCC chairs and mental health officers. I am currently at the coding/thematic analysis stage of this research.
What I have learned is that despite an overwhelming view that individuals are better able to participate within face-to-face, in-person meetings, many ASPCCs continue to take place online. There are a number of reasons for this. In some circumstances, virtual case conferences do suit some individuals. Online meetings can provide a safer environment for those who have had previous unpleasant experiences of multi-disciplinary meetings e.g., hospital discharge, child/adult protection case conferences and mental health tribunals. Some people in receipt of services would rather avoid hospital or social work offices. Attending from their own home allows them more choice and control over the degree of their involvement, as they can mute their audio, switch off their camera and leave when they choose. Some people with impaired mobility or who have other difficulties in travelling to health or social work centres, may find remote meetings more accessible. However some research participants with mobility issues said that they would still rather attend these meetings in person.
For many people subject to adult support and protection measures, virtual meetings are inaccessible and exclusionary. For some with sensory loss, cognitive impairment or mental health symptoms, engaging with disembodied faces on a screen is very challenging. It is difficult to read people’s body language on a small screen. Gestures such as nodding, smiling and other forms of non-verbal affirmation signalling are lacking. Digital emojis while useful, cannot replace the in-person contact and the physical presence of being in the room with others. An inability to develop a rapport with others inhibits meaningful participation and engagement. Lack of technological knowledge or equipment and Wi-Fi issues are additional barriers to be considered.
The most frequently acknowledged benefits of remote ASPCCs are related to efficiency and increased attendance by GPs and other healthcare professionals. These points are echoed in Driscoll et al’s (2020) study on multi-agency safeguarding arrangements and in Byrom and Beardon’s (2021) evaluation of the impact of Covid on MH Tribunals in England and Wales. These may be the most compelling reasons for the continuation of on-line ASPCCs.
Without exception, every participant in the current research study said that decisions regarding the optimal platform should be person-centred and determined by the person’s individual circumstances, their needs and preferences. People should be offered the choice of how they wish to attend their meeting. The question remains as to whether virtual meetings can truly offer a psychological safe space in which attendees can meaningfully contribute and participate.
I would be interested to hear people’s views of the virtual vs in-person debate and your experiences of these online H&SC meetings.
References
Byrom, N., & Beardon, S. (2021). Understanding the impact of COVID-19 on tribunals. The Legal Education Foundation.
Driscoll, J., Lorek, A., Kinnear, E., & Hutchinson, A. (2020). Multi-agency safeguarding arrangements: overcoming the challenges of Covid-19 measures. Journal of children’s services, 15(4), 267-274.
McKay, C., Stavert, J., Johnston, L., Murray, J., Rek, J., Breen, C., Zarins, A. Woodrow. A., Anderson, L. & King, M. COVID-19 Public Inquiry: Research Report for Portfolio 3 The Provision of Health and Social Care Services Adult Social Care. Centre for Mental Health Practice, Policy and Law Research, Edinburgh Napier University
