“when in roam” (remote orientation and...
TRANSCRIPT
“When in ROAM” (Remote Orientation and Mobility):
Exploring new frontiers in video conferencing techniques to expand the delivery of O&M services to clients in regional and remote Western Australia
Amy Barrett-LennardOrientation & Mobility Specialist /
Occupational Therapist
IMC16Dublin, Ireland
Tuesday 27th June [email protected]
Vithya Vijayakumare
Digital Production Coordinator
Accessible Information Services
Accessible ePub 3:The Road to “Inclusive Design”
www.visability.com.au
What is ROAM?
ROAM = Remote
Orientation &
MobilityConducting O&M
assessments and
interventions via video
conferencing
www.visability.com.au
Why ROAM?
www.visability.com.au
• Total area of 2,529,875 km2
(33% of Australia’s total!)
• Population of 2.6 million people
(11% of Australia’s total)
• 533,000 (20%) people live in
regional areas
• Over 25% of VisAbility clients live in
regional areas of WA
Why ROAM? The West Australian (WA) Context
www.visability.com.au
VisAbility in WA
• Head office: Perth
• 4x O&Ms, all part-time
• Regional Offices:
• Mandurah (Peel): 1x OT (part-time)
• Bunbury (South West): 1x O&M, 1x OT (both part-time)
• Albany (Great Southern): 1x OT (part-time)
• Geraldton (Mid West): 1x OT (part-time)
• Typical O&M regional trips:
• Geraldton, Albany, Goldfields, Kimberley region, Pilbara region
www.visability.com.au
• Challenges: geographical vastness and remoteness
• Limited access to services
▪ Primary, medical, aged, allied health, specialist
• Higher costs of service delivery:
▪ Accommodation
▪ Transport
▪ Staff turnover and recruitment
▪ Service time lost to travel
• Key strategy adopted by WA Health Department is rapid
expansion of Telehealth into regional WA
WA Regional Health
www.visability.com.au
• Recruitment difficulties
▪Study options only available interstate/overseas
• Workforce demographic
• Nature of O&M Services
▪ Length of programs
▪Specialised service
O&M Service Delivery in Regional WA
www.visability.com.au
Delivery of Allied Health Services (including
Orientation & Mobility) via video conference is:
✓ Relevant
✓ Needed
✓ Soon to be Standard Practice
How did ROAM begin?
ROAM Relevancy in WA
www.visability.com.au
• 2 year Pilot Project
• Funded by Department of Social
Services (Federal Government)
• Goal: delivering services to
children with sensory
impairment, and their families, in
regional areas
• VidKids Alliance: Australia wide,
multiple agencies involved
• Microsoft Lync
video conferencing software
The Background: VidKids
Services: OT, physiotherapy, speech
pathology, counselling support
www.visability.com.au
What about O&M??
www.visability.com.au
• 1st Pilot Project
completed by VidKids
Alliance; October 2014
• 6 tests completed
• Trialing software and
equipment options
• “Does ROAM have
potential???”
ROAM: First Pilot
www.visability.com.au
• Conducted by VisAbility
• 3 months: April – June 2015
• Funded by VidKids
• Trialling various equipment
and methods
• 11 participants; 6 clients
• 25 trials completed; 36 hours
• “Can ROAM work???”
ROAM: Second Pilot
www.visability.com.au
• Conducted by VisAbility
• 2 year trial: August 2015 – August 2017
• Funded by WA Disability Services
Commission
• Establishing best practice, gaining
experience
• “How do we use ROAM well, in a variety
of O&M programs???”
ROAM: Third Pilot (current)
www.visability.com.au
ROAM Equipment
• iPhone 6+ and HitCase cover
• HitCase chest harness
• Duet dual speaker/microphone
• AfterShokz wireless bone
conducting headphones (for
client)
• HitCase Camera Lens attachments
• Separate mobile and Bluetooth
headset (for support person)
• Computer; Desktop/laptop/tablet
• Vidyo software platform
• beingthere IT support
www.visability.com.au
• Provide instruction
• Seek information
as needed (from
client or support
person)
• Consult other
sources (Google
maps, street view)
ROAM Method: O&M Specialist
www.visability.com.au
• Support Person is with
the client in the
training environment
• Responsible for:▪Equipment set-up
▪Client Safety
▪Providing additional
information to the O&M
Specialist
ROAM Method: Support Person
www.visability.com.au
ROAM Method: SupportPerson
Support Person can be:
• Allied health staff (OT, OT
student, etc.)
• Family (parent, partner, etc.)
• Carer
• Community health worker
www.visability.com.au
ROAM: Live Demonstration
www.visability.com.au
ROAM Outcomes: Current Pilot StatisticsAugust 2015 – 16th June 2017
• Clients: 39
• Age range: 6 months – 91 years
• ROAM service events: 95• Remote: 49
• Face-to-face: 46
• ROAM service hours: 133• Remote: 64
• Face-to-face: 69
www.visability.com.au
• It works!!
• Development of resources and best practice guidelines
• Pilot Project 1 year midway report (clients <65yrs):
• 9% increase in number of clients receiving O&M
• 70% increase in number of O&M service events
• 140% increase in hours of O&M
ROAM Outcomes
www.visability.com.au
• Through ROAM, clients in regional areas are now able
to access an O&M service that is:
▪ thorough
▪ better able to meet their O&M needs
▪ on par with services received by clients in the metropolitan area
• The length of the O&M program is now determined by
the client’s goals
• No longer limited to the length of time the O&M
Specialist spends in their town.
ROAM Outcomes
www.visability.com.au
“ROAM was never intended to
replace face-to-face O&M
service delivery. Rather, it is
designed to complement
existing face-to-face services”
www.visability.com.au
• Cancellation of 3 regional trips:• 2x Geraldton trips (September 2016, February
2017)
• 1x Albany trip (April 2017)
• Cost Saving = Approx. $3240
= Approx. €2204
• Added benefit: less time away from
metro caseloads
ROAM Outcomes: $$$
Albany Trip
Flights $550
Accommodation $675
Car hire and petrol
$450
Meals and extras $233
TOTAL = $1908 = €1296
Geraldton Trip
Accommodation $375
Petrol $150
Meals and extras $140
TOTAL = $665 = €452
www.visability.com.au
• Multi-disciplinary/family involvement in ROAM
sessions
• Exposure to Video Conferencing
• Use of an iPhone:
▪ Existing technology
▪ Many other functional applications (multi-purpose,
e.g. VoiceOver to access information)
▪ Benefits of iPhone extend beyond ROAM program
▪ Accessible (readily available)
▪ Accessible (in-built accessibility)
▪ Superior Technical Support (and peer support)
ROAM Outcomes: Other Benefits
www.visability.com.au
• Perth
• Kununurra
• Fitzroy Crossing
• Broome
• Bunbury
• Albany
• Geraldton
• Exmouth
• Esperance
• Denmark
• And more!
Geographical Expansion
www.visability.com.au
The biggest distance for a ROAM session??
• O&M Specialist: Hobart,
Tasmania
• Client: Dindiloa, WA
• Distance: 4,500km
• Driving Time (including
ferry): 55 hours
• Flying time: 9 hours
www.visability.com.au
• Assessment (Client Interview, Functional Mobility Assessment)
• Orientation training (to a new area, indoors and outdoors)
• Route travel and public transport training
• Road crossing training
• Mobility Aid prescription and training
• School-aged and early intervention
• Acquired Brain Injury (ABI)
• Assistive technology training (e.g. smartphone applications)
• Guide Dogs
ROAM Applications
www.visability.com.au
Camera Options: Additional Lenses
No lens: iPhone 6+ camera HitCase Wide Angle Lens HitCase Super Wide
Angle Lens“What is the goal of the O&M session?”
www.visability.com.au
Camera Options: Camera Angle
Client POV: ‘Street View’ Client POV: ‘Cane View’ Support Person POV
“What is the goal of the O&M session?”
www.visability.com.au
• Technological Malfunctions: several
points of failure
• Equipment malfunctions (not
experienced with current equipment)
• Not suitable in wet weather
• Not suitable for night-time mobility
training
• Impact on rapport building
• Logistics of matching availability of
O&M, Support Person and Client
ROAM: Limitations
www.visability.com.au
• Client feedback survey
• Using 5-point rating scale system
• Completed by third party
• Survey completed pre/post ROAM program
Pilot Project Survey Results (preliminary)
• Support Person feedback survey
• Using 5-point rating scale system
• Completed by third party
• Surveys completed at end of Pilot Project
www.visability.com.au
Self-rating of general mobility and
travel skills
75% reported an increase of 1-2 points
Self-rating of ability to access their local
community
75% reported an increase of 1-2 points
Self-rating of confidence in their mobility
skills and community access
75% reported an increase of 1-2 points
Feeling of safety during ROAM sessions 100% reported feeling “extremely safe”
Frequency of leaving their home 50% reported “same as before”
50% reported “more often”
Satisfaction in the equipment used during
ROAM sessions
75% reported feeling “extremely satisfied”
Satisfaction in the communication during
ROAM sessions
75% reported feeling “extremely satisfied”
Would you recommend the ROAM services
to others?
100% reported “Yes”
www.visability.com.au
• “I felt confident because you were talking right there in my ear and
(SP) was behind me just to watch over me for any danger.”
• “I felt very confident to walk the route myself (after one session)
because the crossing points that you told me were very clear and
easy to remember.”
• “...(the harness) was no problem at all. It was light and
unobtrusive.”
• “…it didn’t feel that much different than a regular session.”
• “I’d feel confident continuing the lessons via video linkup.”
• “I can’t believe how smoothly it went.”
ROAM Feedback: Clients
www.visability.com.au
• “It was a very rewarding experience. I felt confident
whilst with the client, knowing I could talk to the
O&M at any time.”
• “It was remarkable that the client was able to carry
out a typical O&M session… without the O&M being
physically present.”
• “The set up and use of the equipment provided was
very simple.”
ROAM Feedback: Support Persons
www.visability.com.au
• Clients to have their own “ROAM kit”
• Loan ROAM kits – remote areas
• ROAM kits funded by NDIS (National Disability
Insurance Scheme)
ROAM: The Future
www.visability.com.au
• Blind Citizens Convention; Perth, November 2015
• AOMC5 (Australasian Orientation and Mobility Conference 5); Melbourne,
November 2015
• IGDF Seminar (International Guide Dog Federation); Croatia, May 2016
• Article published in IJOM(Vol. 8) (International Journal of Orientation &
Mobility); 2016
• National Disability Services Clinical & Allied Health Forum; Perth, May 2016
• Technology Outlook; Perth, September 2016
• Irish Guide Dogs for the Blind; Cork, June 2017
• IMC16 (16th International Mobility Conference); Dublin, June 2017
Exposure and Industry Response
www.visability.com.au
ROAM Case Studies & Video Samples
www.visability.com.au
Jennifer
• Visual Diagnosis: brain tumour right
hemianopia
• Age: 58
• Client Location: Geraldton
• O&M Location: Perth
• Distance: 424km / 263mi (4.5 hours)
• Support Person: VisAbility OT (Eliza)
• Reason for referral: Difficulties with
depth perception and not confident when
walking in the community
www.visability.com.au
Example of Assessment (Client Interview)
www.visability.com.au
Stephen
• Visual Diagnosis: Toxoplasmosis
Retinochoroiditis Vision impaired
• Age: 48
• Client Location: Geraldton
• O&M Location: Perth
• Distance: 423km / 263mi (4.5 hours)
• Support Person: VisAbility OT (Eliza)
• Reason for referral: Issues with depth
perception and orientation in the
community. Currently using a walking
stick.
www.visability.com.au
Example of Assessment (Functional Mobility)
www.visability.com.au
Bradley• Visual Diagnosis: Retinopathy of
prematurity, myopia Legally blind
• Age: 19
• Client Location: Albany
• O&M Location: Perth
• Distance: 405km / 252mi (4.5 hours)
• Support Person: VisAbility OT (Julie)
• Support Worker: Bison
• Reason for referral: Would like to
increase independent mobility and
community access. Anxious about
crossing roads.
www.visability.com.au
Example of Long Cane Training
www.visability.com.au
Christene
• Visual Diagnosis: Macular
Degeneration (dry) Vision Impaired
• Age: 77
• Client Location: Esperance
• O&M Location: Perth
• Distance: 709km / 441mi (7.5 hours)
• Support Person: VisAbility OT (Allira)
• Reason for referral: Starting to feel less
confident when accessing the
community. Pain in knees following TKR
complications.
www.visability.com.au
Example of Support Cane Training
www.visability.com.au
Arthur
• Visual Diagnosis: Retinopathy of
prematurity Totally blind
• Age: 33
• Client Location: Perth (first pilot)
• O&M Location: Perth
• Distance: 33km / 21mi (30mins)
• Support Person: VisAbility OT (Kirsty)
• Reason for referral: Recently moved to
WA from interstate, requiring general
orientation to his new suburb
www.visability.com.au
Example of Orientation Training (Indoors & Outdoors)
www.visability.com.au
Emmanuel
• Visual Diagnosis: Retinitis Pigmentosa
Light perception
• Age: 44
• Client Location: Perth (first pilot)
• O&M Location: Perth
• Distance: 12km / 7mi (16 mins)
• Support Person: VisAbility OT (Sarah)
• Reason for referral: Recently moved
house, required orientation within his
new suburb and walking route to local
shops
www.visability.com.au
Example of Road Crossing Training
www.visability.com.au
Jayde• Visual Diagnosis: right corneal anterior
staphyloma, left microphthalmia
Legally blind
• Age: 13
• Client Location: Perth (first pilot)
• O&M Location: Perth
• Distance: 40km / 25mi (35 mins)
• Support Person: VisAbility OT (Allira),
Mother (Nicole)
• Reason for referral: Wants to increase
confidence and independence within her
local area; walking route from home to
shopping centre
www.visability.com.au
Example of School-Aged O&M
www.visability.com.au
Diane• Visual Diagnosis: stroke vestibular
ocular reflex dysfunction
• Age: 52
• Client Location: Perth (first pilot)
• O&M Location: Perth
• Distance: 47km / 29mi (40 mins)
• Support Person: OT student (Julia)
• Reason for referral: Unable to travel on
bus without becoming dizzy and severely
nauseous. Currently using walker for
balance. Would like to be more
independent with her mobility.
www.visability.com.au
Example of Public Transport Training
www.visability.com.au
Karen• Visual Diagnosis: Stroke left sided
visual inattention
• Age: 46
• Client Location: Geraldton
• O&M Location: Perth
• Distance: 421km / 262mi (4.5 hours)
• Support Person: VisAbility OT (Eliza),
Partner (Daniel)
• Reason for referral: Would like to increase
independent mobility and community
access. Currently using electric wheelchair.
Goal is to accompany her young daughter
(Scarlett) to and from school.
www.visability.com.au
Example of Wheelchair Mobility Training
www.visability.com.au
Siyat
• Visual Diagnosis: Light perception only
• Age: 50
• Client Location: Perth
• O&M Location: Broome
• Distance: 2,330km / 1,448mi (24 hours)
• Support Person: VisAbility OT (Sarah)
• Reason for referral: Recently moved
house and needing urgent orientation to
new bus stop for travel to full-time work.
O&M away on regional trip at the time
(“reverse ROAM”).
www.visability.com.au
Example of ROAM Session fraught with issues!
www.visability.com.au
Matthew
• Visual Diagnosis: Keratoconus, corneal
transplant Legally blind
• Age: 41
• Client Location: Perth (guide dog trial)
• O&M Location: Perth
• Distance: 0km
• Support Person: VisAbility O&M (Amy)
• Reason for referral: ROAM Guide Dog
trial
www.visability.com.au
Example of Guide Dog Training
www.visability.com.au
Example of Autism Service Dog Training
www.visability.com.au
Empowering people living with disability
www.visability.com.au