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Health care delivery for clients and families can occur in many different ways. Virtual care is one example of how you or your child may participate in care.

Whether you receive care in person or virtually, all care practices are held to the same quality and standard of care as other health services provided by the hospital.

In this resource you will:

  • Learn about virtual care and its benefits
  • Hear from families about their experience with virtual care
  • Find tips to help you decide when virtual care is right for you or your child
  • Understand what to expect from different types of virtual care visits
  • Hear from clinicians about when it is appropriate to have a virtual care visit


Download the resource guide or continue reading below.

    What is Virtual Care?

    Virtual care:

    • happens remotely (i.e. not in-person)
    • uses technology to support a high quality client care experience
    • includes any interaction between clients and/or members of their circle of care

    At Holland Bloorview Kids Rehabilitation Hospital, virtual care visit methods include:

    • Telephone (audio only)
    • Ontario Telemedicine Network (audio and video)
    • ZOOM Healthcare (audio and video)

    To participate in a virtual care visit you may need a:

    • Telephone
    • Computer, smart phone or tablet that has a microphone and camera
    • Good internet connection

    Why participate in virtual care?

    Participating in virtual care has many benefits for you or your child. Some of these benefits may include:

    • Improved access1 to specialized and timely care (e.g. rural areas)
    • Reduced travel costs1, 2 (e.g., parking, gas, travel time)
    • Enhanced communication between you and/or your child’s healthcare provider3 (e.g. more communication)
    • Improved health outcomes4, 5 (e.g. quality of life)

    Quality Virtual Care is Client and Family-Centered Care

    As a recipient of virtual care, you and your family are entitled to:

    RESPECT AND DIGNITY

    • Being treated with respect, care, and courtesy
    • Maintaining your cultural practices
    • Respecting your spiritual and/or religious beliefs
    • Being free from discrimination and inequitable access

    INFORMATION SHARING

    • Ensuring your child’s privacy and confidentiality are protected
    • Being aware of how your child’s health information is being shared and used
    • Having access to your child’s personal health information

    QUALITY OF CARE

    • Receiving high quality and safe care by members of the interdisciplinary clinical team
    • Receiving care in a language that you and your child understand or having access to an interpreter

    PARTICIPATION

    • Being engaged in a manner that is most meaningful for your child and family
    • Receiving the education and support to make care-related decisions
    • Sharing feedback about the quality of care provided

    While quarantined 5 hours away, we were able to receive care from our Pediatrician over the phone. Using email for
    requisitions, consent and so on, has made this much easier. Moving forward, I hope that these multifaceted approaches for medical care rema in available for my medically compromised and at risk children.
    ~Family Member

    Knowing when virtual care is right for me or my child: Things to Consider

    Ask yourself:

    1. Am I comfortable with discussing my/my child’s health by phone or video call?
    2. Will my child and I be able to have a high quality interaction with the clinician?
    3. Do I have the technology required such as a computer, phone, and/or stable internet connection?
    4. Do I have access to a quiet space with minimal distractions and interruptions?
    5. Will someone be available to provide any technical support and/or support to help me/my child during the virtual care session? (e.g., behaviour support; support to set up the room, materials and equipment)

    If you are still unsure if a virtual care visit is right for you or your child, talk to the healthcare provider. Here are some questions you might want to ask them:

    1. Am I/is my child and our type of appointment a good fit for a virtual care visit?
    2. What will I need to do before, during and after the virtual care visit?
    3. Can we achieve the same result as an in-person visit?
    4. What are some benefits and risks of a virtual care visit?

    Virtual care enabled me to contact the coordinator for my child's physician at Holland Bloorview and have the physician contact me to refill my son's medication. Typically, these appointments are done in-person due to the nature of the appointment.
    However, it was extremely meaningful to know that although the clinic was closed, his care team was able to ensure that there were no gaps in his ongoing care, which has a great impact on our family.
    ~Family Member

    What can you expect during a virtual care visit?

    Similar to an in-person visit, you can expect to connect with your or your child’s healthcare provider to discuss:

    • successes
    • challenges
    • progress
    • ideas for working on goals outside of virtual care visits

    Your or your child’s virtual care visit is an opportunity to:

    • work with the healthcare provider to discuss, develop and adjust goals (as needed)
    • connect with your or child’s other healthcare providers for joint visits
    • engage others to observe or participate during the session so that goals can be supported outside of virtual care visits

    What type of appointments are well suited for virtual care?

    We encourage you to have a conversation with your healthcare provider to discuss the fit of virtual care for you and/or your child depending on the appointment. They are knowledgeable about the type of assessments, can answer your questions, and provide further information.

    Areas of care that typically work well in virtual care
    • Conversations and resource consultations with children, youth and families (e.g. legal consultations, orientation to services, referrals to community partners, funding options)
    • Care that does not require the healthcare provider to do any “hands-on” activity which must be done in-person
    • Assessments that can be done effectively in a virtual environment (e.g. while clients are at home, healthcare providers can conduct interviews, review family reports, observe, send materials in advance or show online materials)
    • Family team meetings
    • Goal setting and/or coaching sessions
    • Creation and monitoring of home programming and activities for practice and carry-over
    • Life skills training based on care goals
    • Social and recreational groups
    • Active therapy that can be done effectively from home (possibly with caregiver support)
    • Therapy groups and/or counselling sessions
    • Trying assistive devices or equipment in the home or community (e.g. a shower chair delivered by a vendor)
    • Medication history, assessment, and planning (e.g. reviewing community pharmacies, drug coverage)
    • General drug administration and medication-related follow up
    Areas of care where an in-person visit might be preferred
    • Assessments that:
      • require physical manipulation or examination by a clinician
      • involve specific forms or tools that cannot be done remotely
      • are best performed in person to allow for the observation of subtle or nuanced behaviours
    • Appointments that:
      • need hands-on measurement (e.g. assessing fit and function of prosthesis/orthosis)
      • require specific equipment that is not available to clients or families at home
    • Making or trying assistive devices (i.e. casts, splints, wheelchairs)
    • Therapy that requires:
      • hands-on support from the healthcare provider
      • the healthcare provider to accurately perceive the child’s movements/actions (i.e. speech sounds)
      • physical prompting and therapeutic support
    • Dental care
    • Medication administration teaching, as the client/family’s understanding and technique need to be assessed by the healthcare provider (e.g. injection training)
    • Life skills training that requires experiential learning opportunities (e.g. community navigation, transit training)

    Notes: It is helpful when you or your child is able to attend, focus and physically access the technology needed to participate. Speak with your or child’s healthcare provider about strategies to foster online engagement.

    This resource was created in partnership with the Client and Family Integrated Care and Evidence to Care Teams,
    Family Leaders, and the Holland Bloorview Virtual Care Steering Committee.


    References

    1. Burke, B.L., Hall, R.W. and the Section on Telehealthcare. (2015). Telemedcine: Pediatric Applications. Pediatrics, 136(1): e293–e308.
    2. Doolittle, G.C., Spaulding, A.O., Williams, A.R. (2011). The decreasing cost of telemedicine and telehealth. Telemed J E Health, 17(9): 671–675.
    3. Harper, D.C. (2006). Telemedicine for Children with Disabilities. Children’s Health Care, 35(1): 11-27.
    4. Camden, C., Pratte, G., Fallon, F., Couture, M., Berbari, J. & Tousignant, M. (2019). Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review. Disability and Rehabilitation, 1-13.
    5. Hung, G. & Fong, K. (2019). Effects of telerehabilitation in occupational therapy practice: A systematic review. Hong Kong Journal of Occupational Therapy, 32:1, 3–21.