“When in ROAM” (Remote Orientation and...

“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 2017amy.barrett-lennard@visability.com.au

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

Why ROAM?

• 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

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

• 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

• 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

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

• 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

What about O&M??

• 1st Pilot Project

completed by VidKids

Alliance; October 2014

• 6 tests completed

• Trialing software and

equipment options

• “Does ROAM have

potential???”

ROAM: First Pilot

• 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

• 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)

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

• Provide instruction

• Seek information

as needed (from

client or support

person)

• Consult other

sources (Google

maps, street view)

ROAM Method: O&M Specialist

• 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

ROAM Method: SupportPerson

Support Person can be:

• Allied health staff (OT, OT

student, etc.)

• Family (parent, partner, etc.)

• Carer

• Community health worker

ROAM: Live Demonstration

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

• 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

• 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

“ROAM was never intended to

replace face-to-face O&M

service delivery. Rather, it is

designed to complement

existing face-to-face services”

• Cancellation of 3 regional trips:• 2x Geraldton trips (September 2016, February

• 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

Meals and extras $233

TOTAL = $1908 = €1296

Geraldton Trip

Accommodation $375

Petrol $150

Meals and extras $140

TOTAL = $665 = €452

• 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

• Perth

• Kununurra

• Fitzroy Crossing

• Broome

• Bunbury

• Albany

• Geraldton

• Exmouth

• Esperance

• Denmark

• And more!

Geographical Expansion

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

• 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

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?”

Camera Options: Camera Angle

Client POV: ‘Street View’ Client POV: ‘Cane View’ Support Person POV

“What is the goal of the O&M session?”

• 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

• 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

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

Self-rating of confidence in their mobility

skills and community access

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”

• “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

• “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

• Clients to have their own “ROAM kit”

• Loan ROAM kits – remote areas

• ROAM kits funded by NDIS (National Disability

Insurance Scheme)

ROAM: The Future

• 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

ROAM Case Studies & Video Samples

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

Example of Assessment (Client Interview)

Stephen

• Visual Diagnosis: Toxoplasmosis

Retinochoroiditis Vision impaired

• Age: 48

• Support Person: VisAbility OT (Eliza)

• Reason for referral: Issues with depth

perception and orientation in the

community. Currently using a walking

stick.

Example of Assessment (Functional Mobility)

Bradley• Visual Diagnosis: Retinopathy of

prematurity, myopia Legally blind

• Age: 19

• Client Location: Albany

• Support Person: VisAbility OT (Julie)

• Support Worker: Bison

• Reason for referral: Would like to

increase independent mobility and

community access. Anxious about

crossing roads.

Example of Long Cane Training

Christene

• Visual Diagnosis: Macular

Degeneration (dry) Vision Impaired

• Age: 77

• Client Location: Esperance

• Support Person: VisAbility OT (Allira)

• Reason for referral: Starting to feel less

confident when accessing the

community. Pain in knees following TKR

complications.

Example of Support Cane Training

Arthur

• Visual Diagnosis: Retinopathy of

prematurity Totally blind

• Age: 33

• Client Location: Perth (first pilot)

• 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

Example of Orientation Training (Indoors & Outdoors)

Emmanuel

• Visual Diagnosis: Retinitis Pigmentosa

Light perception

• Age: 44

• 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

Example of Road Crossing Training

Jayde• Visual Diagnosis: right corneal anterior

staphyloma, left microphthalmia

Legally blind

• Age: 13

• 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

Example of School-Aged O&M

Diane• Visual Diagnosis: stroke vestibular

ocular reflex dysfunction

• Age: 52

• 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.

Example of Public Transport Training

Karen• Visual Diagnosis: Stroke left sided

visual inattention

• Age: 46

• 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.

Example of Wheelchair Mobility Training

• 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”).

Example of ROAM Session fraught with issues!

Matthew

• Visual Diagnosis: Keratoconus, corneal

transplant Legally blind

• Age: 41

• Client Location: Perth (guide dog trial)

• Distance: 0km

• Support Person: VisAbility O&M (Amy)

• Reason for referral: ROAM Guide Dog

Example of Guide Dog Training

Example of Autism Service Dog Training

Empowering people living with disability

“When in ROAM” (Remote Orientation and...

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