How telehealth can be used in group-based supports
Sara Abdi, Parenting Research Centre, Australia
RESOURCE SUMMARY
Download printable summary of How telehealth can be used in group-based supports.
Key messages:
- Group telehealth is a viable option for many practitioners and their clients, with high rates of satisfaction reported.
- Preparation ahead of the session and experience delivering group sessions are linked to successful delivery of telehealth groups.
- Practitioners can take advantage of approaches that work better online, such as visual and tech features, use of the client’s home environment, and flexible scheduling.
- Reflective practice along with inviting feedback from group participants can help refine practitioners’ approaches for more effective delivery.
What is this resource about?
Telehealth is the use of telecommunications to deliver services remotely, such as via phone, video, email or text messaging. Groups can be held virtually, with some preparation required to ensure telehealth sessions are delivered effectively. This resource provides guidance on how practitioners can use technology to deliver their group sessions and explores the important considerations for them to make.
Who is this resource for?
This resource is for practitioners working with children and families in a group-based setting to deliver their service. This includes:
- early childhood intervention workers
- playgroup facilitators
- family support/social workers
- counsellors
- psychologists; and
- allied health workers.
Why use telehealth to run groups?
Video telehealth groups have been found to be as effective as in-person groups, and participants in these groups typically report high rates of satisfaction (Gentry et al., 2018). Virtual group sessions can be particularly beneficial for improving participants’ mental health outcomes such as depression, stress and anxiety and overcoming a fear of meeting new people (Banbury et al., 2018).
Practitioners can deliver therapeutic and support sessions via an online platform, which helps minimise the impact of barriers such as time, distance and mobility (Banbury et al., 2018). In these groups, enrolled families can come together and benefit in a range of ways from interacting with the facilitator, the session content, and each other.
Virtual groups can be valuable for families’ mental health and wellbeing, as they may feel more comfortable communicating with practitioners from the comfort of their own home, which can reduce their anxiety and stress. Group telehealth sessions can also be a valuable way to support child mental health.
This paper explores some of the strategies you can incorporate into your sessions.
How to use telehealth to run group sessions
Group telehealth sessions do not have to be an all-or-nothing approach; groups can instead adopt a hybrid model. This model involves a combination of both telehealth and face-to-face sessions, where some weeks groups may be held in-person and other weeks they can be held online. This is flexible, depending on the preferences of you and your group. So, for example if a circumstance arises where several group members are feeling unwell and would prefer an online session, you might organise a telehealth session for that week. Find what works for your group, whether that is predominantly in-person meetings, mostly online sessions, or a mix of both.
When using telehealth to deliver group sessions, you have a few things to think about to optimise your delivery. The adaptations and recommendations in this paper are presented as follows:
- Set up recommendations
- Design recommendations
- Delivery recommendations.
Engaging participants
Different considerations need to be made, depending on who is attending your group session. Working with children and parents respectively comes with its own specific challenges and opportunities, as does working with both groups. In the following sections, we explore how you can engage the different participants you may have in your group.
Engaging parents and facilitating group interactions
Parents may be more passive in online group sessions than in-person ones, potentially due to a lack of familiarity with the platform, feeling less immersed in the group environment, or simply being unsure of their role in the group. Consider these strategies to maintain parents’ engagement throughout the group session:
- Try to limit the use of a question-and-answer approach, which if overused can establish an interview-style tone in the group. If that happens, participants may become more focused on sharing acceptable, efficient responses rather than the true reflections you might be after. Instead of asking direct questions, try to share a reflection which can encourage others to do the same. For example, if someone shares that this week has been stressful for their family, you can repeat this back: ‘So I’m hearing there has been a lot going on for your family this week.’ This type of response can prompt further elaboration.
- You can encourage participants to un-mute themselves and ask questions or share thoughts during the session. If you find that they are uncomfortable doing so, you can suggest they write questions or responses in the chat function. Every so often, remember to check the chat function and share what has been commented, thanking the writer for sharing.
- It may feel instinctual to jump in when no one is speaking during an activity, but instead you can use the silence strategically. Leaving a little extra time to sit in the silence strongly conveys to the group an expectation for a response. Remember to show with your body language that you are comfortable waiting in silence for a moment and adopt a facial expression that shows anticipation.
- It can also help to periodically check in with participants throughout the session for any comments or questions, in case someone has something to share and just needs some prompting.
Delivery considerations
You can improve your session delivery to ensure you and the group participants get the most benefit, by using these strategies during the virtual group.
Incorporate visuals and tech features
Using visuals in telehealth groups promotes participant engagement, particularly for families of children with disability (Angell et al., 2023). Most modern videoconferencing platforms allow you to share your screen and upload images or PowerPoint slides. This can be a great way to share information and engage families. You can experiment and ask families for feedback on which visuals work best for which activities.
Sharing creatively on-screen
The following are some ideas of how you might get creative with sharing content in a telehealth session.
- List one or more key words related to the topic of discussion.
- Add images of families engaged in relevant activities.
- Share video demonstrations of parenting practices.
- Open a text document that you share on your screen with the group and note down participants’ various contributions during a group discussion.
- The ‘whiteboard’ feature that can be found in some videoconferencing platforms allows you to type onto a space that all participants can see (or draw if you have a mouse or stylus). You can even invite participants to do the same.
Establish methods for turn-taking
In group sessions, it can be helpful to manage how participants take turns speaking in a session. Many videoconferencing applications have visual indicators that participants can use to show when they wish to contribute to the discussion. One option is to use the ‘mute’ button that is present in most platforms. Generally, when a participant is muted, this is shown on the screen for other participants to see, in the form of an icon. You can instruct the group to stay on mute until they have something they want to say. Then, participants can take themselves off mute before the previous participant stops speaking, to indicate that they are waiting to speak. Of course, participants will need to be reminded to watch other participants’ mute indicators to keep track of who’s keen to contribute at any given point in time. This method also fits with good online practice in general, in that when a participant is not talking, they are on mute, preventing any background noise from being transmitted to the group.
Another option is to use text-based chat in the background while someone is talking. Most videoconferencing platforms allow text messages to be sent live to the group, which then displays an alert each time a message is sent. You can encourage participants to send a message to the text chat such as ‘I have a thought on that’ or ‘could I say something?’ while someone else is talking, then invite that person to speak next once the current speaker has finished. Your videoconferencing platform may also feature the ability for participants to select a ‘raise hand’ button, which then displays a raised hand overlaid on their video feed and/or next to their name. This can be another way for participants to let others know that they’d like to contribute to the discussion.
Another related issue that may contribute to awkwardness of turn-taking is the amount of time for which each participant speaks, especially in very active groups. You may wish to institute a rough time limit for each contribution, which can help to keep the conversation flowing. Of course, this will need to be explained to the group at the beginning of each session, and you may need to provide reminders and facilitate the conversation throughout.
Invest in participant ownership of the group
Participants in online group sessions may take a passive approach, where they sit back and wait for the facilitator to lead every interaction. This can detract from the kind of engagement your group aims to achieve, so it is important to avoid this by deliberately encouraging a sense of group ownership in participants. Use language that emphasises participant control (for example, ‘What would you like to do next?’, ‘I noticed we don’t have much to say for some of the activities, what should we do about that?’) and defer to the group whenever appropriate. If a participant asks a question, you can ask what the group’s response is instead of answering directly. You may already be familiar with these techniques from running in-person groups, but they are even more crucial in telehealth sessions.
Another option is to appoint an informal host to run one or more aspects of the session, rotating amongst the participants each meeting. Participants are more likely to contribute actively to a discussion if they feel they are helping one of their fellow participants to make the activity run smoothly. This group cohesion can be harder and take longer to establish online (Lopez et al., 2020; Weinberg, 2021) so keep in mind that participants may initially connect more with you as the group facilitator; however, this allegiance can shift to the other group members as more sessions are held (Yalom & Leszcz, 2005).
Take advantage of the activities that work better online
Telehealth sessions can be a great time to teach or practice activities that you wouldn’t be able to do in person. For example, you may wish to demonstrate how to access various websites or apps by sharing your screen and showing the process step-by-step in real time. This could be particularly effective for families who have additional needs and must access a variety of services, or for those with low literacy in English.
The fact that participants can access the group remotely from their home environment may also have some advantages that you can explore. If appropriate, invite participants to share any mementos and associated stories, parenting approaches they’ve been using (such as reward charts stuck to the wall for managing behaviour), or some food they’ve been cooking that is relevant to their culture.
Recognise opportunities to integrate mental health into your telehealth group
As addressing child mental health and wellbeing is a process as opposed to a one-off event, you can create a habit during your group of checking in with parents and children about how their week has been (if this is appropriate for your group). You can ask questions such as, ‘What was easy/has gone well for your family this week?’ or, ‘What was hard for your child this week?’ This can be a great way to open up discussions about wellbeing for their child. You can talk through topics or issues that parents raise as a group, encouraging discussion and sharing, and you may suggest places to seek further advice if appropriate.
Engaging children online
Some children, particularly those with cognitive difficulties (World Health Organisation, 2021) can find it difficult to sit in front of a screen and concentrate during a group telehealth session. It can be helpful to take some time to think about how you can maximise children’s engagement.
- Firstly, set realistic expectations with yourself and caregivers about what can/cannot be achieved during the session; if required, adjust the length of your sessions or the amount of content covered.
- You can open conversations with children by asking questions to establish rapport and increase their comfortability with you and the other group members. This can include questions such as, ‘What is your favourite colour?’, ‘What is your favourite TV show?’, ‘What is your favourite food?’ and so on, where they can share their interests and preferences. You can also do this activity by asking children to draw their favourite food or animal on their device, and use screen-share or send the image in the chat to share it with the group. Art can be an effective way to keep children engaged in the session.
- Encourage families to have toys in the room they are streaming from – ideally quiet toys which children can play with. This helps to prevent children from getting bored and increases their likelihood of maintaining engagement for the duration of the session.
- You can also use technological features such as online drawing tools, eye-catching screen backgrounds and online games to increase and maintain children’s engagement during a session (Montague et al., 2014).
Learn by doing, and adapt
It is important not to give up or become frustrated with running groups via telehealth too soon after starting. Research tells us that practitioners and participants alike initially found virtual group sessions challenging, however this typically improved after a few sessions (Weinberg, 2021). Your proficiency in using telehealth will improve as you go, and a good way to promote this is to be mindful and reflective after your session.
An important aspect of reflection is for you to take some time after a group telehealth session to think about what worked well in the group and what didn’t work so well. For example, you may feel that a certain activity didn’t have as much collaboration from the participants as you had hoped for. You can take note of this, along with potential gaps in the activity (maybe you didn’t share the content with participants ahead of time, or you felt rushed and didn’t sit in silence long enough to allow people to jump in) which you can consider in the next group to do things a little bit differently.
Another way of assessing what works well in telehealth groups is to seek feedback from participants. This can be done informally, through casual conversations with participants or noting observations as groups are running, or more formally by using feedback surveys and/or outcome measures. You can send these surveys out after each session, or every few sessions for participants to complete. There are other relevant metrics you might like to consider as well, such as rates of attendance.
Reflect regularly on the feedback obtained. This can be done in a group setting with colleagues, individually, or both. Form hypotheses about why a particular approach or practice worked or didn’t work, and in cases where there are questions, try a different approach and see if that works. It may be useful to involve the participants in the process – you may share with the group that you noticed one activity or feature of the group wasn’t so successful, or that the participants didn’t get so much out of it, and ask if they would be happy to try approaching it differently. This kind of collaborative approach will also help participants to appreciate that the telehealth group is a work-in-progress and that any aspects that are less than ideal for them might realistically improve in the future.
