Considerations for Occupational, Physio & Speech Therapy Services in the context of the COVID-19 pandemic

There have been increasing concerns from the various stakeholders in therapy service provision over the risk of regression and lost milestones for children with disabilities during the COVID-19 period. This situation can have long-term consequences, especially for the most vulnerable of Children with Disabilities who already experience barriers accessing therapy services, or who are at higher risk of exclusion from the COVID-19 responses for a number of reasons. These include children with disabilities in urban slums, remote locations, and those whose families have lost livelihoods due to job losses among other difficult situations. Most principal caregivers of children with disabilities from vulnerable households depend on community-based rehabilitation centers for therapy, basic healthcare services and information. Unfortunately, these services may not accessible because of the social distancing and other restriction measures put in place by the Ministry of Health to reduce COVID-19 community infections.

Occupational therapy session at The Action Foundation Hub

Background

Occupational, Physio and Speech Therapists provide holistic rehabilitation services and thus play a critical role when it comes to addressing health needs of children with disabilities; their services during this COVID-19 period are vital. The role of their individualized approach to provision of care cannot be over-emphasized. This calls for ensuring that there are guidelines that will not only ensure continued provision of therapy services, but also ensure that the therapists are well able to protect themselves, as well as the children they attend to and their caregivers from risks of contracting the virus . They should be able to determine risk and take action to reduce risk of infection and spread of COVID-19 in the rehabilitation settings.

In most settings in the country, there are undiagnosed COVID-19 cases and limited testing facilities. For the therapy providers who are still providing therapy, the reality is that they are potentially interacting with “asymptomatic and undiagnosed” clients.

In a series of webinars convened by The Action Foundation (TAF) and The Kenya Institute of Special Education (KISE) on Therapy Support for Children with Disabilities in the COVID-19 pandemic, participants recommended that occupational, physio and speech therapy should be considered as essential services; and that strategies be put in place to guarantee this. In the subsequent deliberations by a working group comprising rehabilitation professionals, persons with disability, parents of children with disability and organizations working with/for people with disabilities, the following considerations were developed to facilitate continued provision of therapy services.

Considerations for Occupational, Physio & Speech Therapy Services in the context of the COVID-19 pandemic

The local context in which the therapy practitioners operate should inform the measures that they adopt. They can be working in different settings such as community settings, inpatient/hospitals settings, outpatient setting & psychiatrist settings. They should be well aware of their local risk of infection and transmission in relation to the COVID-19 pandemic. The therapist shall first ensure his or her safety, physical and mental wellbeing before discharging their various functions. They should ensure that they only make essential trips to minimize on exposure to contracting the virus.
Working closely with principal caregivers of children with disabilities and their families to ensure access to rehabilitation services and medicines when needed.
Therapists should practice respiratory etiquette by ensuring that they cough and sneeze into disposable tissue or into elbow-bend if tissue is not available. Also ensure proper disposal of used tissues, gloves and disinfect hands immediately after a cough or sneeze.
Therapists should continuously monitor own health status and commit to ensuring that they contact relevant health facilities in line with existing Ministry of Health guidelines if they come across a case that exhibits symptoms of COVID-19 such as fever, cough or shortness of breath.
It is important that when planning services, therapists who fall into the high-risk categories should avoid contact with clients. These include pregnant therapist, those with known chronic respiratory illness, immunosuppressed or may have other an underlying health condition such as heart disease, lung disease or diabetes
At all times implement triage strategies to determine whether their clients are in need of additional medical attention and to identify possible COVID-19 infection.
Setting up accessible handwashing stations that provide clean running water and soap for regular and thorough hand washing in accessible places at therapy centers. Alternatively ensure that all persons perform hand rubbing by using alcohol-based hand sanitizers
At all times be geared in Personal Protective Equipment when attending to clients and interacting with other people. Also ensuring they wear masks whenever they go out and in crowded places
At all times be continually updated with information on the virus to help them make decisions, provide reassurance to clients and respond to clients’ concerns. Therapists have a responsibility to share knowledge on preventing transmission of COVID-19. This should be done at any patient interaction be it in the clinic, on the phone or via digital consultation.
Use virtual therapy and replace in-person meetings in the workplace with video or telephone conferences. The use of digital practices such as tele-therapy, tele-medicine is highly encouraged where possible. A variety of approaches can be used such as the use of general communication tools such as email, chat/messaging and video conferencing and/or specific therapy platforms such as online exercise prescription tools.
Where raised levels of anxiety or depression, occur in children with disabilities, their principal caregivers and family members, the therapists should ensure they access the psychosocial care and support needed during the rehabilitation process.
Therapists should be in a position to identify when a patient’s normal family or social support networks may have been disrupted due to the COVID-19 and facilitate access to psychosocial support and follow-up accordingly.
Therapy services providers should be equipped in psychological skills, training and access to necessary resources needed to offer their services during this COVID-19 period.
Peer-to-peer support mechanisms structures for the practitioners should be put in place as much as possible, this can be done face-to-face or remotely.
Child friendly information on COVID-19 should be created to help children with disabilities understand what is going on and how they can protect themselves from COVID-19.

Additional Resources

The social environment in which both the therapy professional and the clientele operate in is very important. With the current emphasis on social isolation and distancing, there is need to facilitate communication and encourage open dialogue between the involved parties. This is fundamental to the success of the interventions adopted and ensuring support to children with disabilities, their principal caregivers and family members.