The arrival of COVID-19 saw organisations around the globe scrambling to adjust to a new way of doing business. However, one Australian early parenting organisation was taking it all in its stride.
Tresillian is a not-for-profit, early parenting organisation that has been operating for more than 100 years, assisting 80,000 families annually with expert parenting advice on babies, toddlers, and young children.
In 2018, Tresillian’s NSW operations were going strong: The group’s regional service had expanded to include eight Family Care Centres; and they had partnered with the Mid North Coast Local Area Health District to launch the Tresillian 2U Mobile Early Years parenting service – a customised, telehealth-enabled van that brings specialist services to rural areas.
This was all in addition to Tresillian’s long-established phone-support service, and Sydney metro operations that include specialist day services for NSW families experiencing early parenting challenges, and inpatient residential programs for families experiencing persistent difficulties.
However, says Tresillian’s Deborah Stockton, who was Operational Manager Regional Services at the time, there were still many remote and isolated NSW families who struggled to access services.
The solution, she says, was telehealth.
Tresillian’s telehealth service was launched in September 2017, providing isolated families with the ability to attend remote virtual visits with child and family nurses for specialist support and advice. The service was embraced by families, and quickly expanded to be incorporated into the Tresillian Standardised Service Model for all Tresillian Family Care Centres, and expanding further to include group telehealth sessions via video conference for both health promotion and therapeutic group programs.
And then COVID-19 hit: “And that’s when we went into a rapid scale-up for our metropolitan services that hadn’t really been using telehealth,” said Ms Stockton.
In just three weeks, Tresillian delivered telehealth training to 80 clinicians and provided hardware including laptops and video cameras to staff across metropolitan Sydney. The organisation was also contracted by insurance company, Medibank Private, to deliver telehealth services to its customers.
“We already had a whole cohort of regional staff who were very confident using telehealth, and they were able to share their experiences with their metropolitan colleagues,” said Ms Stockton who is a child and family health nurse and a registered midwife.
“We pulled together a team and ran rolling workshops virtually and, where there were opportunities for Covid-safe small groups of staff, face-to-face sessions were run in metropolitan areas. Coaching and reflective practice sessions tailored to the needs of individuals and teams enabled further capacity and importantly confidence building.”
“What started as a journey to expand the reach of our regional sites through telehealth, has now seen telehealth become embedded in all aspects of our services.”
Telehealth in rural areas
Using Tresillian’s telehealth service, nurses can remotely observe and assess children and families, and provide follow-up appointments to support parents implementing strategies and plans.
Parents typically access the service via their mobile phone, tablet, or laptop. If there are internet access issues, telephone is used as a backup or, if possible, parents can visit their local community health centre and connect using the Local Health District internet-connected devices.
“Importantly, the nurses live and work in the same rural communities to which they provide the telehealth service, drawing on their well-established knowledge and relationships with other service providers to address the multi-faceted needs of families with young children,” said Ms Stockton who became Director of Clinical Services Integration in early 2020.
“Using video conferencing and having the same clinician makes the experience more personal for parents, so they feel comfortable opening up and talking about their challenges with their nurse, allied health professional, psychologist, social worker, or mental health nurse.
“They need to be able to build trust and rapport.”
Keeping telehealth sustainable
Tresillian staff have undergone extensive telehealth training – both with online modules, as well as Tresillian’s own in-house training – and the group has created a set of telehealth guidelines to support practice when conducting virtual consultations.
To support staff during the rapid scale-up of telehealth during the COVID-19 pandemic, Tresillian established communities of practice so clinicians could share telehealth challenges and successes with colleagues, while a series of governance and support structures were put in place to ensure clinician and parent feedback informs future initiatives.
In 2021, in partnership with the Mid North Coast Local Health District, Tresillian also opened regional Australia’s tertiary level residential unit at Macksville, so rural families could access Tresillian’s well-respected inpatient residential services.
“It has been an incredible journey,” said Ms Stockton. “What I enjoy most is hearing from parents about the difference Tresillian services make in their lives – the difference in their family relationships, and enjoyment of their baby.
“It’s not unusual to hear parents say ‘you saved our lives’. Our services mean that much to parents.”
Parents can also utilise Tresillian’s SleepWellBaby app, developed through a partnership with SleepFit. Launched in late 2019, the app provides access to a digital program including Tresillian’s evidence-based parenting education, advice and tools on key new-parent concerns such as baby sleep and settling, development, feeding and nutrition.
The app also has a clinical data dashboard which shows nurses the information that parents input about baby sleep and feeding routines, as well as a log of wet and dirty nappies. Parents can also rate their own emotional wellbeing and progress. This information is shared in real time with Tresillian nurses providing telehealth coaching sessions to inform parent and baby telehealth interactions.
“It helps our nurses to maximise the time and interaction they have during telehealth coaching sessions with parents,” said Ms Stockton. “The parents and our clinical coaching staff absolutely love the app. It is invaluable and it has provided us with great learnings.”
During the recent COVID-19 lockdown in Sydney, the NSW Government provided free access to SleepWellBaby for parents, with more than 4000 downloads of the app in the first week alone.
A new virtual service
Tresillian will also soon launch a Virtual Residential Parenting Service. The service is enabled through a partnership between NSW Department of Health, Tresillian, and Karitane, which will also be providing the service.
Parents in rural and regional NSW will remotely participate in an intensive five-day/four-night, ‘virtual’ residential parenting service program with access to a multi-disciplinary team of health professionals to help parents experiencing persistent early parenting challenges, which can impact the whole family. These include problematic sleep difficulties, feeding concerns and other challenges parents might be facing in relation to caring for their babies and children, and in their role as a parent.
“What we were hearing from health professionals in rural and regional areas in particular, was that it wasn’t viable for some parents to travel to Sydney to attend our residential programs,” said Ms Stockton.
“Not only can the travel, the cost and the logistics be problematic, but these parents are tired, exhausted and sleep deprived, often with a baby who has sleep difficulties. They need to be surrounded by their partner and their extended family; so, wherever possible, we want to provide parents with options and take our services to the family.”
Parents who are referred to the Virtual Residential Parenting Service will access Tresillian’s nurses via their smart device or web camera. Parents will have a daily series of scheduled remote consultations via video conference with a multi-disciplinary ‘My Virtual Care Team’ made up of child and family nurses, and medical and allied health professionals who will observe parent and baby and provide guidance and support.
Unscheduled appointments will also be available on an as-needs basis.
“We know that a lot of important work gets done by being alongside parents in those difficult moments such as when they’re settling their baby, or feeding interaction; so, trying to make sure we factor this scope into our virtual model has been really important,” said Ms Stockton.
Learn more about Tresillian Family Care Centres here.