Feedback from Facilitators & Families about Online Caring for Carers Experience in Nova Scotia

Feedback from Facilitators & Families about Online Caring for Carers Experience

By Dani Himmelman
Coordinator
Families Matter In Mental Health
Schizophrenia Society of Nova Scotia

Two online programs were delivered in Nova Scotia, Canada, between May and July 2020:

The Covid-19 outbreak has prevented in-person Caring for Carers programs (known in Nova Scotia as Families Matter in Mental Health) from being offered since March, 2020. We recognized that families need support now more than ever and that Covid may prohibit in-person programs for some time. With support from the Nova Scotia Health Authority, we decided to offer an online version of the program via Zoom. Some clinicians expressed concerns about the technical aspects of offering the program online and about staying true to the model. Some were unable to be involved because of Covid related additional work and home responsibilities. Five facilitators (3 clinicians and 2 family members) agreed to take on the challenge of delivering 2 online programs between May and July 2020.

During program planning, facilitators identified some concerns and each was addressed: 

1. Lack of familiarity with online platforms and technical aspects of Zoom (facilitators & participants) – one facilitator took the lead on technical aspects and facilitators did a practice session together. The program coordinator contacted each participant who had registered for the planned in-person programs to discuss the logistics of the online format and to provide general support. Families were sent a tutorial on how to download Zoom and join a meeting. In session 1 screen options were reviewed with families (i.e. mute, hand raising, chat space etc.)
2. Possible privacy concerns – only families registered for the program received the meeting link and all participants entered a waiting room and were identified before being admitted.
3. Barriers that exclude some families (i.e. reluctance to attend online, inadequate computer skills/internet connection) – it seemed preferable to offer an online program to families able to attend rather than offer nothing for an extended period of time. It was noted that there are also barriers to accessing in-person programs (ex. geography and travel).
4. Maintaining the integrity of the program – the goal was to deliver the program as much as possible in the same way as an in-person program (same agendas, session content, handouts etc.).
5. Building rapport, engaging families, and encouraging discussion in and online format – participant numbers were low and families were asked to join with video which helped everyone connect.
6. Practical concerns (i.e. access to a white board/flipchart, practicing communication and problem-solving skills, providing handouts) – white board and screen sharing options were used and breakout rooms are suggested for skills practice. Handouts were emailed before or after each session. Short power point slides for agendas and some content were used by 1 group for a visual reference.
7. Group size for online programs – numbers were limited to less than 10 families per group to reduce logistical challenges and support a positive experience for everyone during this first attempt at online delivery. Two programs were run with a combined total of 14 families.
8. Number of sessions – the program was reduced from 11 to 9 two-hour sessions, due to time constraints. This limited the content covered. We would avoid that whenever possible in the future.
9. Hosting Zoom and handling IT concerns – The Schizophrenia Society (contracted by the Department of Health and Wellness to coordinate the provincial Families Matter program) funded and hosted the Zoom platform and provided all IT support.

Participant Attendance: (9 sessions in total)

9 sessions – 8/14 people (57%)
8 sessions – 3/14 people (21%)
7 sessions – 2/14 people (14%)
4 sessions – 1/14 people (7%)
Overall attendance was 90% and attendance at 7 or more of the 9 sessions was 92%. This is as good or better than our in-person programs.

Post Group Participant Feedback:

All 14 families said they would recommend the online program if an in-person program was not available. When asked to rate their experience of attending the group online – 1 person rated it as average, 6 rated it as good, and 7 rated it as excellent. Feedback for individual sessions did not reflect a change in positive/negative responses compared to in-person programs offered in the past.

Comments from families:
“Program was excellent. I am glad I was part of this experience. Thank you.”
“It was a good experience. For some people, a Zoom format may even be more suitable than in-person and it would be nice if both formats could be offered.”
“Was able to put things into practice during the course and debrief about our experiences and effectiveness.”
“I am glad that I participated in the program. The facilitators were knowledgeable, approachable and supportive. I liked how they spoke of personal situations as it normalized what the participants were experiencing. I will definitely refer back to handouts that I received, particularly those dealing with communication skills. It was good to meet others who are facing the challenges of having a family member(s) living with mental illness.”

Post Group Facilitator Feedback:

Facilitators were amazed at how quickly participants connected. The online format did not limit participation and discussion. Visual presence affects engagement and participation, so it is recommended families use video when possible. Practicing skills poses similar challenges in online and in-person groups, so breakout rooms are advisable. A size limit of 3 to 4 families per facilitator is suggested. It was helpful to assign 1 facilitator each session to monitor the ‘room’ (i.e. facial expressions, raised hands, chat box, admitting/readmitting people). Overall, facilitators were impressed by how well the online format worked, how user friendly it was, and by the flexibility it adds to program delivery.

Advantages of In-person vs Online Programs (gathered from a post-group Network Meeting discussion among trained clinician and family facilitators):

In-person programs:

• allow time for informal conversations before & after sessions & during break (starting online sessions early/staying online after close/connecting people via email, can offset this somewhat)
• allow for private conversations (for online programs, this can be arranged, but not as naturally)
• do not require technology skills or reliable computer/internet connections (families without computers/reliable internet may be able to access online programs via computers in a local health clinic or library)
• allow participants to speak freely if the person they support lives in their home

Online programs:

• remove geographic barriers (programs are not limited by driving distance, areas where trained facilitators are located, inadequate registration numbers in local areas)
• eliminate weather-related travel issues and travel time
• allow a level of anonymity (i.e. can attend a program outside one’s local community)
• eliminate child care concerns for affected families
• provide a viable option when in-person programs are not possible (i.e. Covid-19 restrictions) and add flexibility to program delivery

Summary

There are advantages to both in-person and online programs. The Zoom facilitators recommend the online program as a good option. The post program facilitator Network Meeting discussion suggested that many facilitators are interested in the online option and that offering a combination of both in-person and online programs is worth considering going forward. Many facilitators are gaining online meeting experience since Covid-19 has restricted in-person meetings. This has helped it become a more acceptable and viable option for facilitators and families alike.