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1. Scope

1.1. The purpose of this instruction is to provide direction for the clinical and practical considerations in undertaking online video counselling and support (OVCS).

2. Background

2.1. Open Arms policies encompass service delivery through multiple channels to reduce barriers to care and enhance access to counselling and support. This includes the use of phone-based, audio and online video counselling and support (OVCS) to augment face to face options.

2.2. These instructions do not replace standard Open Arms service delivery protocols or procedures, as set out in the Open Arms Policy. The instructions provide a set of considerations that need to be followed in addition to standard Open Arms service delivery.

2.3. OVCS is typically delivered by Open Arms clinicians. However, there are a range of online video-based supports provided by Open Arms workers. In some instances Open Arms Community and Peer Advisors may also provide support to clients in an online environment. The practice of online video-based service delivery by all Open Arms workers should comply with those outlined in this procedure.

3. Appropriate Online Platforms

3.1. Open Arms workers must use Coviu hosted by Healthdirect for OVCS. Open Arms workers and outreach program counsellors (OPCs) access their Healthdirect dashboard via this link: https://vcc.healthdirect.org.au/login, using Google Chrome on a device outside the DVA network. Clients access the Healthdirect waiting room through an OVCS link on the Open Arms website.

3.2. Although OPCs can elect to utilise any video meeting platform as agreed between the counsellor and the client, they are strongly encouraged to use Coviu hosted by Healthdirect due to the higher security rating when compared to other platforms. However, where access to Healthdirect becomes an issue, Zoom or Skype are identified as the preferred alternatives for OPCs because of their ability to schedule meetings in advance and the level of encryption.

3.3. DVA devices on the DVA network are able to access a browser version of Zoom using the Chrome web browser. Stand-alone devices such as tablets, laptops or appropriate personal devices will be needed to run Healthdirect. It is important to access Coviu hosted by Healthdirect via one of the supported browsers to run correctly,¬ this includes Chrome.

3.4. Guidance for using each of these and additional resources to support setup is at Attachment A.

4. Implementation Considerations

To enable access to online counselling and support the following additional considerations apply:

4.1. Consent

  • It is important that clients enter into a video counselling or support arrangement fully aware of the risks and limitations of the technology associated with the platform. Having clients read and agree to the Online Video Counselling and Support Consent form ensures clients are informed of the risks and benefits. This consent informs the client about considerations concerning online platforms specifically, and does not negate the need for completion of the standard informed consent for Open Arms to provide services. Verbal consent is sufficient if recorded in the client’s file on VERA, noting that signed consent is preferred wherever possible.
  • A verbal reconfirmation of this consent should be obtained at the commencement of each subsequent OVCS session and documented in the client's file. It is not necessary to repeat the initial discussion or obtain written consent each session. This is simply reconfirming with the client that they remain willing to participate in the online platform counselling, or if any concerns have arisen since the previous session.

4.2. Managing Clinical Risk

  • Open Arms’ workers and OPCs will conduct risk assessments appropriate to the individual client circumstance and in accordance with existing policy, including consideration of any specific risk associated with a remote service delivery option and escalation protocols. The Open Arms worker/OPC will collaborate with the client on a plan that could be enacted should it become apparent during the session that additional support is required.

4.3 Assessing Suitability

Assessment of client suitability for OVCS should also be made as this mode of delivery will not suit all clients.

  • Does the client have adequate equipment/connectivity, enough mobile data or secure Wi-Fi?
  • Does the client have the tech skills to support their interaction with an Open Arms worker/OPC online?
  • Does the client have the necessary language skills if using email/chat/messaging?
  • Environment – Do they have a safe, uninterrupted place for the session?
  • Assess safety - what format of virtual counselling is safest for them if they are not safe at home?
  • How might previous and concurrent mental health treatment affect online counselling?
  • How might personality type, presenting complaint, and diagnosis influence the person's suitability for online counselling and support services?
  • How might physical and medical factors affect online counselling?
  • Is there any disability that will make the client unsuitable for online counselling?
  • How might cross-cultural issues affect online counselling?

4.4 Emergency contacts

  • The name and phone number of an emergency contact nominated by the client must be obtained and confirmed prior to counselling commencing. Medical contact details for the client’s local GP, medical officer or other medical case manager who can be contacted if immediate or follow-up medical intervention is also required. This information is requested in the OVCS Client Instructions and Information Form but can also be collected by phone or email.

4.5. Provisions for Continuity of Counselling and Support Sessions in the Event of an ICT Interruption

  • Any ICT can fail. The connection between the worker’s/OPC’s and client’s devices needs to be tested, so any problems can be identified and resolved. Testing at the commencement of every online session should occur before proceeding further. This is to ensure that the online medium is functioning well and can support the delivery of appropriate mental health support.
  • An alternative telephone number is required to contact the client if the video link drops out. If this occurs, then contact should be made immediately. This needs to occur even if the video link can be restored quickly, to ensure the continuity of the counselling and support session. If the video link cannot be restored, the session should be completed by telephone.
  • This plan needs to be made clear and agreed upon by the client.
  • It is important that the client does not try to call the Open Arms worker/OPC. This prevents both ringing at once and therefore a frustrating block in communication. If the client does not answer the phone within five minutes of disconnection, and has not made contact by another means (for example. text message), the Open Arms worker may contact the emergency contact. Sometimes the client is willing to text that they are okay but just needs some time. So be prepared to use both phone and text.
  • If connectivity is poor you can turn off video and continue with audio until connectivity improves. By this means you may able to avoid disconnection.

5. Preparing for Online Video Counselling

5.1. Instructions To The Client

  • The client will need a specified email address to return forms, questionnaires and homework. This may be an Open Arms account or that of the OPC. In instances where this is not available alternative arrangements may need to be considered.
  • Prior to video counselling commencing, the client must be emailed the following information:
  • Online Video Counselling and Support Consent (202-03/ T1).
  • Online Video Counselling and Support Client Information (202-03/ T2). This document provides the client with information about the need for consent, technological requirements and practical considerations for engaging in OVCS.


  • Clients using Healthdirect are directed to the OVCS link on the Open Arms website. Instructions for using other platforms are in the Client Information document.
  • The client should complete and return the information form to Open Arms where practical to do so, before the first video session. Alternatively the client can provide this information by telephone and it can be recorded in the client’s VERA file. No sessions can commence without the provision of this information as Open Arms online counselling or support is not a crisis service.

5.2. Preparing for a Session

  • In addition to standard preparations for a counselling and support session, the Open Arms worker/OPC must ensure that:
  • The ICT is in good order and functioning correctly at both ends and, if possible prior to the first session, a test connection has been successful.
  • The required client contact numbers have been uploaded to VERA and are also at hand in written/printed form in case of need.
  • The emergency contact number is accessible during the counselling and support session.
  • The Open Arms worker knows the geographical location of the client and has researched crisis resources for that area.
  • Any documents the Open Arms worker wants the client to have access to during the session are emailed well in advance, with any instructions for their use, and the client is alerted to these.


5.3. After The Session

  • In addition to documenting the counselling and support session appropriately in VERA, in the same way that face-to-face sessions are documented, the Open Arms worker/OPC should:
  • ensure that the client has returned any completed measures or forms from the session, or completed the measures verbally during the session, and record in VERA.
  • record the session in VERA, using a ‘Skype’ event type and cart item. The ’Skype‘ item is to be used irrespective of the online platform being used.


Note: A future update to VERA will amend the event type and cart item to a more generic ‘Online Counselling’ item.

6. Parent Procedure

6.1. 202-03 – Counselling Procedure


7. Related Templates

7.1. 202-03/ T1 – Online Video Counselling and Support Consent
7.2. 202-03/ T2 – OVCS Client Information
7.3. 202-03/ T6 – OVCS Checklist for Open Arms Employees


ATTACHMENT A

Brief Notes for Open Arms Workers and OPCs Using OVCS

Device requirements

You will need access to a PC, laptop or tablet/iPad/smartphone with a camera, speakers and microphone (built in or separate) and that is running a current or recent version Operating System (Windows XP or newer/Apple OS X/Android OS).

A computer/tablet/phone processor minimum of 1 GHz is needed and for best results a 1.8 GHz processor (or similar) is recommended.

If you use a smartphone, ensure that call blocking is turned on, however it is not recommended that mobile phones are used for the purpose of OVCS as the screens are too small to see the client well and pick up micro gestures, important facial expressions and other body language. It is also physically unstable for the client and the video of you is likely to move around too much.

Internet requirements

A broadband internet connection is required (with minimum speeds of 512kbps down / 128kbps up).
High speed broadband (4Mbps down / 512kbps) is recommended.
Secure password protected Wi-Fi is essential and a backup plan of a ‘4G hot spot’ connection through your phone or a separate mobile broadband link, should the Wi-Fi or broadband internet connection become unstable.

Specific App Requirements

NOTE: There are Task cards for each App on the COVID-19 Self Help Portal:
https://confluence.vera.org.au/display/POLICY/Open+Arms+COVID-19+Self-Service
Coviu hosted by Healthdirect
Coviu hosted by Healthdirect is the required app for Open Arms workers and strongly encouraged for use by OPCs.
Open Arms workers and outreach program counsellors (OPCs) access their Healthdirect dashboard via this link: https://vcc.healthdirect.org.au/login, ideally using Google Chrome on a device outside the DVA network.

Clients access the Healthdirect waiting room through an OVCS link on the Open Arms website.

There is a separate waiting room for each state. The client’s full name and mobile phone number will appear in the waiting room. Identify the correct client using both their name and phone number, and then select the client to start the OVCS session.

Zoom Basic

The downloadable Zoom Application can be loaded and accessed on a personal iPad, desktop or laptop outside the DVA network. Using the device’s web browser, go to the Apple Store or Google Play and find Zoom.

Zoom also has a Browser version which can be accessed using DVA devices on the DVA network via the Chrome web browser.

Zoom is used quite extensively as an enterprise conference solution and Zoom Basic can be adapted to use for one-on-one meetings such as counselling and also for groups. It uses a cloud platform accessed via an app, and supports document sharing.

You can sign up for Zoom Basic for free, download the app, and be supported to convene unlimited 1 to 1 meetings using your computer or mobile device.
The host (Open Arms worker) sets up a meeting by selecting “Host a meeting” in the app and selects “Schedule a meeting” to create a future meeting, to generate and send the client a link to join the meeting. This needs to be done for every session. Do not use repeated Zoom links as this compromises security. Do not use your personal meeting ID. This should only be use for impromptu, immediate online discussion between colleagues. Anyone who has your personal meeting ID can come back at any time.
Each user will need to install the Zoom app before they can access the meeting. Clients can join a Zoom meeting using a web-browser, click on the Zoom link in the email and the Zoom app will automatically download on their device, the link will take them straight into the Zoom meeting. They don’t have to register for Zoom to go in by a web-browser.
When emailing the Zoom link, it is recommended that you delete the phone numbers (under the link) which can be used to call into the meeting by phone. This will reduce possible confusion if the connectivity drops out and the client tries to call into the Zoom meeting while you are trying to call them to see if they are OK.

Important Zoom Settings:

• Make sure that mute is not on when the client enters the meeting – it can be anxiety provoking if the microphone does not work upon entry to the meeting.
• Embed password in meeting link for one-click join – turn on for added security.
• Require Encryption for 3rd Party Endpoints (H323/SIP) – turn on. This is essential for security and confidentiality.
• Auto saving chats – turn on. This is to record any exchanges of information via text – such as sending a web link for the client through chat.
• File transfer – this will enable the Open Arms worker to send files to the client and vice versa (make sure you have anti-virus software as a client could send you a compromised file).
• Screen sharing, Annotation, whiteboard – turn on so you can share docs, draw and play videos.
• Allow removed participants to re-join – if the client leaves due to poor connectivity, the client can re-join the meeting by clicking the link again.
• Identify guest participants in the meeting/webinar – turn on so you can see anyone else who may use the link to come into the meeting.
• Waiting room – Open Arms workers may wish for their clients to enter a ‘waiting room’ and then the worker can admit the client to the meeting when they are ready. This often gives comfort to the client that they will be received and that they have made it to the meeting.
• When attendees join meeting before host – turn on. This needs to be turned on as it sends the Open Arms worker an email saying that the client is ready to join.
• When a meeting is cancelled – turn on. An email is sent to the host and the client to state that the meeting has been cancelled.
• Profile: You can set an Open Arms logo, a picture, or photo in your profile settings so the client sees this when they are in the waiting room and know they are in the right place.

Zoom provides an excellent ‘how to’ guide, on line. Familiarise yourself with this guide prior to use.
Open Arms workers should ensure information on their login ID and password is provided to the relevant Regional Clinical Practice Manager.
Additional information and further troubleshooting can be found at:
https://support.zoom.us/hc/en-us/categories/200101697-Getting-Started

Privacy Note

If you need to name a meeting in Zoom, avoid using the client’s name. It is recommended to use the client’s VERA ID as an identifier.

Skype Standard

The Skype App needs to be loaded and registered on an Open Arms iPad, desktop, laptop or personal device outside the DVA network. Using the device’s web browser, go to Skype.com, the Apple Store or Google Play and find Skype and click the Download or Install button (NOTE: Not Skype for Business) and follow the instructions.
Once the software/App is installed, setting up the account will require the following information:

• Name: This is your account name.
• Skype Name: This is the name that appears on the call (i.e. the client will see this name) and you must have Open Arms in the name, and perhaps your first name or initials.
o For example, you might use: OpenArmsKAH.
• Password: Ensure your password meets the minimum security requirements as stipulated in the setup and that it can be remembered.

Open Arms workers should ensure information on their login ID and password is provided to the relevant Regional Clinical Practice Manager.
Further information and general troubleshooting can be found at:
https://support.skype.com/en/faq/FA11098/how-do-i-get-started-with-skype

Important note on security when using Skype:

Skype have implemented the Signal protocols so that you can create conversations in a more secure environment (only the sender and receiver get to see what is sent). However, to enable this you will need to start a new conversation. Instructions are available on the website:
https://support.skype.com/en/faq/FA34824/what-are-skype-private-conversations

Once you have a "private conversation" set up, end-to-end encryption will be in place.



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