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).

2.1. 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.

3.1. 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.

4.1. 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.

5.1. 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:

• 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:

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:

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