Abstract:
This project examined the use of video teleconferencing technology in the supervision of persons with traumatic brain injury enrolled in a community reintegration program utilizing host home placement following inpatient rehabilitation. Using a three-month A-B-A design, weekly video teleconferencing supervision meetings with the client's clinical case coordinator were substituted for in-person supervision visits during intervention Phase B. Weekly ratings of ommunication effectiveness, impact on working relationships, and overall satisfaction were completed by clients, their clinical case coordinator, and their resident host home "mentor" throughout the three months.

In a single case study of a 41-year old aphasic man three years post severe TBI, the client and the clinical case coordinator found video teleconferencing meetings to be as effective as face-to-face meetings for communication of clinical concerns and problems. Mentor ratings were judged to be of uncertain validity. In debriefing interviews, the client reported greater discomfort in the video teleconferencing sessions but appreciated the ability to make use of gestural communication. The mentor reported that the video teleconferencing condition was helpful in focusing goal-oriented conversations and made scheduling of, and preparation for, supervision meetings significantly less difficult. Feelings of being "camera shy" and frustration with the effects of slower than real-time transmission speed were accommodated to fairly quickly. The clinical case coordinator reported far greater ease of scheduling and the obvious savings in travel time and expense. Poor transmission quality on some occasions was felt to be a disadvantage. Equipment for the project was selected on the basis of easy availability through consumer products' retailers and relatively reasonable cost.

Cost analysis suggested that a three year break-even point for equipment costs could be reached when video teleconferencing meetings were substituted for half of the regularly scheduled weekly clinical case coordinator home visits. Cost savings would be increased for clients living at a greater distance from case coordinators' central office and for more frequent substitution of video teleconferencing meetings for in-person meetings.

These findings suggest that clinical supervision conducted via video teleconferencing may be liberally substituted for in-person visits for clients with whom an ongoing clinical relationship has been established and that service for clients following TBI may be extended over greater geographical distances as a result.