1 Questionnaire Results - Professionals

1 QUESTIONNAIRE RESULTS - PROFESSIONALS

A total of 80 participants completed the service professionals questionnaire either directly using the online Survey Monkey tool or face to face at stakeholder events. Of the 80 who participated, response numbers to each question varied, the results indicate the n value for each question.

1.1 REMOTE ACCESS QUESTIONNAIRE RESULTS

1. Do you or your organisation use remote access software? (n = 73)

Response Answer Options Response Count Percent Yes 69.9% 51 No 30.1% 22

Extracted themes from stakeholder events and additional comments: “NO - but at home have linked to sensory software” “Not at present but seriously considering it” “Equipment problems can be solved a lot more quickly, quick fixes are easy (from a supplier and user perspective)”

2. What has remote access been used for? (Select as many as apply) (n=45)

NB: Of those that reported that they have used remote access software 6 did not respond to question 2 to clarify its use.

Answer Options Response Percent Response Count Troubleshooting problems 95.6% 43 Configuration settings/changes e.g adjusting screen 57.8% 26 resolution Software updates/changes e.g. editing symbols in grids 44.4% 20 Training e.g. staff training on software package 26.7% 12 Other 15.6% 7 Of the 7 that responded “Other”, 4 could be classified under other categories. Some other comments refer to traditional IT support and working from home.

“IT technicians use VPN/VNC for remote technical support”

“Working from remote locations (e.g. home)”

3. What remote access programs have you used? (Select as many as apply) (n=39)

Answer Options Response Percent Response Count LogMeIn 17.9% 7 PCAnywhere 5.1% 2 RemoteAssistance 12.8% 5 TeamViewer 20.5% 8 Smartbox/Sensory Software 53.8% 21 Corporate Solution 20.5% 8 Other 46.2% 18

Smartbox and Sensory Software are commercial distributors of AAC hardware and software. They provide remote support using Teamviewer proprietary software, however it was felt those completing the questionnaire may only recognise the distributor as the provider of support. 4. Which devices has your organisation connected to? (select as many as apply) (n=54)

Answer Options Response Percent Response Count Windows computer/laptop 96.3% 52 Mac OS computer/laptop 1.9% 1 iPad/iPhone 22.2% 12 Windows tablet 7.4% 4 Android tablet/ smart phone 0.0% 0 High-tech Communication aid 29.6% 16 Dynavox 9.3% 5 Liberator 9.3% 5 Other 22.2% 12

All responses selecting “other” would be classified as high-tech communication aids e.g. Tellus, Tobii C12, Futurepad etc. This would therefore raise the total response count for High-tech Communication aid to n=28. It should also be noted that many high-tech communication aids use Microsoft Windows operating systems. 5. Have you encountered any problems during remote access? (n=49)

Answer Response Response Options Percent Count Yes 40.8% 20 No 59.2% 29

6. If yes, briefly describe: (n=20)

The responses can be categorised as follows:

Problem Encountered Total (n) Technical issues Connection issues 6 Performance issues 5 Functionality issues 3 Security issues 4 Other 2

Extracted themes from stakeholder events and additional comments: “Some people don’t have internet access, how to they receive support?” “Professionals felt that there may be a need for specialist support i.e. from technicians etc”

7. Were any changes made to the network before you were able to use the application? (select as many as apply) (n=35)

Answer Options Response Percent Response Count Firewall / Internet connection 25.7% 9 PC Permissions, eg: administrator rights. 34.3% 12 Security settings 22.9% 8 No changes made 48.6% 17 Other 14.3% 5 Of the responses selecting “other”, three responses indicated that they were unsure but local IT teams were required to be involved. One response required changes to the South West Grid for Learning proxy server.

8. Information governance refers to the sharing of personal data. Have you encountered any problems with such restrictions? (n=46)

Response Response Answer Options Percent Count Yes 34.8% 16 No 65.2% 30

Extracted themes from stakeholder events and additional comments: “Using NHS computers would be a problem” “No - but I can envision this being an issue if we started using remote access eg Skype” “Those that do support service users often have problems with the connection, with many carrying out the work from home.” “We need more information/explanation about it. People think it’s ‘hacking into’ their PC & collecting personal data” 9. If yes, please briefly describe: (n=15)

Response Very restricted. Everything encrypted - ports locked No Skype Safeguarding restrictions. 'Smooth wall' internet filtering programme must be loaded to all technology before linking to school networks Likely confidentiality issues Unable to information-share with NHS as Independent organisation No social networking Pupil information is encrypted memory sticks Business case required for each connection. The time it takes to get this (has to be verified with manager - so done at home) This is the reason why we are not able to use Skype. NHS restrictions The sharing of video evidence for assessments Necessitated ensuring no files containing client information were open when IT men accessing computer remotely. Recording/Photos re patient info on iPad and uploading to PC Clinical Record. IT currently exploring governance issues re this and Facetime/Skype. Issues communicating patient identifiable information between ???? (social enterprise) and other Health organisations. Staff at school employed by different bodies ie NHS/Education/Private IT Dept reluctant to allow purchase of iPads due to concerns about personal information being lost - now resolved Complicated to set up baracuda people at far end don't know how to open Not problems as such just a difference regionally of what people do and do not share over e mail / open sources etc, we are very tight on this and have clear documentation and policy

10. What network connection is used for remote access / connecting to the above devices? (n=48)

Answer Options Response Percent Response Count Corporate network connection 35.4% 17 School network 29.2% 14 NHS Network 43.8% 21 Personal home internet connection 41.7% 20 Other 25.0% 12 1.2 VIDEO CONFERENCING QUESTIONNAIRE RESULTS

12. Do you or your organisation use video conferencing? (n=66)

Answer Options Response Percent Response Count Yes 63.6% 42 No 36.4% 24

13. What is Video Conferencing used for in your Organisation? (n=35)

Answer Options Response Percent Response Count

IT Services 14.3% 5 Training 22.9% 8 Meetings 74.3% 26 Education Purposes 20.0% 7 Clinical appointments 17.1% 6 Other 22.9% 8

The following show the ‘Other’ comments.

Support Council Staff Sales Clinical supervision It is available to all services should they need it. Solicitors office Cornwall Council is trialling VC. It may soon be possible for all employees to use at their desk.

14. What clinical purposes have you used Video Conferencing for? (n=17)

Response Response Answer Options Percent Count Face to face initial 17.6% 3 assessments Review 29.4% 5 appointments Training Sessions 76.5% 13 Catch up meetings 41.2% 7 Other 70.6% 12

Below is a selection of the ‘Other’ comments

Therapy session. I was able to conduct an initial trial before the organisational change and subsequent loss of IT interest and support. Feedback to parents on initial assessment and objectives. Showing equipment and software Connecting children who are long term sick with their classroom Actual therapy sessions but on occasions simply liaison but that is often a part of the actual SLT session MDT meetings 15. Do you feel that Video Conferencing could be used for any of the following clinical purposes? (n=51)

Face to face initial assessments 13.7% 7 Review appointments 68.6% 35 Training Sessions 86.3% 44 Catch up meetings 88.2% 45 Other 23.5% 12

Below is a selection of ‘Other’ comments

Service Users communication practise Acquired brain injury patients could benefit from support from local services, reviews Second opinions conference calls I think for assessments including initial assessments face to face contact is required. Direct therapy Consultation / advice sessions 16. Which software packages have you used for Video Conferencing? (n=42)

Answer Options Response Percent Response Count Skype 100.0% 42 MSN messenger 4.8% 2 Google Video 2.4% 1 Lifesize 2.4% 1 Polycom 9.5% 4 FaceTime 11.9% 5 Vidyo 2.4% 1 Other 16.7% 7

SEQOL has networked videoconferencing facilities at HQ using N3 (I think) Don't know - set up between Isle of Scilly and Cornwall Foundation Trust. GOTO Meeting / GOTO Training Visimeet just trialling GoToMyMeeting

17. What hardware have you used for Video Conferencing? (n=45)

PC 64.4% 29 Laptop 91.1% 41 Separate Webcam (not built in to laptop) 62.2% 28 Headset 35.6% 16 TV Screen or separate large screen monitor 20.0% 9 Smartphone, eg: Iphone, android 13.3% 6 Tablet, eg: ipad, Samsung slate. 17.8% 8 Dedicated video conferencing hardware 13.3% 6 Other 2.2% 1 18. What network connection have you used for Video Conferencing? (n=37)

Answer Options Response Percent Response Count Corporate network connection 32.4% 12 School network 13.5% 5 NHS Network 27.0% 10 Personal home internet connection 67.6% 25 Other 16.2% 6

19. What connection was used at the far end? (n=35)

Response Response Answer Options Percent Count Corporate network connection 25.7% 9 School network 14.3% 5 NHS Network 20.0% 7 Personal home internet connection 74.3% 26 Other 2.9% 1 20. Have you encountered any problems during Video Conferencing sessions? (n=37)

Answer Options Response Percent Response Count Not able to get it to work 24.3% 9 Connection dropping 62.2% 23 Poor quality video 59.5% 22 Poor quality sound 62.2% 23 Video and sound not lining up. 29.7% 11 Other 16.2% 6

Variations in quality of equipment used and competence of user. Wi-Fi and linking non local authority devices to the LA network is not permitted Sometimes quality of connection Very good result and perfect use of time, no travelling. Administrator Privileges preventing software download e.g for Skype

21. What was the sound quality like? (n=34)

Poor 1 Useable 20 Good 13 Excellent 0 Total 34

22. Was the sound quality suitable to replace face to face sessions? (n=27)

23. What was the video quality like? (n=35)

Poor 1 Useable 24 Good 9 Excellent 1 Total 35

24. Was the video quality suitable to replace face to face sessions? (n=32)

Answer Response Response Options Percent Count Yes 68.8% 22 No 31.3% 10 25. Have you experienced times where Video Conferencing would be useful but this was blocked or would not work within your organisation? (n=38)

Answer Response Response Options Percent Count Yes 65.8% 25 No 34.2% 13 Below is a selection of ‘’Why’ comments

Not accessible through firewall in county offices. Schools do not always have wireless Pupil's AAC devices often do not connect to the school network. Blocked by IT / Local Authority In our organisation we don't even always have acccess to computers, let alone wifi or video conferencing. We have no wifi in our Trust Only available in very limited locations in Trust Sound but no video - work session Now blocked by lack of engagement from new IT services Skype - support sessions not possible on NHS network. Separate independent wi-fi required. LSVT therapy now not possible via Skype IT failures Issues getting software onto PC laptop - resorted to using own device. No WI-FI access for iPad use. No money for premium Skype account for speaking to more than one person. IT would not work because use of Skype not approved. Could not use iPads easily due to lack of wireless connection at work. Different schools have different policies on Skype. No school internet access Blocked by NHS Technical staff being precious about 'their' networks. Has proved difficult in some of the schools that I connect to but it has been possible to work round that but has limited the immediate flexibility of using Skype. Governance and firewalls Rooms in which videoconferencing set up not available when you want them. Possibly also issues re governance. ISPN lines not working N3 gateways not open Security issues from work.

28. Can you Video Conference from your base location? (n=49)

Answer Response Response Options Percent Count Yes 42.9% 21 No 57.1% 28 30. Who has been involved in delivering Video Conferencing appointments? (n=27)

Answer Options Response Percent Response Count Practitioners 70.4% 19 Service users 37.0% 10 Family members 40.7% 11 Support workers 29.6% 8 IT support 51.9% 14

31. Have you had training prior to carrying out a Video Conferencing session? (n=39)

35. Have you experienced times where Video Conferencing could not be used due to the service user’s needs? (n=32)

Answer Response Response Options Percent Count Yes 12.5% 4 Below is a selection of ‘Why’ comments No 87.5% 28 Lack of internet connection Lots of people Pupils not familiar with the room/disliking the environment lack of clear communication with partner at other end Inability to move remote camera. Others needed at V/C (ie TAs, OTs) but not available. Work with people with LD who may not understand 38. Have you found any particular locations within which Video Conferencing has provided a useful session tool? (n=14)

Answer Options Response Percent Response Count Education establishments 50.0% 7 Residential care settings 7.1% 1 Own home 57.1% 8 Day care settings 7.1% 1 Healthcare settings 21.4% 3 Other 14.3% 2

43. How have those receiving Video Conferencing sessions generally rated it? (n=16)

Very happy 6 Comfortable 9 Uneasy 1 Wouldn't participate again 0 44. What is the average length of journey that your service users currently have to make to access AAC services? (n=53)

Below is a selection of ‘Why’ comments0-10 miles 22 10-30 miles 18 If met in person first Person receiving LSVT via Skype30-60 was miles satisfied 8 Comfortable/uneasy/wouldn't60-100 participate miles again ALL ticked 3+ comment 'Mixed!' some specific observationsOver that have100 miles been useful to shape2 my service

45. What is the maximum length of journey that your service users currently have to make to access AAC services? (n=50)

15 miles 17 30 miles 8 45 miles 7 60 miles 3 75 miles 6 Over 100 miles 9 2 QUESTIONNAIRE RESULTS – SERVICE USERS

2.1 REMOTE ACCESS RESULTS

A total of 8 participants completed the service users questionnaire these were completed at focus group sessions. Of the 8 who participated response numbers to each question varied, the results indicate the n value for each question.

1. Has anyone ever accessed your computer or communication aid by connecting remotely? (n=8)

2. If Yes, who was it? (n=5)

Answer Options Response Percent Response Count Equipment supplier 60.0% 3 Local AAC service 20.0% 1 Local practitioner (school/SLT department) 20.0% 1 2.2 VIDEO CONFERENCING RESULTS

3. Have you ever had a video conferencing appointment? (n=6)

Response Response Answer Options Percent Count Yes 33.3% 2 No 66.7% 4

4. If yes, who with? (n=1)

Answer Options Response Percent Response Count Equipment supplier 0.0% 0 Local AAC service 0.0% 0 Local practitioner (school/SLT department) 100.0% 1 Other 0.0% 0 5. Where did the appointment take place? (n=2)

Answer Options Response Percent Response Count Home 0.0% 0 Clinic 0.0% 0 School 0.0% 0 Other 100.0% 2

Of the respondent’s that selected “Other” their answers are as follows: “Solicitors office” “Office”

6. What were the videoconferencing sessions for? (n=2) Answer Options Response Percent Response Count Assessment 0.0% 0 Review appointments 0.0% 0 Training 0.0% 0 Other 100.0% 2

Of the respondent’s that selected “Other” both their answers are as follows: “face to face appointment”

7. Did you have any problems during the Videoconferencing sessions?

Questions 8-10 had no responses.

11. Is video conferencing suitable to replace face to face sessions?

Answer Response Percent Response Count Options Yes 20.0% 1 No 80.0% 4 12. How do you feel about videoconferencing sessions? (n=6)

Answer Options Response Count Would prefer this type of session to a face to face session 0 Very happy 1 Comfortable 3 Uneasy 2 Would not participate again 0

13. What is your average length of journey to access AAC services? (n=7)

Answer Options Response Count 0-10 miles 2 10-30 miles 3 30-60 miles 2 60-100 miles 0 Over 100 miles 0 14. What is the maximum length of journey you have to make to access AAC services? (n=6)

Answer Options Response Count 15 miles 2 30 miles 1 45 miles 0 60 miles 1 75 miles 0 Over 100 miles 3

15. What is the average cost of a return journey to access AAC services? (n=2)

Response Total (£) 1 46 2 5 3 QUESTIONNAIRE ANALYSIS

3.1 QUESTIONNAIRE DISCUSSION AND LIMITATIONS

The service professionals questionnaire was completed by a total of 80 participants, as mentioned not all questions were completed. Respondents were able to complete the questionnaire either electronically using Survey Monkey or on paper through stakeholder days. The disparity in the total number completing the questionnaire and those that responded to all questions could be attributed to misunderstanding of the question or feeling it is not applicable. The reduction in n value reduces confidence in the results. Respondent numbers could have been improved with greater guidance and assistance completing the questionnaire, however due to resource and time restrictions for this project this was not feasible. Another measure for the online survey would be to mark questions as mandatory so that a response is required prior to submitting the questionnaire.

Answers to questionnaires also revealed misinterpretation of the question. For example for question 13, What is Video Conferencing used for in your Organisation? Some responses include: “I haven't used this” and “catching up with the grandparents”. These responses may have been reduced with greater guidance and assistance completing the questionnaire. Prior to distribution of the questionnaire it was distributed amongst those involved in the project, misinterpretation could also have been reduced by piloting the questionnaire outside those involved in the project.

The distribution of the survey was to those who expressed an interest in Objective 7 and so was not a randomised sample. This may reduce the confidence of inference of results for the population of professionals and users involved in AAC services. The completion of the survey was also not limited to the number of individuals per service or organisation so for example there may be 3 respondents from an organisation that is using video conferencing.

3.2 REMOTE ACCESS DISCUSSION

Awareness and use of remote access tools is prevalent amongst those involved in AAC services, 70% of 73 respondents have personally or at an organisation level used remote access technology. The most popular use is for troubleshooting problems of electronic devices (44%). Other uses include configuration changes, training and software updates. As remote access software is used frequently by IT services within organisations the responses here are more widely related to all uses of remote access and not specifically with a device supported by AAC services. This is also supported by the most popular devices connected to are Microsoft Windows based PC and laptops. (96%, n=54).

There is large range of remote access applications available this survey identified 15 different applications those responding had used. The most popular form of remote access software identified s Teamviewer with 74% (n=39) of respondents familiar with this application. Of this 21 respondents have used Teamviewer through equipment suppliers, Smartbox or Sensory Software. The stakeholder day revealed positive feedback for remote access sessions with suppliers from both the supplier and user side.

“Equipment problems can be solved a lot more quickly, quick fixes are easy (from a supplier and user perspective)” Of those who have used remote access (n=49) 40% reported problems during a session. This was most significantly due to technical issues spread between connection issues, performance and functionality. A limitation for remote access was also highlighted: “Some people don’t have internet access, how to they receive support?” An overarching comment identifies the barrier of technical knowledge and skills about remote access and specific applications is limited amongst professionals working in AAC and who would themselves be expected to be the provider of remote access “Professionals felt that there may be a need for specialist support i.e. from technicians etc”. The questionnaire highlighted the mixed picture across organisations relating to security and information governance concerns for remote access. From an IT perspective 50% of those using remote access required at least one change or configuration setting for either their computer or network. Restrictions of information encryption and firewalls set by IT for organisations such as those working within the NHS were also identified. Information governance was highlighted as a barrier or concern for 35% of respondents.

3.3 VIDEO CONFERENCING DISCUSSION

From the survey carried out, Videoconferencing is becoming more and more popular. Of the 66 people that were surveyed 64% have used videoconference at some point either for personal use or work purposes, mainly for meetings. Respondents that use videoconferencing for clinical work, this is mainly for training sessions, 76% of users. Catch-up and review sessions also feature highly.

Skype is the main software package that has been used, and of those surveyed, everyone had used it. This was due to it being free to use and these sessions quite often take place from home to home due to services being blocked at work (25%), or other network connection issues such as connection dropping (63%). This is despite people wanting to use videoconferencing at work. Of the people surveyed over half found videoconferencing most useful from home or in a school. This is perhaps due to less strict firewalls than the NHS or other companies. Attempting to carryout videoconference at work can be very frustrating. 65% of those surveyed Many companies block free software packages, like Skype, or don’t offer wireless connections in suitable places. Clinical governance is also a concern for network administrators which normally leads to videoconferences not being able to take place. A product that would be introduced would need to be simple for network admins to configure on the firewall to ensure that connections are not blocked. Clinical governance would also need to be a consideration when selecting products to be trailed.

There are many different videoconferencing packages which is shown as after Skype, no other particular package has been used by more than 12% of responders. Currently of the software packages that have been used, the sound and video quality is not at an excellent level but is considered to be a useable level. 60% of users have experienced poor quality video and sound, and a further 30% have suffered jitter, where the sound and video do not line up which can make carrying out a videoconference very frustrating. Network and broadband speeds would need to be checked before videoconferences took place to ensure that quality is as good as possible and jitter kept to a minimum.

It is important to assess service users’ needs before attempting to carry out a remote assessment. This could be a need for technology that isn’t available, such as a remote control camera, or those at the remote end are not confident enough to carry out the necessary setup. But for those that have experienced videoconferencing, of those surveyed, no one would not participate, and only 1 was unsure if they would again. All other responders would be comfortable or very happy to use videoconferencing again.