PACT Teleconference guidance for professionals

PACT can be delivered through teleconference during this period of limited or restricted faceto-face contact.

Our experience is that teleconference sessions can be very effective and often you forget you’re not sitting the same room! Here is some guidance.

Home-made videos for PACT teleconference sessions
Parents/caregivers may use any recording device, a mobile phone, camcorder or iPad for home-made PACT video recordings. Parent/ caregivers make a video recording every 2 weeks before the next PACT teleconference session.

Parents are given simple steps of advice to making the video recording:
a) The recorder can be positioned upright on a shelf, ledge or table making sure it’s on a wide angle lens to capture both adult and child in the recording.

b) The camera should be close enough to record the voices with adequate sound quality. Any background noise should be limited or avoided, e.g. TV/ video/ music off.

c) Avoid positioning the camera facing a window or bright light to reduce glare but have sufficient light in the room to see the face of both adult and child in the video recording.

d) The camera should be left on record to make two 5-minute video recordings or one
continuous 10-minute video recording.

e) If two parents are practicing PACT at home they can make a 5 minute recording each.

f) The video recording/s are transferred to the PACT therapist using a secure internet platform, depending on availability and the therapist’s policy e.g. WeTransfer or SharePoint.

g) The video should be transferred to the PACT therapist a minimum of 2 working days before the PACT teleconference session between therapist and parent/caregiver.

PACT at Home: The therapist discusses with parent/caregivers how to find the best space for home-made video recordings e.g. in an available distraction free space e.g. a bedroom or quiet space in a room.

As the PACT progresses, video recordings may take place in different areas of the home e.g. (in the kitchen, secluded outside space or garden) to record interaction in daily routines. The therapist advises on appropriate materials and interaction opportunities e.g. using household items, available toys or interaction in daily routines e.g. washing hands,
making toast, bubbles, pouring juice, play with or without toys, e.g. hide and seek, signing and rhymes, depending on child motivation.

PACT Practice: Daily home practice between PACT sessions continues as described in the PACT manual.

Parent/caregivers can prepare for daily 30-minute home practice sessions by selecting a small set of objects/ toys and removing or limiting other distractions from the room e.g. a room where there is no TV, video, computer, phone or radio (or, if not removed, turned off). The therapist can help parents consider any necessary adaptations, and to identify the best time of day when they can be alone with the child (e.g. after tea or after bath time).

The time and date of the teleconference is agreed every two weeks. Where possible the therapists and parent/caregiver should have reviewed the full video recording before the teleconference session and each considered two best clips (1 minute each).

Tele-conference Session
The six monthly alternate weekly teleconference sessions between parent/caregiver and therapist can use any platform e.g. Skype, Facetime or phone.

Where possible the video recordings are shared on the teleconference platform, e.g. if using Skype, click ‘share file’, a window pops up with the video recording on the screen which is already displaying the therapist and parent. If sound quality is affected you may turn off the video picture to improve sound quality.

At each PACT teleconference session, the therapist agrees a date for the subsequent session and discusses the contexts/activities in which the parent may make the next home-made video to be submitted to the therapist 2 working days before the next session (or as agreed by the therapist).

The homemade videos demonstrate the PACT goals practiced and or accomplished. The video may demonstrate PACT Stage-specific or generalisation of goals in daily routines or other settings, depending on the home context.

An additional person may be available to make the home video recording or a ‘selfie’ video will be sufficient depending on individual circumstances.

Each PACT teleconference session should last approximately 60 minutes. In a similar way to the PACT visits, the following sequence is followed at each session:

1. Beginning: Review of progress and setting the agenda (5-10 mins)
Each session begins with initial feedback on the previous 2 week’s daily practice. The parent/caregiver is asked to recall their previous sessions goals, to describe examples of their home practice and progress. The therapists ask how many days parents were able to practice the context and duration of their home practice. The parent is also asked if they noticed any changes in the child’s communication since the previous session.

2. Middle: Video review and Feedback (20-30 minutes)
The therapist asks if adults have already reviewed the new home-made video recording from beginning to end, if not, adults are asked to review the full video in the tele-conference session.

The therapist identifies 2 clips (1 minute each) starting with the best clip.

The therapist replays and provides PACT feedback for each 1 minute clip on the teleconference screen using the same PACT feedback techniques as described in the PACT manual i.e. freezing the video clip to highlight an important moment, playing the video backwards and forward to observe the sequence of the interaction and using cascading probes to reflect on skills and techniques.

The therapist asks the parent to describe their observations, reflecting on both child and adult responses and skills related to the PACT stage. The discussion focuses on PACT stage specific strategies and techniques detailed in the PACT manual. The therapist uses record sheets to note communication responses observed during the teleconference video playback.

3. End: Summary and Home Programme (10 mins)
At the end of the PACT teleconference session, the therapist summarises progress achieved and successful strategies used. Rather than telling the parent, the therapist asks the parent to recall the new goals discussed during the video feedback e.g. saying ’of all the thing we discussed today, what new goals will you take away?’

The summary of the session, stage specific strategies and new goals are written in the PACT programme and emailed to the parent/caregiver. The written programme also summarises the agreed home based activities to achieve these goals.

The PACT goals are written in the parent’s own words, with clear behavioral examples based on child’s development,skills and stage of PACT being implemented.

Enjoy your teleconference PACT sessions!

Catherine Aldred