title: Clinical supervision of a client with traumatic brain injury in a host home placement using video teleconferencing: a case study.
abstract: OBJECTIVE
  To examine the use of video teleconferencing (VTC) technology in the supervision of a 41-year-old man with expressive aphasia during community reintegration in a host home setting 3 years after severe traumatic brain injury (TBI).
  
  
  METHODS
  Using a 3-month A-B-A design, weekly VTC meetings were substituted for in-person visits by the client's case coordinator.
  
  
  METHODS
  Weekly ratings of satisfaction with the medium of communication used (VTC vs in-person meetings) by each participant.
  
  
  RESULTS
  The client and the case coordinator found VTC meetings to be as effective as face-to-face supervision visits for communication of clinical concerns and problems. The client reported feeling self-conscious about having the equipment in his living space because of privacy concerns. The mentor reported that VTC helped focus on questions and answers in goal-oriented conversations, was easier to schedule, and had the advantage of not requiring preparation of the house for in-person meetings. Reported disadvantages included feelings of camera shyness as well as impatience due to slow video transmission speed at times. The case coordinator also found VTC meetings easier to schedule and reported savings in travel time and expense. Reported disadvantages included reduced transmission quality and speed on some occasions. The cost break-even point for VTC was reached at 1 year with substitution of VTC sessions for half of weekly case coordinator home visits and 2 home visits per year by the coordinator's supervisor.
  
  
  CONCLUSIONS
  VTC might be liberally substituted for in-person supervision visits in the context of an ongoing clinical relationship during community reintegration following TBI.
authors.affiliation: Center for Comprehensive Service-New England (a Partner of MENTOR Acquired Brain Injury Network), Braintree, MA 02184, USA. nealmcgrath@rcn.com
authors.forename: Neal
authors.initials: N
authors.lastname: McGrath
authors.forename: Murdo M
authors.initials: MM
authors.lastname: Dowds
authors.forename: Richard
authors.initials: R
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D001039:Aphasia, Broca / Q000209:etiology / Q000628:therapy*; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D017216:Telemedicine; D049269:Videoconferencing