Research has shown that using telehealth for rehabilitation assessment can be an effective approach. The COVID-19 pandemic and subsequent lockdowns led to many rehabilitation counselors pivoting to telehealth assessment with their clients. This study explores rehabilitation counselors’ use of rehabilitation assessments and telehealth since the beginning of the COVID-19 pandemic. Using a mixed-methods approach, data from 41 rehabilitation counselors across Australia were analyzed. Participants were asked which measures they used prior to the pandemic, how their use of the measures changed during telehealth, and how their work changed due to the COVID-19 pandemic. The Depression Anxiety Stress Scales and the Occupational Search Inventory were the most commonly used tests. Theoretical analysis demonstrated that participants utilized tests based on their usefulness in comprehensive assessment and rehabilitation planning, for engaging the client in the assessment process, out of necessity (mandated tests), and due to attributes of the test the counselor valued. Participants described the impact of COVID-19 on assessment practice demonstrating that despite challenges to telehealth, there were also benefits and that assessment measures could be altered for use in telehealth. Although telehealth had an impact on how rehabilitation counselors provided assessments, many found ways to make it work at a distance.

ObjectiveThe COVID-19 pandemic dramatically altered social determinants of health including work, education, social connections, movement, and perceived control; and loneliness was commonly experienced. This longitudinal study examined how social determinants at the personal (micro), community (meso), and societal (macro) levels predicted loneliness during the pandemic.MethodsParticipants were 2056 Australian adults surveyed up to three times over 18 months in 2020 and 2021. Multi-level mixed-effect regressions were conducted predicting loneliness from social determinants at baseline and two follow-ups.ResultsLoneliness was associated with numerous micro determinants: male gender, lifetime diagnosis of a mental health disorder, experience of recent stressful event(s), low income, living alone or couples with children, living in housing with low natural light, noise, and major building defects. Lower resilience and perceived control over health and life were also associated with greater loneliness. At the meso level, reduced engagement with social groups, living in inner regional areas, and living in neighbourhoods with low levels of belongingness and collective resilience was associated with increased loneliness. At the macro level, increased loneliness was associated with State/Territory of residence.ConclusionsTherapeutic initiatives must go beyond psychological intervention, and must recognise the social determinants of loneliness at the meso and macro levels.

Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.

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