Working with the public, you have a responsibility to protect people from harm. This includes taking reasonable steps to protect your clients and others from coronavirus. This is called a risk assessment and it’ll help you manage risk and protect people.

You must:

• Identify what work activity or situations might cause transmission of the virus
  think about who could be at risk
• Decide how likely it is that someone could be exposed
• Act to remove the activity or situation, or if this isn’t possible, control the risk
• You don’t have to write anything down, but it might help if you do. Especially for insurance purposes

We encourage you take practical measures, such as:

• Putting in place social distancing measures where possible
• Staggering shifts in multi-disciplinary clinics
• Providing additional hand-washing and hand disinfectant facilities
• Identify areas of high-traffic and hand contamination – such has stairways and bathrooms
• Consider Natural Ventilation in the room

We highly recommend against waiting rooms and instead encourage clients to wait outside the premises and to be called in for their appointment.  

Appointment times should be staggered by a minimum of 30 minutes which should further remove the need for a waiting room.

A detailed client risk assessment needs to be done in addition to your regular consultation to determine risk to both you and your client and if treatment should be undergone. 

You should additionally check with your client the day of treatment to make sure nothing has changed in regards to symptoms.

There is a client Risk Assessment form in the Downloads section, but here we will walk you through the reasons or meaning for the questions and their answers:

Have you or anyone in your household ever been diagnosed with Covid-19?

If client or anyone in their household has previously been diagnosed with Covid-19, then significant research shows that there is a possibility they could be suffering with blood clots, so your pressure should reflect this possibility.

Have you or anyone in your household shown any of the following symptoms in the last 7 days?

If the answer to this question is yes, then the treatment can not continue until after 2 weeks of isolation with no symptoms in the household.  Your client notes should reflect this.

Have you or anyone in your family been advised by the government as being clinically vulnerable and to shield?

If the answer to this is yes and client is the vulnerable one, and social distancing is still in place, then treatment should only happen if you can demonstrate that the client  is considered to be in ‘high-level’ need of treatment where quality of life would deteriorate without treatment.  Both client and therapist are advised to wear a face covering in this situation.

If their family member is the vulnerable one, this does not mean you need to avoid treatment, but you should be aware that if social distancing is still in place, treating this person would be an elevated risk and both parties would be advised to wear a face covering. 

If the client chooses not to wear a face covering, this should be noted.

Even if social distancing is lifted, extra care should be taken when treating vulnerable or shielding clients.

Are you or anyone in your family currently suffering from: (clinically vulnerable list)

If the answer to this is yes, please follow the same advise as previous question.

Have you recently travelled abroad?

If travel was within 7 days, treatment should be avoided until after 7 days has passed.  This should be noted.

Have you noticed any new rashes on your body or feet?

Rashes on the body and feet have been shown to be related to severe cases of covid-19.  Although the research isn’t definitive, there have been links that if someone has these rashes and marks they may also be susceptible to post-covid blood clotting. 

For Massage, this should be deemed a potential contraindication and you should ask the client to consider getting GP clearance, first.

For other modalities such as Reflexology, extra care should be given and pressue should be very light. Yogatherapy should also take this into consideration.

Have you experienced any pain or cramping in your legs/calves?

If the answer to this is yes, then treatment is contraindicated for all therapies and client should be advised to get GP Clearance

Do you promise to contact your therapist immediately if you or anyone in your household develops symptoms associated with covid-19 within 7 days of your treatment?

Please check below guidance for what to do in case of infection.  Explain to your client the protocol that will be taken in this case.

If anything changes between now and your appointment time, do you promise to inform your therapist before your appointment date?

Do not depend on your client to update you 🙂 Inform them that you will call/text/email them the day of their appointment to check that nothing has changed.

The last 2 replies are very important to communicate as they may contradict your current GDPR rules.  You should also inform client that track and tracing apps could pose a client confidentiality and GDPR risk.

It is important that talking is kept to a minimum during treatments. So, to reduce talking and to maximise the effective use of your face-to-face time together, we recommend that consultations are done virtually before the live appointment session.

For Established clients:

• Sessions must be held over a video conferencing application such as skype or zoom (or a similar application) where you both can see and hear each other.
• The same levels of privacy and client confidentiality must be respected as if you were in clinic.  (i.e., sessions are not to be held in the same room as your partner, children, etc)
• You must have a way to contact the client should you become disconnected through Zoom, such as a telephone, etc.  You do not want to leave them abandoned in the middle of a session.
• Both yourself and the client must be confident that they understand the self-care techniques you have provided them and are able to practice them safely once the session has closed.

For New Clients:

• All of the above, plus an additional thorough online client consultation.
• With clients that you have never worked with face-to-face, common sense should be used and only the lowest of risk techniques should be used with them.

The above is basic advice, but we advise you to contact your insurance company to discuss your personal circumstance before engaging in virtual consultations and offering self-care advise.

Where your therapy requires posture assessment, you might want to additionally consider applications such as posturescreen mobile to assisst you. 

Clients should also be advised beforehand of the new protocols by email or text, such as:

• Additional measures you are taking for their safety
• If they usually wait in your waiting room, then advise that the waiting room will be closed
• Online payments
• New GDPR considerations, including the potential use of track and trace applications and the contact that will be required if your clinic should face a contamination.

Last Updated 09 July, 2020

• While social distancing is still in place, we advise treating those who are deemed clinically vulnerable only in an urgent-need basis where not having treatment would cause detrimental deterioration to their condition. (i.e. vulnerable person in therapy for stroke rehab)
• After social distancing is lifted, as well as in the case for before, we advise using visor, face coverings and gloves when working with this particular group.

We also advise to schedule vulnerable people at the beginning of your working day, whenever possible.

Who is classified as a vulnerable person?

Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place some people at greatest risk of severe illness from coronavirus. Disease severity, history or treatment levels will also affect who is in this group.
Clinically extremely vulnerable people may include:

• Solid organ transplant recipients.
• People with specific cancers:
  • people with cancer who are undergoing active chemotherapy
  • people with lung cancer who are undergoing radical radiotherapy
  • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • people having immunotherapy or other continuing antibody treatments for cancer
  • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
• People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD).
• People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell).
• People on immunosuppression therapies sufficient to significantly increase risk of infection.
• Women who are pregnant with significant heart disease, congenital or acquired.
• Other people have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.

GPs and hospital clinicians have been provided with guidance to support these decisions.

More information about who has been classed as clinically extremely vulnerable is available on the NHS Digital website.

If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

For more info:
https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Updated 09 July, 2020

First and foremost:

We deem this environment to be the highest risk for therapist.  While Social Distancing is still in place, we advise limiting mobile treatments only to urgent-care need clients.

No work should be carried out in a household which is isolating because one or more family members has symptoms.

When working in a household where somebody is clinically vulnerable, but has not been asked to shield, for example, the home of someone over 70, prior arrangements should be made with vulnerable people to avoid any face-to-face contact, for example, when answering the door. You should be particularly strict about handwashing, coughing and sneezing hygiene, such as covering your nose and mouth and disposing of single-use tissues.

We advise to Communicate with households prior to arrival, and on arrival, to ensure the household understands the social distancing and hygiene measures that should be followed once work has commenced to minimise risk for all parties.

In this instance, we advise the use of a visor, face covering and gloves  by the therapist.  Government Guidelines for using the bathroom of another household still varies across regions, so to avoid confusion, in this time we advise the stringent use of hand sanitisor.  You are advised not to sit in furniture and to consider a change of clothes between clients.  Remember, hands should be thoroughly sanitised after removing gloves, and before and after removing your face covering.  

Linens must stored in a sealed bag or container until they are washed.

Full sanitation of all items brought into the home of the client needs to be considered.

PLEASE CHECK WITH YOUR INSURANCE BEFORE ENGAGING IN MOBILE TREATMENTS.

For further information, you can view the government’s guidance on working in other people’s homes

Updated 9 July, 2020

First and foremost:

We deem this environment to be very high risk for both client and therapist. If the government allows the CAM industry back to work while social distancing is in place, we advise limiting in-home clinic treatments only to high-level need clients who are not in shielding or deemed clinically vulnerable and only if your own household does not contain someone who is vulnerable or shielding.

At this time, to maintain cohesive recommendations across regions, you must limit to a maximum of 2 clients per day, and you are not to mix any other households in your home in that same day.

Hand sanitisor should be provided for the client, and until all devolved government guidance allows for the use of using the bathroom in the home of another, we are advising against the client’s use of your bathroom within your home. If there is a sink within your treatment room, then this is fine for use. 

No work should be carried out in a household which is isolating because one or more family members has symptoms.

When working in your home with somebody who is clinically vulnerable, but has not been asked to shield, for example, someone over 70, prior arrangements should be made with vulnerable people to avoid any face-to-face contact, for example, when answering the door. You should be particularly strict about handwashing, coughing and sneezing hygiene, such as covering your nose and mouth and disposing of single-use tissues.

We advise to Communicate with clients prior to arrival, and on arrival, to ensure the client understands the social distancing and hygiene measures that should be followed once work has commenced to minimise risk for all parties.

In this instance, we advise the use of a face covering and visor  by the therapist.  It is advised that clients do not to sit in furniture and to also change clothes between clients.  Remember, hands should be sanitised, and preferably washed before and after removing your face covering

PLEASE CHECK WITH YOUR INSURANCE BEFORE ENGAGING IN TREATMENTs FROM YOUR HOME

For further information, you can view the government’s guidance on working in other people’s homes

Last Updated: 09 July, 2020

This guidance is covering a  range of modalities and some will pose much less risk than others, so we are going to try and help you to risk assess the nature of the therapy you practice.  Your individual circumstance may vary, and this assessment is under the pretense that you are treating a non-vulnerable client in a controlled environment (i.e. in a clinic, not mobile), so please just use this assessment as a simple guidance to help you consider the risks you should be looking to consider in your own work.

Government Guidance for Close Contact Indicate that the first line fo defense for protection is Ventilation and Reduced Treatment Time in enclosed spaces.  Further PPE is indicative of your risk assessment and circumstances

Please read this section of guidance along with other sections as it does not give a complete picture.

• Therapeutic, Remedial, and Sports Massage – Low-Risk
  • Virtual Consult, virtual payments, virtual rebooking.
  • Clinic time reduced to maximum 45 minutes in enclosed environment (treatment outside where possible, such as onsite sports massage, can exceed 45 mins)
  • Therapist should familiarise themselves with the post covid skin rashes for those who developed respiratory symptoms.
  • Evidence has suggested that blood clots could be a post-covid symptom.  So if client previously had covid, then very light pressure should be used.
  • Skin-to-skin contact reduced. (i.e. consider and try to reduce techniques that exceed hands [such as forearm] wherever possible)
  • AVOID touching or treating around the face – no neck treatments supine.
  • Hands should be treated last.

• Pregnancy Massage – low-risk
  • According to the Royal College of Obstetricians and Gynecology, all evidence suggests that pregnant women are at no greater risk of becoming seriously unwell that other healthy adults if they develop coronavirus. 
  • Virtual Consult, virtual payments, virtual rebooking.
  • Clinic time reduced to maximum 45 minutes
  • Skin-to-skin contact reduced. (i.e. consider and try to reduce techniques that exceed hands [such as forearm] wherever possible)
  • As treatment is side-lying, ensure all cushions have washable removable covers.
  • AVOID touching or treating around the face – no neck treatments supine.
  • Hands should be treated last.

• Reflexology – Low-Risk
  • Virtual Consult, virtual payments, virtual rebooking.
  • Clinic time reduced to maximum 45 minutes in enclosed environment
  • AVOID touching or treating around the face.
  • Therapist should familiarise themselves with the rashes such as ‘covid toe’ which have been reported to those who have had covid with respiratory symptoms
  • Hands should be treated last.

• Bowen Technique – Low-Risk
  • Virtual Consult, virtual payments, virtual rebooking.
  • Clinic time reduced to maximum 45 minutes in enclosed environment
  • Therapist should familiarise themselves with the post covid skin rashes for those who developed respiratory symptoms.
  • Skin-to-skin contact reduced. Clothed if possible. 
  • AVOID touching or treating around the face – no neck treatments supine.
  • Hands should be treated last.
  • As Bowen Therapists leave the room, provisions for hand sanitising before and after touching the door handle need to be considered both when exiting and entering.

• Myofascial Release – Low-Risk
  • Virtual Consult, virtual payments, virtual rebooking.
  • Clinic time reduced to maximum 45 minutes in enclosed environment
  • Therapist should familiarise themselves with the post covid skin rashes for those who developed respiratory symptoms.
  • Skin-to-skin contact reduced. (i.e. consider and try to reduce techniques that exceed hands [such as forearm] wherever possible)
  • AVOID touching or treating around the face – no neck treatments supine.
  • Hands should be treated last.

• Yogatherapy (1 to 1) – Low Risk
  • Virtual Consult, virtual payments, virtual booking.
  • Maintain a social distance during session
  • Because of nature of breathing for this therapy, while social distancing is in place, we recommend a face covering worn by the therapist and by the client at their own discretion.

• Seated Acupressure – Low Risk
  • Virtual Consult, Virtual payment, virtual rebooking
  • Disposable chair covering where possible
  • Plastic disposable facecover where possible