Home visits are not normally associated with independent therapy practice. Therapists can choose if they want to provide this service and personally I do but with experience, I have learnt to put some safety measures in place.
Reasons to offer home visits
I have been asked to provide home visits on many occasions and I have seen a few clients in the comfort of their home, either because they have been disabled and couldn’t travel easily or because their mental health issues made it difficult to leave the house. I tend to discuss the necessity of home visits with the client or case manager and try to make sure, they are really needed and not part of avoidance behaviour or pure convenience.
The benefits and the downsides of home visits
I think a home visit can give a therapist a very different insight into a client’s life and maybe even their mindset. Seeing how they live can give additional information, that they would not have if the client attends the clinic; but a home visit can also push a therapist out of their comfort zone. The welcome you receive can be quite different too. I have had clients, who thought it was appropriate to have the big screen TV playing during the home visit or who wanted to go for a smoke during sessions, but I have also had clients, who offered me tea and biscuits and were very appreciative of receiving a home visit.
On most occasions, I have felt safe in my clients’ houses, although I am female and some of my clients have been male and often lived by themselves.
Only on one occasion have I asked a case manager to attend the home visit for the PTSD assessment with me. That was because the female client lived in a very deprived area and was experiencing threats from her neighbours and her attacker.
I had a bit of an awakening though when I did a driving exposure with a client. The journey started at his house and during the exposure, he wanted to drive into the back roads of a deserted old retail estate, as he hasn’t been there for a long time. Once we came to the end of that road I realised that I never considered these situations in my risk assessments for home visits or exposure therapy. Luckily my client was a lovely person, who was only focusing on getting his breathing right. I took a deep breath too and made a mental note to reflect on this and put some safety measures in place.
It is important to decide in advance what safety measures are appropriate for each separate situation you may encounter doing home visits. I have some suggestions here but if you do offer home visits, think through what hazards you could come across and how you would deal with them. Here are some of my ideas:
- If you are doing driving exposure with a client, agree the route in advance and let a trusted person know about this route.
- Have someone, a colleague or partner, who is aware that you are doing a home visit and agree to phone in or message them at a set time to let them know you have left the visit.
- Have an app on your phone that will allow this person to find your phone if necessary so that hopefully they can trace you if you don’t ring or return home when expected.
- There are devices and apps specifically designed to safeguard lone workers which will send your whereabouts to selected people, open up an audio or video link from where you are or alert the emergency services. Some of these do require you to buy a device or pay a monthly amount so it will depend on how much lone working you do.
What are the costs?
From a business perspective, it is good to be clear about what to charge for this 5-star customer service. I take the view, that I could see clients at my practice during the time spend driving and therefore charge my full fee for the driving time, plus the expense of petrol cost at 45 p per mile on top of the actual session time.
Final thoughts and links
Home visits can be rewarding on many levels, but the therapist’s safety always has to have priority. I would love to hear my colleagues’ experiences in this field, so please feel free to comment on my reflections or share your thoughts below.
For more information about personal safety and lone working, the Suzy Lamplugh Trust has some very useful resources
The Hollie Gazzard Trust also offers a very useful app called the Hollie Guard