TABLE 2.

Factors that enabled successful engagement with telehealth‐delivered care for young people and families during COVID‐19

Factor	Experiences	Recommendations
Technology
Online platform	Having a secure, versatile platform accessible via a range of devices was critical. Many patients connected using their smartphones	Have connection instructions you can email or text to patients in advance, including technology needed, and where would be an appropriate setting to connect from Consider a “test” session Ensure you have their telephone number so you can “walk them through” the process of connecting the first time if needed
Relational processes
Consent processes	Patients benefited from discussions about the process of telehealth and hearing about experiences with other patients using it	Consider institutional and country‐specific consent processes regarding telehealth Clarify for patients the security of the platform, and whether you will be recording Discuss in advance what you will do in the case of technical difficulties Ensure you have contact details (eg, phone) in case of disconnection/technical difficulties
Ongoing evaluation of telehealth model	AYA patients’ preferences for/comfort with telehealth were variable. Some patients preferred a simple telephone connection to videoconferencing. Patients’ engagement with telehealth was strengthened by continually reviewing how they were finding the modality and openly addressing when their situations meant that telehealth was no longer feasible (eg, due to lack of privacy at home)	Do not assume that particular patient groups will feel the same way about using telehealth. Patients’ feelings about telehealth will likely also change over time Acknowledge the limitations and benefits of communicating using telehealth upfront Make time to explicitly “check in” with patients at each session about how they are finding the telehealth model. This could include asking about perceived advantages/disadvantages, what the patient–therapist pair are learning through the process (and/or about each other), and whether they would prefer to revert to face‐to‐face (if possible) or telephone‐only connection
Risk management
Regular screening, action plan should safety risks arise	As in face‐to‐face practice, patient presentation was part of risk screening as necessary Safety discussed with new patients upfront, also ensuring we had their home contact details in case concerns arose	Telehealth is appropriate to use with patient groups with a range of vulnerabilities, provided adequate risk screening is put in place prior to the first session, and at each online session Important to ensure contact details are available for the patient's home/next‐of‐kin, and/or a trusted health professional (eg, general practitioner) should acute mental health risks arise
Therapeutic strategies
Explicitly naming/exploring their setting	Patients engaged with describing their current setting such as where they were, what room (and what they normally do in that room, eg., an “art room”), who else was home. This was especially helpful as rapport‐building for new patients	Consider explicitly using the new online connection as a point of discussion and connection with patients/families, and an opening to learn about where each is situated, both in terms of their geography, their family/home situation and in terms of what they have experienced in their day/week so far
Flexible use of online tools	Collaborative exercises during sessions (eg, case formulation development, brainstorming new concepts) were undertaken using the “share screen” function to create a virtual notepad	Ensure familiarity with the online tool prior to use with patient so that you are ready to capitalise on all its features, to enable collaborative activities. Ensure computer desktop is presentable and ready for screen sharing prior to session