Table I.

Adapting Parenting Interventions for Group Telepsychology Using Process Fidelity: The Example of Bootcamp for ADHD (BC-ADHD)

Process construct	Brief definition	Implementation challenges	Recommended adaptations
Keeping parents focused on foundational principles and evidence-based practices	Refocusing off-topic discussions, including when caregivers suggest something that would be contraindicated (e.g., pro-corporal punishment)	Distractions during telepsychology (e.g., emails/texts, phone calls, other family member intrusions) are greater than for in-person groups Distracted caregiver may only “half-listen” to the group discussion and unintentionally respond in a way that is off-topic or disruptive Difficulty supporting family organization of group materials	Ask caregivers to (a) use a quiet and private room, (b) limit involvement in other activities, (c) focus on group interactions, (d) use a large and stable screen to see all group members, (e) connect with audio and video if possible, (f) use earphones to prevent feedback sounds, (g) turn off their own mirror video to prevent unneeded distractions, (h) mute their speaker unless they talk to the group, and (i) if available, use the Raise Your Hand function to request the right to talk Clarify and amplify key communications to ensure mutual understanding and keep caregivers focused
Encouraging parents’ active engagement	Using open-ended questions, affirmations, reflections, and summaries to encourage caregiver engagement; adapting material to individual caregiver situations	Challenges with distributing handouts and other materials could lead to less parental engagement in group Limited ability to respond to non-verbal communication could result in clinicians inadvertently adopting a more prescriptive and less engaging approach Chat and Q&A functions imply delayed question and answer—and one speaker at a time—further limiting engagement	Send handouts to caregivers in advance electronically Use screen sharing/whiteboard to highlight key information, give homework, and facilitate discussion Scan caregivers for non-verbal responses and call on caregivers based on non-verbal reactions Ask caregivers’ permission to call on them when they are quiet and then do so once permission is received Reflect caregiver responses even more frequently to keep families engaged Divide content into segments and provide introductory content for each specific segment to generate interest/engagement Ask caregivers to avoid using Chat and Q&A functions
Providing emotional validation	Providing social support, emotional reassurance, or validation of parents’ feelings	Many body language indicators of active listening and eye contact are challenges to perceive online Attention to individual group members’ emotions and non-verbal cues requires more effort Bandwidth problems may reduce opportunities for validation	Take advantage of the increased ability to identify facial expressions online when using the “Speaker view,” if available Scan participants’ reactions and emotions as other participants are talking; name and validate reactions as they are noticed Periodically look at clinician camera to improve perceived eye contact by all members, especially when validating participant emotions
Eliciting and strengthening change talk	Affirming parents’ desire, ability, reasons, and need for change (e.g., accepting their child’s diagnosis or treatment)	Diminished ability for group members to see other family members’ non-verbal affirmations of their efforts Telepsychology platforms encourage turn-taking more than cross-talk Diminished affirming vocalizations from other caregivers, because they do not want to “steal” the camera from others	Consider use of an interactive whiteboard to show a change continuum; ask caregivers to indicate where they see themselves on the “acceptance range” Pause to summarize caregivers’ narratives, key points, emotion cues, and non-verbal affirmations Use homework review as an opportunity to affirm caregivers’ efforts
Building connections among parents	Building connections among parents by highlighting shared experiences or efforts	Sometimes feels more impersonal for caregivers to connect virtually with others Fewer informal opportunities for families to connect before and after sessions Takes more effort to encourage parent–parent connection	Use the ‘Gallery View’ to see all group members Restate responses to the group to connect families Scan, acknowledge, and reflect participants’ reactions to build connections among parents To reduce disruptions and improve group cohesion, encourage the use of the ‘Raise Your Hand’ function Offer to keep the online connection open after the session for interested participants to allow follow-up conversations with other group members

Note. BC-ADHD = Bootcamp for Attention-Deficit/Hyperactivity Disorder.