Table 2.

Themes and exemplary quotes

Theme	Exemplary quote
Challenges with telehealth
Inhibits clinician feedback	We actually messed around with trying to do video conferencing and unfortunately that was diabolically bad no matter what our best intent was. We actually ran a two-camera system—one so that we could see so we had to use a laptop for [him] to be able to review the information on. So we had one laptop that was capturing what [he] was, hopefully what [he] was going to point out on the screen what his selection was. And another one to, I think it was to measure his facial gestures. So we effectively had two cameras working at the same time and it was just horrendous. …Yeah, you just couldn’t get the nuances, so it ended up that I had to be interpreting [his] responses for the therapists because they weren’t there to see them themselves. And so you lost depth on the screen, you lost the nuances of [name), the movements of [his] hands, and if his hand waivered before, so you lost so much information. Unfortunately it was really, really tough.’P3, cares for a 0–6 year-old with a neuro-developmental disability
Difficulty building rapport and trust	Yeah, so for my son in particular… eye contact is an incredibly important aspect to relationship rapport, trust, communication. And he wasn't getting that. Not in the way that he needed to. So, it was already a barrier to effective communication for him. Additionally, he’s quite sociable, so in-person is the way that he gets his validation and feels supported. So, for both those reasons, communication and validation, it just wasn't effective at all. P7, cares for 15–24 year-old with a neurological and intellectual disability
Lack of access to resources	Probably the other difficulty was not having what we needed for the therapies. So the different tools and things that the therapist either brings to our house or have at their place. So I find myself having to buy a lot of things so we can do those games and those things that I probably wouldn't necessarily have bought otherwise because we don’t use them every day. …and if it doesn't work we don’t necessarily use it again. So I was just buying something to try that she didn’t like. So I found that that was probably the other difficulty, was I guess getting the necessary equipment and therapy aids to help during that time. P2, cares for a 0–6 year-old with a developmental disability
Young clients disengaged/distracted	…he was hiding under the computer because he’s worked out that if I hide I don't need to do it. And we had to do every single thing with him one on one. So that was extremely taxing so basically we were all doing OT and it took two adults to help him go through this. So I would highly discredit that for our case. It didn't work at all. …there’s nothing like face to face, and especially he didn’t associate being at home with doing OT. He was with mum and dad and a person who’s not here can't really tell him what to do. To him it made no sense. He tried to engage but he just couldn’t. It’s the whole routine it was very difficult, just the actual change of routine and not being able to go to school. So then you add therapy at home as well and it just was hell. P6, cares for a 7–14 year-old with a neuro-developmental and psychosocial disability
Evoked behavioural issues	We did attempt to do that over a Zoom video conference call, and it was a disaster, to be optimistic. Yeah, he’s a 7 year-old who can’t sit still at the best of times. So to be taking instruction and engaging with someone over a video call, yeah, it was really a waste of time; hence we didn’t do many more. I mean he struggles with communication as it is, anyway. So yeah, communication and attention, behaviour, they’re all the things that we’re working on. You need to have really strong skills in those areas I think to focus on a Zoom conference, which it wasn’t suitable for him at all. P5, cares for a 7–14 year-old with a neuro-developmental disability
Reliant on caregiver facilitation	And also when she moves around the room I felt like I was a dog, and I’d start following her around with the iPad to try and show whoever we were dealing with that, yeah, this is what she’s doing, or if they wanted her to move somewhere else to try something different. So it definitely put a lot more complexity into just the process by having to do it online. …It’s hard to get a two year-old to be engaged with therapy at the best of times, especially, obviously, things that they don’t want to do. So it just added I think more pressure for me because I had to be really present. Whereas if the therapy happens face-to-face, I can step back and watch how they’re doing it and learn a bit more, and get her to interact with someone else. And obviously, that wasn’t happening, so I have to be hands-on …but I don’t think it’s necessarily the best thing for my daughter to have me do some of the stuff because she doesn't like it. And so I think sometimes having someone else do it, she’s a bit more tolerant of certain things. P2, cares for a 0–6 year-old with a developmental disability
Suggestions to improve telehealth
Prepare for telehealth sessions	And I think the other thing that helped was just having everything set up, having everything ready to go. So we would set them up with their tables and chairs, for example, and have everything sitting there ready to do. I think that was another I guess enabler to the sessions. P1, cares for 0–6 year-olds with a developmental disability
Establish expectations	I think particularly for the clients, especially when we're looking at assessment, tutorials, and simple tutorials at the outset will probably go a long way to helping. How much to assist your child without breaking the assessment. How do you guide without answering, and things like that. P3, cares for a 0–6 year-old with a neuro-developmental disability
Increase exposure to telehealth	A lot of it was practice, so if we were thrown into that situation again I think it would be a little bit different. So I think having them consistently and the boys getting used to them – if that was what we chose to do—then that would help. P1, cares for 0–6 year-olds with a developmental disability
Assess suitability of specific services	What I actually concluded for us, was that those sessions were appropriate for training of support workers and communication partners and other people in(my son’s)life. So, it was about rethinking what we needed to do. So, if we were locked down and we're not getting access to services and supports, then those services and supports that we do have needed to step up in terms of being, as I said, communication partners or almost therapy assistance in a way, so it was more effective for us to get the support workers up to speed on what we were trying to do with [my son] in terms of speech, OT, behaviour, then for the session to be with [my son). So, it’s more about rethinking and repackaging what you're using the sessions for. P7, cares for 15–24 year-old with a neurological and intellectual disability
Access to support workers	Look, certainly from our end the support workers; that made it a lot easier because then it wasn’t just me. At least then they did have someone else to engage in. …I think certainly, we were lucky because we did have the support workers. And on a global sense, I guess if you didn’t have that that will be very hard. So that would be my number one thing that would help any family I think, would be just having that extra support there that were able to come. I know for some ladies they weren’t able to have anyone, so that was really tricky, but for us, that made a really big difference.P1, cares for 0–6 year-olds with a developmental disability