Challenges and Facilitators to Telehealth Occupational Therapy for Autistic Children During COVID-19

Abstract

Pre-pandemic, telehealth occupational therapy (OT) for autistic children appeared promising, but research was limited. The pandemic provided a unique opportunity to investigate how clinics transitioned to telehealth. The purpose of this study was to examine barriers and facilitators that influenced delivery of OT services through telehealth for autistic children during the pandemic. We conducted semi-structured qualitative interviews with 13 participants (three administrators, six OTs, and four parents of autistic children) at three Los Angeles area clinics over a 7-month period. We used narrative and thematic analysis to identify four themes. We identified (a) Challenges and (b) Facilitators to Conducting Telehealth OT, including practical strategies for successful facilitation, and (c) Negative and (d) Positive Outcomes of Conducting Telehealth OT. As telehealth will likely remain a viable means of OT service delivery in the future, our findings provide insight into ways that it can be improved and sustained.

Lived experiences of caregivers upon receiving occupational therapy through telehealth amidst the pandemic

“…As most occupational therapists are considered novice in the practice of telehealth in the Philippines, the PAOT has created a set of guidelines (Philippine Academy of Occupational Therapists, 2020) to ensure that the quality of services provided in telehealth is the same as occupational therapy services delivered in-person, complying with all jurisdictional, institutional, and professional regulations (World Federation of Occupational Therapists, 2021). Recently, a summary of reported strategies for promoting successful telehealth occupational therapy sessions is available with the following overarching phases: 1) staff trainings on telehealth occupational therapy; 2) resources for families and staff; 3) interventions and in-session strategies; and 4) parent education and coaching (Angell et al, 2023).…”

“…Moreover, while providing occupational therapy services, Filipino occupational therapists, at that time, were encouraged to attend training that is specific on telehealth provision provided by local and international professional organizations to augment their lack of training in telehealth (Sy et al, 2020). Although the steps were not exactly akin to Angell's et al (2023) list of telehealth strategies, it is evident that telehealth procedures are still evolving and changing the occupational therapy practice landscape to date. We, however, need to reflect and act upon the issue about how telehealth, as a tool, can be maximized in resource-constrained countries juxtaposing varying contexts and dimensions including family values, a health system that is not oriented towards primary care and has a low recognition of occupational therapy as a profession.…”

“…Telehealth remains to be perceived as a 'viable alternative' to face-to-face consultation and therapy locally (Leochico et al, 2020). Benefits of telehealth include foregrounding the essence of family-centered care, better understanding of the family towards the child's condition, and accessibility in the middle of emergency situations; whereas challenges of telehealth include an increased demand for time and energy from both ends (service user and service provider), poor internet connectivity in the Philippines, decreased well-being of both therapists and parents among others (Angell et al, 2023;Eguia & Capio, 2022;Delos Reyes, 2021;Leochico et al, 2020). Considering all these factors, plus the forthcoming implementation of the Universal Health Care law in the Philippines, a future-thinking perspective sees telehealth not merely as an optional or alternative way of receiving occupational therapy services, but rather telehealth should be an integrative part of the occupational therapy service delivery model in the Philippines (Chiu et al, 2023).…”

“This Is Going To Be Different, But It’s Not Impossible”: Adapting To Telehealth Occupational Therapy For Autistic Children

“…An OTJR: Occupational Therapy Journal of Research special issue on telehealth similarly noted that telehealth went from an ‘emerging’ delivery model to defining everyday practice during COVID-19 ( Little & Proffitt, 2023 ). Studies included within this special issue broadly concluded that telehealth-delivered occupational therapy presents both advantages and limitations across varying practice settings and populations ( Angell et al, 2023 ; Lamash et al, 2023 ; Little et al, 2023 ; Pineda et al, 2023 ; Sleight et al, 2023 ). Participants from these studies often supported ongoing telehealth-delivered occupational therapy, but not necessarily as a universal replacement for in-person care ( Angell et al, 2023 ; Pineda et al, 2023 ).…”

Parent Satisfaction With a Telehealth Parent Coaching Intervention to Support Family Participation

“…Telehealth can require parents of CSHCN to directly support their child technologically, physically, and contextually based on session implementation goals. Being hands-on, while parents are also caring for potential siblings, home, and work obligations, potentially increases parental stress and feelings of responsibility during telehealth when compared with an in-person visit (Angell et al, 2023; Camden & Silva, 2021). Pediatric rehabilitation providers also report telehealth barriers including feeling limited in provider evaluation and intervention options without hands on capacities, and experiencing a steep implementation learning curve often without formal training availability (Wittmeier et al, 2022).…”