Parent engagement and therapeutic alliance in allied health teletherapy programs

Abstract

Teletherapy services are being increasingly provided by allied health professionals to address major inequities of access. While clinical outcomes and stakeholder satisfaction are crucial for paediatric teletherapy's continued viability, processes for increasing parent/caregiver satisfaction, and for modifying aspects of caregiver engagement to improve outcomes, are under-researched. Studies of in-person therapy have shown that engagement, satisfaction and outcomes are influenced by the development of therapeutic alliance. This study investigates influences on parents' engagement with a teletherapy program and their therapeutic alliance with the therapist. Using a qualitative approach, data were analysed from semi-structured telephone interviews with six parents in rural New South Wales, whose children had completed paediatric teletherapy programs provided by a psychologist, speech pathologist or occupational therapist. Parents described factors that affected aspects of their engagement and alliance. Thematic analysis with constant comparison was used to determine the themes of the interviews, which were (a) initial engagement, (b) collaboration and (c) rapport. The themes demonstrate that parents were evaluating the efforts the therapists were making in (a) communicating, (b) truly partnering with them, both being elements of collaboration and (c) building rapport with them and the child. A conceptual model, Parent And Caregiver Evaluation Cycle In Teletherapy (PACECIT), is proposed by the researchers to explain how parents evaluated the therapist to judge the current state of a personal relationship and to judge the effectiveness of a collaborative relationship, both influencing the therapeutic alliance and motivation for engagement. The findings emphasise the importance of fulfilling parent/caregiver expectations for clear and frequent communication, and discussion of their ideas. Also important is the development of therapeutic alliance through utilising parents' observations of non-verbal communication to maintain an effective rapport and enhance engagement.

Pediatric Outpatient Occupational Therapy: Transitioning From In-Person Services to Telehealth

“…Although previous work from our institution found high levels of satisfaction among patients receiving telehealth services (Tanner et al, 2020), future research could explore the link between patient satisfaction and visit length and/or patient engagement. One study found that patient engagement and therapeutic alliance were associated with a preference for telehealth services (Fairweather et al, 2022). Another study found that ease of process in terms of administration and technology can also affect satisfaction with telehealth services (Guntu et al, 2022).…”

Therapeutic touch and therapeutic alliance in pediatric care and neonatology: An active inference framework

“…Through the frequent use of affective touch as a mode of communication, it can help to develop behavioral synchrony, coupling, and a shared dynamic neural code between the practitioner, patient and their family (95). This can lead to an increase in rapport, trust, and mutual respect in the therapeutic relationship, allowing the caregiver to provide more supportive and autonomous care to the child's clinical needs (96,97). Furthermore, incorporating family-centered care, which takes into consideration the values, attitudes, and context of the child's family in conjunction with the biomedical aspects of treatment, is regarded as best practice in pediatrics.…”

“…Furthermore, incorporating family-centered care, which takes into consideration the values, attitudes, and context of the child's family in conjunction with the biomedical aspects of treatment, is regarded as best practice in pediatrics. The use of therapeutic affective touch in conjunction with family-centered care can help to attain patient satisfaction, biobehavioral synchrony, therapeutic alliance, and cooperative communication and improve both physical and psychological well-being for conditions such as juvenile idiopathic arthritis (96)(97)(98)(99)(100).…”

“…Due to the practitioner's expertise and potentially therapeutic affective touch through the triggering of oxytocin, their diagnosis is likely to be regarded as more precise and trustworthy than the patient's or caregiver's assessment of the source of the pain. Moreover, the patient and caregivers will be able to assess rapport and the robustness of the therapeutic alliance through touch and other nonverbal cues (96). Anticipating how the patient and caregiver will react is accomplished through top-down predictions made prior to the response occurring (149).…”

Co-designing solutions to enhance access and engagement in pediatric telerehabilitation

“…Telerehabilitation is defined as therapy occurring remotely over a telecommunication platform such as telephone or video conferencing ( 9 ). Increasingly, telerehabilitation services are being provided by allied health clinicians and are proposed as a solution to barriers encountered when accessing in-person rehabilitation services, such as the time and cost associated with travelling to appointments ( 7 , 10 ). In a 2023 systematic review examining the effectiveness of telerehabilitation in children with developmental disabilities, telerehabilitation was found to be more effective when compared to no treatment for outcomes such as functional performance, hand function, visual perception, and behaviour or as effective when compared to no treatment (i.e., waitlist) and usual treatment, respectively ( 11 ).…”