Changing connections: parent/caregiver engagement and therapeutic alliance in paediatric teletherapy

Mr Glenn Fairweather1, Prof. Michelle Lincoln1, Dr. Robyn Ramsden2

1The University of Sydney, Lidcombe, Sydney, Australia, 2Deakin University, Burwood, Melbourne, Australia


Background: Allied health teletherapy services are being provided through internet videoconferencing to Australian rural and remote communities to address inequities of access, and fiscal priorities. No study had examined the development and relationship of parent-therapist therapeutic alliance and parent engagement in paediatric teletherapy. Research has indicated both have significant impacts on the outcomes of in-person paediatric therapy.

Aims: The aims of this study were: 1) To determine what parents/carers of children who have completed paediatric teletherapy programs, provided by speech pathologists, occupational therapists and psychologists, believe are factors that influence their own engagement and therapeutic alliance, 2) To provide empirical data which may inform improved teletherapy program design and delivery.

Method: Semi-structured telephone interviews, which included completion of the Therapeutic Alliance Scales for Caregivers and Parents (TASCP), were conducted with parents in rural NSW, whose children had completed paediatric teletherapy programs provided by one of three allied health disciplines. Participants described factors that affected aspects of their engagement and alliance. Thematic analysis generated a conceptual model of their subjective experience. Relevant quantitative data was derived from analysis of TASCP ratings.

Results: Parents’ repeated evaluations of the therapists’ communication, partnering, and rapport were crucial to the development of their parent-therapist alliance and engagement. The TASCP was an easily administered measure, reflective of affective bonds and collaboration.

Conclusion/Relevance: There are significant quality improvement implications for teletherapy design, and workforce up-skilling. The TASCP is potentially useful for tracking the effects on alliance of program changes. Important research questions are highlighted.


Glenn has been a speech pathologist for 34 years. He was Speech Pathology Team Leader at Royal Far West, a children’s charity servicing NSW’s rural and remote families and communities, for 28 years. He and his staff established a network of outreach clinics across NSW and provided telepractice services to numerous rural schools, public and private. He has also managed a part-time private practice since 1989, and is now a PhD candidate at the University of Sydney, with a number of published articles relevant to teletherapy. Glenn is passionate about overcoming inequities in access to healthcare.

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