Illuminating their reality: the use of metaphor by parents of children with disabilities to express their experiences of health care.

PURPOSE: To explore the nature and meaning of metaphors used by parents of children with disabilities when describing their healthcare experiences. METHOD: A systematic procedure was used to identify and analyze metaphors spontaneously mentioned by parents in 13 focus groups held with 65 Canadian parents of children with disabilities. Attention was paid to identifying deep (i.e., meaningful) metaphors rather than common expressions. RESULTS: A total of 214 deep metaphors were identified and categorized into four target-source groupings. Parents used journey metaphors to describe experiences of uncertainty, conflict and harm metaphors to describe confrontational, harmful, and demeaning experiences of care, games and puzzles to describe the unknowns of care and attempts to resolve these unknowns, and metaphors concerning environmental barriers (i.e., walls and doors) to express feelings of exclusion and difficulties accessing care. CONCLUSIONS: Parents' metaphors expressed experiences of uncertainty, powerlessness, and attempts to exert agency in healthcare interactions. The metaphorical groupings provide new insights into how and why lack of family-centeredness in service delivery is bewildering, distressing, and disempowering to parents. Implications for service providers include paying attention to what metaphor use reveals about parents' experiences, and discussing parents' metaphors with them to create joint understanding, providing a fertile ground for collaboration.

Study findings indicated a clear lack of family-centeredness in gaining access to services, communicating with service providers and being listened to, and in decision-making power.Given that many service providers believe they are family-centered, the strong negative connotations of the metaphors used by parents are surprising and worrisome.Parents' use of metaphors not only reflects a lack of family-centered care, but indicates that parents experience unintentional harm in their interactions with service providers.Service providers can benefit from knowing the fundamental issues of uncertainty and power that underlie parents' use of metaphors to communicate vividly the tensions and issues they face.

The Pediatric Autism Research Cohort (PARC) Study: protocol for a patient-oriented prospective study examining trajectories of functioning in children with autism.

INTRODUCTION: The developmentally variable nature of autism poses challenges in providing timely services tailored to a child's needs. Despite a recent focus on longitudinal research, priority-setting initiatives with stakeholders highlighted the importance of studying a child's day-to-day functioning and social determinants of health to inform clinical care. To address this, we are conducting a pragmatic multi-site, patient-oriented longitudinal investigation: the Pediatric Autism Research Cohort (PARC) Study. In young children (<7 years of age) newly diagnosed with autism, we will: (1) examine variability in trajectories of adaptive functioning from the point of diagnosis into transition to school; and (2) identify factors associated with trajectories of adaptive functioning. METHODS AND ANALYSIS: We aim to recruit 1300 children under 7 years of age with a recent (within 12 months) diagnosis of autism from seven sites: six in Canada; one in Israel. Participants will be followed prospectively from diagnosis to age 8 years, with assessments at 6-month intervals. Parents/caregivers will complete questionnaires administered via a customized online research portal. Following each assessment timepoint, families will receive a research summary report describing their child's progress on adaptive functioning and related domains. Analysis of the longitudinal data will map trajectories and examine child, family and service characteristics associated with chronogeneity (interindividual and intraindividual heterogeneity over time) and possible trajectory turning points around sensitive periods like the transition to school. ETHICS AND DISSEMINATION: Ethics approvals have been received by all sites. All parents/respondents will provide informed consent when enrolling in the study. Using an integrated knowledge translation approach, where stakeholders are directly engaged in the research process, the PARC Study will identify factors associated with trajectories of functioning in children with autism. Resulting evidence will be shared with government policy makers to inform provincial and national programs. Findings will be disseminated at conferences and published in peer-reviewed journals.

Family-centered service through the eyes of insiders: Healthcare providers who are parents speak about receiving and providing healthcare in child health.

BACKGROUND: When healthcare providers (HCPs) become patients, the experience affects their sense of identity, the care they receive, and their clinical practice. In child health, considerably less is known about the experiences of HCP-parents who access the pediatric healthcare system with their own children with disabilities and/or chronic medical conditions. AIMS: This study aimed to examine the experiences of HCPs who have children with disabilities to identify their experiences with healthcare delivery. METHODS AND PROCEDURES: A qualitative descriptive study was conducted with HCP-parents, using focus groups and open-ended interviews. Data were analyzed using reflexive thematic analysis. RESULTS: For HCP-parents, the experience of having a child with a disability affects how they see themselves, their patients, service organizations, and the healthcare system in general. Having medical knowledge and access to networks brings both benefits and unique challenges. HCP-parents also have unique needs that are not currently being addressed. The lived experiences of HCP-parents can contribute to improving patient care. However, the value of this lived experience is unrecognized and underutilized. CONCLUSIONS: The lived experiences of HCP-parents can contribute important insights regarding service delivery, and in particular regarding the application of Family-Centered Service.

"From All, To All": Implementing a collaborative online conference to reflect on the daily living of individuals with cerebral palsy.

BACKGROUND: Translating knowledge to improve paediatric rehabilitation has become a research area of interest. This study describes the development and evaluation of an online conference that brought together perspectives of individuals with cerebral palsy (CP), families, health care professionals, and researchers to discuss the daily living of individuals with CP. METHODS: We anchored the development and implementation of the online conference in the action cycle of the Knowledge to Action Framework. To develop the meeting, we included representatives from each stakeholder group in the programme committee. The conference programme was designed having the lifespan perspective of individuals with CP, from birth to adulthood, as its central core, with themes related to daily living (e.g., self-care, mobility, and continuing education). Participants' satisfaction with the conference was assessed using an anonymized online survey sent to all participants. RESULTS: The conference had 1656 attendees, of whom 675 answered the online satisfaction survey. Most participants rated the structure of the conference (i.e., quality of the technical support, audio and video, and online platform) and discussed topics (i.e., relevance, content, discussion, speakers, and available time) positively. CONCLUSION: Collaborative conferences that include stakeholders throughout the planning and implementation are a viable, effective knowledge translation strategy that allows for sharing experiences and disseminating knowledge among families and individuals with CP, health care professionals, and researchers.

Tasks performed by parents to enable telepractice for children with communication disorders: an interview study with clinicians and parents.

PURPOSE: Current service models in childhood rehabilitation promote the active participation of parents/caregivers in their children's therapies. The existing literature provides a limited understanding of the tasks and responsibilities parents undertake in their children's therapies, especially over telepractice. This study describes the tasks undertaken by parents in their children's speech therapy delivered virtually during the COVID-19 pandemic. METHODS: A qualitative descriptive study was conducted with parents and speech-language pathologists, using open-ended interviews. Interviews were analyzed using a combination qualitative content analysis and thematic analysis. RESULTS: Parents performed many tasks to enable telepractice. These tasks happened before (e.g., setting up both physical and virtual space for therapy), during (e.g., managing child's behavior), and after the virtual therapy session (e.g., carrying out home practice). While parents were willing to perform these tasks in order to help their children, some expressed the toll that it can take on them. CONCLUSIONS: Compared to what is known from in-person visits, some of these tasks were novel and unique to telepractice. We recommend that clinicians and parents collaboratively decide on tasks and responsibilities to avoid burdening parents, and that they weigh the costs associated with performing these tasks against the benefits of teletherapy.IMPLICATIONS FOR REHABILITATIONParents perform many tasks to support their children's therapies, both during and outside of therapy sessionsTherapies delivered virtually require parents to assume additional tasks to support their childrenFor services to be Family-Centered, tasks and responsibilities need to be decided collaboratively between parents and clinicians.

Changing Directions and Expanding Horizons: Moving towards More Inclusive Healthcare for Parents of Children with Developmental Disabilities.

Family-centred service (FCS) acknowledges the importance of family engagement in therapeutic processes and focuses on the needs of all family members. This way of thinking and practicing is becoming increasingly recognized as an optimal care delivery model for families of children with developmental disabilities (DDs). However, in most places, disability services are oftentimes 'child-centric', wherein family members are seen only as partners in therapy or care delivery, while their own needs are not addressed. This arises from the lack of awareness of complex and highly individual family needs by professionals with whom they interact, but also from a significant lack of service infrastructure oriented towards parent-specific needs in existing service delivery models. This concept paper highlights the known challenges associated with parenting a child with a DD and discusses the intersectionality of factors impacting parental health and well-being, with a goal of promoting more equitable, holistic, and inclusive healthcare for all family members of children with DDs.

What do parents want from healthcare services? Reports of parents' experiences with pediatric service delivery for their children with disabilities.

PURPOSE: Family-centred service (FCS) is an established approach for delivering services in children's rehabilitation and healthcare. This article describes that parents continue to report mixed experiences with healthcare services for their children, as well as their ideas about what they need and want from these services. These findings will inform the development of an up-to-date measure of Family-Centred Service called Measure of Processes of Care (MPOC 2.0). METHODS: A qualitative descriptive study was conducted with parents, using focus groups and open-ended interviews. Data were analyzed using inductive content analysis. RESULTS: Parents want care that is individualized, co-ordinated, easily accessible, and takes into account the entire family dynamic. They want service providers (SPs) to be informed and invested in their child's care, and to provide parents with practical assistance. They also want to be treated with respect, caring and empathy, and to work together with SPs on the care plan. Novel components of care not identified in the original FCS guiding principles include: responsiveness to needs and mental health; effective communication (vs information giving); practical support (in addition to emotional and informational support); and availability and scheduling. CONCLUSIONS: This article identifies components of healthcare that families find helpful and desirable.Implications for RehabilitationFamily-centred service (FCS) is an established approach for delivering services in children's rehabilitation and healthcare.However, parents continue to experiences aspects of care that are not family-centred.Parents of children with disabilities identified components of care that they want from healthcare services.New components of care that go beyond what was identified in the original measure of FCS (MPOC) include: effective communication (vs information giving); practical support (in addition to emotional and informational support); and availability and scheduling.

Development of the Gross Motor Function Family Report (GMF-FR) for Children with Cerebral Palsy.

Purpose: To describe the initial steps in the development of a family-completed, modified version of the Gross Motor Function Measure (GMFM-88) to report gross motor function of young people with cerebral palsy in their natural environments. Methods: Development of the Gross Motor Function - Family Report (GMF-FR) was based on expert opinion involving 13 experienced clinicians and researchers, in four steps: (1) item identification to target items that reflect functional gross motor performance; (2) item selection; (3) critical analysis of the items; and (4) item and scoring modification. Results: Several modifications to existing items and scoring were made, including wording changes to optimize ease of families' understanding, the addition of photographs to illustrate all items, changes to the items to enable use of furniture instead of specialized equipment, and modifications to scoring criteria to ensure a focus on functional motor skills. Ultimately, 30 items were selected, and specific testing/scoring instructions were created for each item. Conclusions: GMF-FR is a new family-report tool, based on the GMFM-88. When validated, it can be used as a telehealth outcome measure to capture family-reported functional motor skill performance in home and community environments.

Objectif : décrire les premières étapes de l'élaboration d'une version modifiée de la mesure de la fonction motrice globale (GMFM-88) remplie par la famille pour rendre compte de la fonction motrice globale des jeunes ayant la paralysie cérébrale dans leur environnement naturel. Méthodologie : l'élaboration de l'outil de fonction motrice globale ­ rapport familial (GMF-FR), qui repose sur l'avis d'experts ­ soit 13 cliniciens et chercheurs d'expérience ­, s'est déclinée en quatre étapes : 1) détermination des points, pour cibler ceux qui reflète le rendement de la fonction motrice globale; 2) sélection des points; 3) analyse critique des points et 4) modifications aux points et aux scores. Résultats : les experts ont apporté plusieurs modifications aux points et aux scores en place, y compris de la reformulation pour que les familles comprennent plus facilement, l'ajout de photos pour illustrer tous les points, des changements aux points pour utiliser des meubles plutôt que du matériel spécialisé et la modification des critères des scores afin de se concentrer sur les habiletés motrices fonctionnelles. Au bout du compte, les experts ont retenu 30 points, chacun étant assorti de directives précises sur le test et le score. Conclusions : La mesure GMF-FR est un nouvel outil de déclaration par la famille, inspiré du GMFM-88. Une fois validé, il peut être utilisé comme mesure de résultats en télésanté, afin de saisir le rendement des habiletés motrices fonctionnelles à la maison et dans les environnements communautaires.

Patients and Families as Partners in Patient-Oriented Research: How Should They Be Compensated?

Patient and family engagement has become a widely accepted approach in health care research. We recognize that research conducted in partnership with people with relevant lived experience can substantially improve the quality of that research and lead to meaningful outcomes. Despite the benefits of patient-researcher collaboration, research teams sometimes face challenges in answering the questions of how patient and family research partners should be compensated, due to the limited guidance and lack of infrastructure for acknowledging partner contributions. In this paper, we present some of the resources that might help teams to navigate conversations about compensation with their patient and family partners and report how existing resources can be leveraged to compensate patient and family partners fairly and appropriately. We also present some of our first-hand experiences with patient and family compensation and offer suggestions for research leaders, agencies, and organizations so that the health care stakeholders can collectively move toward more equitable recognition of patient and family partners in research.

Desenvolvimento de crianças, adolescentes e jovens adultos com Paralisia Cerebral de acordo com a CIF? Uma revisão do escopo.

A CIF pode ser usada para mapear uma série de desfechos por meio de estudos de desenvolvimento. Os principais desfechos investigados em crianças com PC foram atividade e estrutura e função corporal. Pouco tem sido explorado os desfechos de participação e fatores contextuais ao longo do tempo. A principal classificação utilizada para estratificar os participantes foi o Sistema de Classificação da Função Motora Grossa. Estudos futuros devem ampliar seu foco para diferentes áreas da CIF, e na transição para a vida adulta. Estudos sobre o desenvolvimento de indivíduos com PC ajudam terapeutas e pais a planejarem abordagens de tratamento e prognóstico futuro. Os principais desfechos investigados em indivíduos com PC foram atividade e estruturas e funções corporais. Pouco tem sido explorado em desfechos de participação e de fatores contextuais ao longo do tempo.

OBJETIVOS: Identificar e fornecer uma visão geral descritiva dos estudos de desenvolvimento de crianças, adolescentes e jovens adultos com paralisia cerebral (PC); e mapear áreas de foco de acordo com os componentes da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) da OMS. MÉTODO: Estudos longitudinais do desenvolvimento de crianças, adolescentes e/ou jovens adultos com PC foram incluídos nesta revisão de escopo. A busca por estudos elegíveis foi realizada nas bases de dados: MEDLINE, PubMed, LILACS, EMBASE, Cochrane, CINAHL, Scopus, e foi restrita aos anos de 2002-2022. Todas os desfechos dos estudos foram classificados em componentes da CIF. RESULTADOS: Nos 56 estudos incluídos, houve 19.438 participantes, envolvendo principalmente crianças, seguidas de adolescentes e, por último, jovens adultos. Todos os componentes da CIF foram investigados e muitos estudos relataram resultados em mais de um componente. O componente atividade foi o mais investigado (67,9%; n = 38 estudos), seguida da estrutura e função corporal (42,9%; n = 24 estudos). A participação (14,2%; n = 8 estudos) e os fatores ambientais (3,6%; n = 2 estudos) foram os menos estudados. Nenhum dos estudos investigou fatores pessoais como desfecho. INTERPRETAÇÃO: Esta revisão de escopo fornece uma visão geral dos estudos sobre o desenvolvimento de crianças, adolescentes e jovens adultos com PC, usando a estrutura da CIF, identificando áreas atuais de foco e lacunas. Estudos futuros devem visar a participação, os fatores contextuais e a transição para a vida adulta. O QUE ESTE ESTUDO ADICIONA: A CIF pode ser usada para mapear uma série de desfechos por meio de estudos de desenvolvimento. Os principais desfechos investigados em crianças com PC foram atividade e estrutura e função corporal. Pouco tem sido explorado os desfechos de participação e fatores contextuais ao longo do tempo. A principal classificação utilizada para estratificar os participantes foi o Sistema de Classificação da Função Motora Grossa. Estudos futuros devem ampliar seu foco para diferentes áreas da CIF, e na transição para a vida adulta.

Christy Brown's 'My Left Foot': An insider's insights into growing up with cerebral palsy.

IMPORTANCE: The field of childhood disability has undergone a sea-change in the past two decades. Remarkably, 70 years ago, the ideas now taking root were expressed with poignant clarity by Ireland's Christy Brown, providing lessons that were there to be learned, illustrating why 'My Left Foot' remains a singular contribution to the literature about child development and disability. OBJECTIVE OF THIS ESSAY: The World Health Organization's 2001 reconsideration of 'disability' (the International Classification of Functioning, Disability and Health or ICF) has spawned considerable uptake and adaptation of contemporary concepts, notably with the 'F-Words for Childhood Disability' (now the 'F-words for Child Development'). Published in 1954, Christy Brown's ground-breaking poetic autobiography 'My Left Foot' resonates today with messages that bring the ICF to life vividly and memorably. REVIEW: The author, a developmental paediatrician, has refracted the themes of 'My Left Foot' through an ICF lens to illustrate that concepts now considered modern have long been in plain sight, but sadly ignored. Christy Brown's first-person narrative animates ideas and messages for all who work in the field of childhood disability. FINDINGS: This essay is a personal reflection that draws together both contemporary 21st century concepts and ideas from the time that Christy Brown was a young author reporting his perspectives and perceptions on living with 'disability'. CONCLUSIONS AND RELEVANCE: The lessons Christy Brown generously shared 70 years ago should be heeded today. In the context of modern thinking and action regarding 'childhood disability', we need an approach to all we do that sees and respects children with 'disabilities' as whole people, that situates them in the context of family and community, that identifies and promotes their strengths and aspirations within both the health professional community and the community at large and enables them to 'become' and to 'belong'.

Construct Validity of the Autism Classification System of Functioning: Social Communication (ACSF:SC) Across Childhood and Adolescence.

This study examined the construct validity of the Autism Classification System of Functioning: Social Communication (ACSF). Participants included 145 parents of children with autism (2-19 years). The degree of convergent and discriminant validity between parent reported ACSF and subscales from Social Responsiveness Scale 2nd edition and Behavior Assessment System for Children, 3rd Edition were examined against a priori hypotheses. We examined construct validity in the entire sample as well as in specific age cohorts. Our findings suggest that ACSF can provide a valid classification system of social communication ability in children with autism 2-19 years of age, and its two subscales may be used to examine different aspects of social communication ability.

Development of children, adolescents, and young adults with cerebral palsy according to the ICF: A scoping review.

AIM: To identify and provide a descriptive overview of the development of children, adolescents, and young adults with cerebral palsy (CP) in longitudinal studies; and map areas of focus according to the components of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). METHOD: Longitudinal studies of the development of children, adolescents, and/or young adults with CP were included in this scoping review. A search for eligible studies was conducted in the databases MEDLINE, PubMed, LILACS, EMBASE, Cochrane, CINAHL, and Scopus, and was restricted to the years 2002 to 2022. All outcome measures of the studies were classified into ICF components. RESULTS: In the 56 studies included, there were 19 438 participants, involving mainly children, followed by adolescents, and lastly young adults. All components of the ICF were investigated and many studies reported outcomes in more than one component. Activity was the most investigated (67.9%; n = 38 studies), followed by body functions and structures (42.9%; n = 24 studies). Participation (14.2%; n = 8 studies) and environmental factors (3.6%; n = 2 studies) were the least studied. None of the studies investigated personal factors as an outcome. INTERPRETATION: This scoping review provides an overview of studies on the development of children, adolescents, and young adults with CP, using the ICF framework, identifying current areas of focus and gaps in the research. Future studies should target participation, contextual factors, and the transition into adulthood. WHAT THIS PAPER ADDS: The International Classification of Functioning, Disability, and Health can be used to map a range of outcomes through developmental studies. The main outcomes investigated in children with cerebral palsy were activity, and body functions and structures. Little has been explored in participation and contextual factors outcomes over time. The main classification used to stratify the participants was the Gross Motor Function Classification System.

Being physically active with epilepsy: Insights from young people and their parents.

INTRODUCTION: Researchers have called for innovative tailored interventions to address specific challenges to physical activity (PA) engagement for young people with epilepsy (YPE). Working with YPE and their parents, this study aimed to identify barriers and facilitators to adoption and maintenance of PA among YPE prior to and during the COVID-19 pandemic. METHODS: Ten YPE (all female) and their 13 caregivers, and five additional caregivers to males (N = 18; 72% mothers), completed virtual focus group sessions prior to and during the COVID-19 pandemic. Trained Child Life specialists asked questions about barriers and facilitators of PA engagement experienced by YWE, which included a specific focus on the impact of epilepsy. RESULTS: Thematic analysis of the data identified both epilepsy-specific and generic themes that impact PA participation among YPE. These included: (i) epilepsy experience/impact and accommodation; (ii) safety precautions; (iii) concern about seizures; (iv) social connections and acceptance; (v) parent and family support; (vi) intrapersonal self-regulation and motivation; (vii) health benefits; and (viii) key factors in common with all youth. CONCLUSION: This study provides valuable insight into diverse social-ecological health factors that impact PA participation among YPE from two key stakeholder perspectives (YPE and their caregivers). By understanding these lived experiences, providers can better tailor individual support for YPE and their families to foster and maintain a healthy active lifestyle.

Speech-language pathologists' treatment goals for preschool language disorders: An ICF analysis.

Purpose: The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework to conceptualise clinical services. This study explored how speech-language pathologists (SLPs) conceptualised therapy goals for preschoolers with language difficulties and disorders within the ICF framework.Method: An online survey was distributed to SLPs practising in a publicly funded Preschool Speech and Language program in Ontario, Canada. SLPs rated their familiarity with the ICF framework, and then reported all therapy goals for one child with language difficulty/disorder on their caseload. For each reported goal, SLPs indicated the ICF component(s) they felt the goal addressed. Researchers then independently categorised SLPs' reported goals into the ICF components.Result: Ninety-three SLPs completed the survey, and 81% reported they were at least "somewhat" familiar with the ICF framework. On average, SLPs reported three therapy goals per child, and felt the Activities and Participation components were most frequently targeted (73% and 72% of all reported goals, respectively). Researchers categorised SLPs' reported goals differently, and identified 57% of goals addressing the Activities component, and 21% the Participation component.Conclusion: There is a need to better understand how SLPs and researchers conceptualise the ICF framework, particularly the Participation component.

Training Intervention and Program of Support for Fostering the Adoption of Family-Centered Telehealth in Pediatric Rehabilitation: Protocol for a Multimethod, Prospective, Hybrid Type 3 Implementation-Effectiveness Study.

BACKGROUND: Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness. OBJECTIVE: This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists' adoption, service wait times, families' perception of service quality, and costs. METHODS: This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists' adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs. RESULTS: Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period. CONCLUSIONS: This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities. TRIAL REGISTRATION: ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40218.