Introducing a novel clinical tool to describe child engagement in telehealth speech and language assessments.

Purpose : Telehealth may be a solution to access barriers in speech-language pathology. Previous investigations of telehealth assessment have alluded to factors affecting children's engagement, though these factors have not been comprehensively described. Aim : This study aimed to develop a novel clinical tool to describe the factors affecting children's engagement in paediatric telehealth assessments. Method : The Factors Affecting Child Engagement in Telehealth Sessions (FACETS) tool was developed using a mixed methods approach. Iterative analysis was conducted through a qualitative evidence synthesis, followed by the application of the tool to seven children aged between 4;3 and 5;7 years old who participated in a speech and language assessment via telehealth. Descriptive data were obtained regarding engagement on both a child-by-child and task-by-task basis. Reliability of the FACETS was determined via percent agreement and Cohen's kappa between two independent raters. Result : Using a mixed methods design, the FACETS framework was developed and refined. Application of the tool to seven case studies revealed variability in engagement with acceptable inter-rater reliability. Conclusion : The FACETS may be a useful resource for describing the factors that influence children's engagement in telehealth during the assessment. The FACETS requires further testing with clinical populations.