Table 4 Survey themes and quotes

Barriers

Theme 1: Barriers to telehealth CAT delivery are limitations of equipment and platforms, and lack of Veteran resources and technical skill

“Syncing of sound is the major one, but also lack of instruments for patients and their internet connection being slow.” [survey 84, music therapist]

Theme 2: Less control over the virtual space including therapist reliance on Veteran to find a private, quiet space that is safe and contains the needed materials for a CAT session

“not really knowing what is going on outside of the camera despite asking them to have a place where they feel comfortable (privacy).” [survey 88, art therapist]

Theme 3: Building rapport is more difficult through telehealth CAT due to interaction that is limited, less nuanced, and personal

“It feels less personal; not as easy to build therapeutic rapport.” [survey 62, music therapist]

Adaptations to CAT sessions

Theme 1: Therapists are adapting how they prepare for sessions by using materials from Veterans’ home, mailing materials in advance, and relying on more verbal instructions compared to in person sessions

“I'm having to consider how to best offer services using the client's available resources.” [survey 10, music therapist]

Theme 2: Therapists are modifying the CAT experiences to include less synchronous music making, restricted range of movement to ensure safety, and more reliance on Veterans learning the art and music experiences independently of hands-on instruction

“Adapted live engagements to account for latency issues and given veteran more opportunities to be a leader/communicate in a different way during sessions.” [survey 9, music therapist]

Theme 3: Due to Veterans’ needs during the COVID-19 pandemic, therapists modified goals to a general focus on self-care and maintaining social interactions

“I am finding that the goal of staying connected with others and not isolating has risen to the top of the priority list for many of my patients.” [survey 69, music therapist]

Adaptations to facilitate telehealth delivery

Theme 1: The addition of audio interfaces, cameras and lighting improves the quality and ease of delivery of telehealth CAT

“using an audio interface to improve instrument playing audio.” [survey 28, music therapist]

Theme 2: Additional tools through software and screen sharing enhances visuals and music sharing to facilitate easier delivery and improve quality of telehealth CAT interactions

“Screen sharing has been a support to art therapy services as reference images, how-to videos, websites, tutorials and other resources can be easily shared in real time.” [survey 19, art therapist]

Theme 3: Providing telehealth CAT from the provider’s home increases the number of patients to receive services

“I do not have assigned space and have bounced from conference room to conference room to have programming. With virtual care I can see twice as many groups without space limitations.” [survey 4, music therapist]

Benefits

Theme 1: Telehealth Improves access and reach by providing continuity of care, and reaching Veterans who are homebound, or live far from nearest medical facility

[Benefit of telehealth is..] “being able to see a larger number of veterans in the community that might not be seen otherwise due to transportation issues or scheduling.” [survey 76, music therapist]

Theme 2: Telehealth provides additional therapeutic benefits from Veterans being able to attend sessions from home while maintaining social connections

“Patients are able to engage from their own home and are creating healing environments within their spaces.” [survey 23, art therapist]

Theme 3: Telehealth delivery provides enhanced therapist creativity, improves scheduling flexibility and makes more efficient use of therapists’ time

“I have felt challenged to move out of my comfort zone and I feel that's made me grow as a clinician.” [survey 10, music therapist]