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Introduction: Quality services for persons with intellectual and developmental disabilities and mental health needs (IDD-MH) requires timely access to services that are responsive to their needs and preferences. This study explores virtual service delivery from the perspectives of family caregivers of persons IDD-MH during the onset of the COVID-19 pandemic. Methods: Recorded clinical interviews from 577 family caregivers, collected as part of START (Systemic, Therapeutic, Assessment, Resources, and Treatment) service implementation between March and July 2020, were retrospectively analyzed using a qualitative content analysis approach. Results: Four factors influenced quality: accessibility of teleservices for persons with IDD-MH; confluence of demands on the caregiver setting; telecommunications infrastructure; and adaptability of services. Perceptions fluctuated with the interaction of these factors. Conclusions: While many may benefit from teleservices during future public health emergencies, providers should consider individual, family, community, and service system factors to ensure teleservice access, appropriateness, and accountability for family caregivers of persons with IDD-MH.