A qualitative evaluation of team and family perceptions of family-based treatment delivered by videoconferencing (FBT-V) for adolescent Anorexia Nervosa during the COVID-19 pandemic

Jennifer Couturier, Danielle Pellegrini, Laura Grennan, Maria Nicula, Catherine Miller, Paul Agar, Cheryl Webb, Kristen Anderson, Melanie Barwick, Gina Dimitropoulos, Sheri Findlay, Melissa Kimber, Gail McVey, Rob Paularinne, Aylee Nelson, Karen DeGagne, Kerry Bourret, Shelley Restall, Jodi Rosner, Kim Hewitt-McVicker, Jessica Pereira, Martha McLeod, Caitlin Shipley, Sherri Miller, Ahmed Boachie, Marla Engelberg, Samantha Martin, Jennifer Holmes-Haronitis, James Lock, Jennifer Couturier, Danielle Pellegrini, Laura Grennan, Maria Nicula, Catherine Miller, Paul Agar, Cheryl Webb, Kristen Anderson, Melanie Barwick, Gina Dimitropoulos, Sheri Findlay, Melissa Kimber, Gail McVey, Rob Paularinne, Aylee Nelson, Karen DeGagne, Kerry Bourret, Shelley Restall, Jodi Rosner, Kim Hewitt-McVicker, Jessica Pereira, Martha McLeod, Caitlin Shipley, Sherri Miller, Ahmed Boachie, Marla Engelberg, Samantha Martin, Jennifer Holmes-Haronitis, James Lock

Abstract

Background: During the COVID-19 pandemic, outpatient eating disorder care, including Family-Based Treatment (FBT), rapidly transitioned from in-person to virtual delivery in many programs. This paper reports on the experiences of teams and families with FBT delivered by videoconferencing (FBT-V) who were part of a larger implementation study.

Methods: Four pediatric eating disorder programs in Ontario, Canada, including their therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5), participated in our study. We provided FBT-V training and delivered clinical consultation. Therapists recorded and submitted their first four FBT-V sessions. Focus groups were conducted with teams and families at each site after the first four FBT-V sessions. Focus group transcripts were transcribed verbatim and key concepts were identified through line-by-line reading and categorizing of the text. All transcripts were double-coded. Focus group data were analyzed using directed and summative qualitative content analysis.

Results: Analysis of focus group data from teams and families revealed four overarching categories-pros of FBT-V, cons of FBT-V, FBT-V process, and suggestions for enhancing and improving FBT-V. Pros included being able to treat more patients and developing a better understanding of family dynamics by being virtually invited into the family's home (identified by teams), as well as convenience and comfort (identified by families). Both teams and families recognized technical difficulties as a potential con of FBT-V, yet teams also commented on distractions in family homes as a con, while families expressed difficulties in developing therapeutic rapport. Regarding FBT-V process, teams and families discussed the importance and challenge of patient weighing at home. In terms of suggestions for improvement, teams proposed assessing a family's suitability or motivation for FBT-V to ensure it would be appropriate, while families strongly suggested implementing hybrid models of FBT in the future which would include some in-person and some virtual sessions.

Conclusion: Team and family perceptions of FBT-V were generally positive, indicating acceptability and feasibility of this treatment. Suggestions for improved FBT-V practices were made by both groups, and require future investigation, such as examining hybrid models of FBT that involve in-person and virtual elements. Trial registration ClinicalTrials.gov NCT04678843 .

Keywords: Anorexia Nervosa; COVID-19; Eating disorders; Families; Family-based treatment; Medical practitioners; Program administrators; Qualitative research; Therapists; Virtual care.

Conflict of interest statement

JL receives royalties from Guilford Press and Routledge for books related to family-based treatment and is co-owner of the Training Institute for Child and Adolescent Eating Disorders that trains professionals in family-based treatment.

© 2022. The Author(s).

References

    1. Devoe JD, Han A, Anderson A, Katzman DK, Patten SB, Soumbasis A, et al. The impact of the COVID-19 pandemic on eating disorders: a systematic review. Int J Eat Disord. 2022 doi: 10.1002/eat.23704.
    1. Colleluori G, Goria I, Zillanti C, Marucci S, Dalla RL. Eating disorders during COVID-19 pandemic: the experience of Italian healthcare providers. Eat Weight Disord. 2021;26(8):2787–2793. doi: 10.1007/s40519-021-01116-5.
    1. Otto AK, Jary JM, Sturza J, Miller CA, Prohaska N, Bravender T, et al. Medical admissions among adolescents with eating disorders during the COVID-19 pandemic. Pediatrics. 2021;148(4).
    1. Agostino H, Burstein B, Moubayed D, Taddeo D, Grady R, Vyver E, et al. Trends in the incidence of new-onset Anorexia Nervosa and atypical Anorexia Nervosa among youth during the COVID-19 pandemic in Canada. JAMA Netw Open. 2021;4(12):e2137395. doi: 10.1001/jamanetworkopen.2021.37395.
    1. Toulany A, Kurdyak P, Guttmann A, Stukel TA, Fu L, Strauss R, et al. Acute care visits for eating disorders among children and adolescents after the onset of the COVID-19 pandemic. J Adolesc Health. 2022;70(1):42–47. doi: 10.1016/j.jadohealth.2021.09.025.
    1. Taquet M, Geddes JR, Luciano S, Harrison PJ. Incidence and outcomes of eating disorders during the COVID-19 pandemic. Br J Psychiatry. 2021;220:1–3.
    1. Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord. 2020;8:4. doi: 10.1186/s40337-020-0277-8.
    1. Lock J, Le Grange D. Treatment manual for anorexia nervosa: a family-based approach. Second edition ed. New York: The Guilford Press; 2013.
    1. Couturier J, Kimber M, Szatmari P. Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2013;46(1):3–11. doi: 10.1002/eat.22042.
    1. Eisler I, Simic M, Hodsoll J, Asen E, Berelowitz M, Connan F, et al. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa. BMC Psychiatry. 2016;16(1):422. doi: 10.1186/s12888-016-1129-6.
    1. Anderson KE, Byrne CE, Crosby RD, Le Grange D. Utilizing Telehealth to deliver family-based treatment for adolescent anorexia nervosa. Int J Eat Disord. 2017;50(10):1235–1238. doi: 10.1002/eat.22759.
    1. Goldfield GS, Boachie A. Delivery of family therapy in the treatment of anorexia nervosa using telehealth. Telemed J E Health. 2003;9(1):111–114. doi: 10.1089/153056203763317729.
    1. Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957–962. doi: 10.1093/jamia/ocaa067.
    1. Rathod S, Gega L, Degnan A, Pikard J, Khan T, Husain N, et al. The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses. Neuropsychiatr Dis Treat. 2018;14:165–178. doi: 10.2147/NDT.S138430.
    1. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8:117. doi: 10.1186/1748-5908-8-117.
    1. Baumann AA, Powell BJ, Kohl PL, Tabak RG, Penalba V, Proctor EE, et al. Cultural adaptation and implementation of evidence-based parent-training: a systematic review and critique of guiding evidence. Child Youth Serv Rev. 2015;53:113–120. doi: 10.1016/j.childyouth.2015.03.025.
    1. Wiltsey Stirman S, Gutner CA, Crits-Christoph P, Edmunds J, Evans AC, Beidas RS. Relationships between clinician-level attributes and fidelity-consistent and fidelity-inconsistent modifications to an evidence-based psychotherapy. Implement Sci. 2015;10:115. doi: 10.1186/s13012-015-0308-z.
    1. Hellner M, Bohon C, Kolander S, Parks E. Virtually delivered family-based eating disorder treatment using an enhanced multidisciplinary care team: a case study. Clin Case Rep. 2021;9(6):e04173. doi: 10.1002/ccr3.4173.
    1. Matheson BE, Bohon C, Lock J. Family-based treatment via videoconference: clinical recommendations for treatment providers during COVID-19 and beyond. Int J Eat Disord. 2020;53(7):1142–1154. doi: 10.1002/eat.23326.
    1. Couturier J, Pellegrini D, Miller C, Agar P, Webb C, Anderson K, et al. Adapting and adopting highly specialized pediatric eating disorder treatment to virtual care: a protocol for an implementation study in the COVID-19 context. Implement Sci Commun. 2021;2(1):38. doi: 10.1186/s43058-021-00143-8.
    1. Couturier J, Pellegrini D, Nicula M, Grennan L, Miller C, Agar P, et al. Multidisciplinary implementation of family-based treatment delivered by videoconferencing (FBT-V) for adolescent Anorexia nervosa during the COVID-19 pandemic (submitted); 2022.
    1. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–340. doi: 10.1002/1098-240X(200008)23:4<334::AID-NUR9>;2-G.
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288. doi: 10.1177/1049732305276687.
    1. Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health care research. Glob Qual Nurs Res. 2017;4:2333393617742282.
    1. Romanchych E, Desai R, Bartha C, Carson N, Korenblum M, Monga S. Healthcare providers' perceptions of virtual-care with children's mental health in a pandemic: a hospital and community perspective. Early Interv Psychiatry. 2021;16:433. doi: 10.1111/eip.13196.
    1. Latzer Y, Herman E, Ashkenazi R, Atias O, Laufer S, Biran Ovadia A, et al. Virtual online home-based treatment during the COVID-19 pandemic for ultra-orthodox young women with eating disorders. Front Psychiatry. 2021;12:654589. doi: 10.3389/fpsyt.2021.654589.
    1. Jenkins-Guarnieri MA, Pruitt LD, Luxton DD, Johnson K. Patient perceptions of telemental health: Systematic review of direct comparisons to in-person psychotherapeutic treatments. Telemed e-Health. 2015;21(8):652–660. doi: 10.1089/tmj.2014.0165.
    1. Rivett M. Relational lockdown and relational Trauma(dagger) in the time of coronavirus: a reflection from a UK family therapist. Fam Process. 2020;59(3):1024–1033. doi: 10.1111/famp.12571.
    1. Sherbersky H, Ziminski J, Pote H. The journey towards digital systemic competence: thoughts on training, supervision and competence evaluation. J Fam Ther. 2021;43:351–371. doi: 10.1111/1467-6427.12328.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する