Multidisciplinary implementation 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; James Lock

doi:10.1093/tbm/ibac086

Multidisciplinary implementation of family-based treatment delivered by videoconferencing (FBT-V) for adolescent anorexia nervosa during the COVID-19 pandemic

Transl Behav Med. 2023 Feb 28;13(2):85-97. doi: 10.1093/tbm/ibac086.

Authors

Jennifer Couturier^{1

2}, Danielle Pellegrini¹, Laura Grennan¹, Maria Nicula¹, Catherine Miller³, Paul Agar², Cheryl Webb^{1

2}, Kristen Anderson⁴, Melanie Barwick^{5

6}, Gina Dimitropoulos⁷, Sheri Findlay^{2

8}, Melissa Kimber¹, Gail McVey^{5

9}, James Lock¹⁰

Affiliations

¹ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
² Eating Disorder Program, McMaster Children's Hospital, Hamilton, ON, Canada.
³ Eating Disorder Program, Canadian Mental Health Association, Waterloo Wellington, Kitchener, ON, Canada.
⁴ Chicago Center for Evidence-Based Treatment, Chicago, IL, USA.
⁵ Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
⁶ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
⁷ Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
⁸ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁹ Ontario Community Outreach Program for Eating Disorders, University Health Network, Toronto, ON, Canada.
¹⁰ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.

Abstract

Family-Based Treatment (FBT)-the most widely supported treatment for pediatric eating disorders-transitioned to virtual delivery in many programs due to COVID-19. Using a blended implementation approach, we systematically examined therapist adherence to key components of FBT and fidelity to FBT by videoconferencing (FBT-V), preliminary patient outcomes, and team experiences with our FBT-V implementation approach as well as familial perceptions of FBT-V effectiveness. We examined our implementation approach across four pediatric eating disorder programs in Ontario, Canada, using mixed methods. Participants included therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5; 21 family members in total). We developed implementation teams at each site, provided FBT-V training, and offered clinical and implementation consultation. Therapists submitted video recordings of their first four FBT-V sessions for fidelity rating, and patient outcomes. Therapists self-reported readiness, attitudes, confidence, and adherence to FBT-V. Focus groups were conducted with each team and family after the first four sessions of FBT-V. Quantitative data were analyzed using repeated measures ANOVA. Qualitative data were analyzed using directed and summative content analysis. Therapists adhered to key FBT components and maintained FBT-V fidelity. Changes in therapists' readiness, attitudes, and confidence in FBT-V over time were not significant. All patients gained weight. Focus groups revealed implementation facilitators/barriers, positives/negatives surrounding FBT-V training and consultation, suggestions for improvement, and effectiveness attributed to FBT-V. Our implementation approach appeared to be feasible and acceptable. Future research with a larger sample is required, furthering our understanding of this approach and exploring how organizational factors influence treatment fidelity.

Trial registration: ClinicalTrials.gov NCT04678843.

Keywords: Adolescents; Anorexia nervosa; COVID-19; Family-based treatment; Implementation research; Virtual care.

Plain language summary

We qualitatively and quantitatively examined the initial implementation (the first four sessions) of Family-Based Treatment (FBT) delivered by videoconferencing (FBT-V) during the COVID-19 pandemic using an evidence-based implementation approach. This included developing implementation teams (consisting of a lead therapist, medical practitioner, and program administrator) at each site, providing FBT-V training to all participants, and offering clinical consultation to all participating therapists and implementation consultation to implementation teams. Therapists were required to submit video recordings of their first four FBT-V sessions. Therapist adherence to key components of FBT as well as fidelity to the FBT-V model, team and family experiences with FBT-V, and preliminary patient outcomes (e.g., weight gain) were examined. Our findings suggest that our implementation approach was feasible and acceptable; therapists adhered to key FBT components and maintained FBT-V fidelity, patients gained weight, and teams and families expressed satisfaction with our intervention. Further research is needed with a larger sample and for a longer duration.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anorexia Nervosa* / therapy
COVID-19*
Child
Family Therapy / methods
Humans
Pandemics
Videoconferencing

Associated data

ClinicalTrials.gov/NCT04678843

Grants and funding

448560/CIHR/Canada