Couturier Jennifer, Pellegrini Danielle, Miller Catherine, Agar Paul, Webb Cheryl, Anderson Kristen, Barwick Melanie, Dimitropoulos Gina, Findlay Sheri, Kimber Melissa, McVey Gail, Lock James
McMaster University, 1280 Main St W, Hamilton, Ontario, Canada.
Canadian Mental Health Association - Waterloo Wellington, 1 Blue Springs Dr, Waterloo, Ontario, Canada.
Implement Sci Commun. 2021 Apr 8;2(1):38. doi: 10.1186/s43058-021-00143-8.
The COVID-19 pandemic has negatively impacted individuals with eating disorders; resulting in increased symptoms, as well as feelings of isolation and anxiety. To conform with social distancing requirements, outpatient eating disorder treatment in Canada is being delivered virtually, but a lack of direction surrounding this change creates challenges for practitioners, patients, and families. As a result, there is an urgent need to not only adapt evidence-based care, including family-based treatment (FBT), to virtual formats, but to study its implementation in eating disorder programs. We propose to study the initial adaptation and adoption of virtual family-based treatment (vFBT) with the ultimate goal of improving access to services for youth with eating disorders.
We will use a multi-site case study with a mixed method pre/post design to examine the impact of our implementation approach across four pediatric eating disorder programs. We will develop implementation teams at each site (consisting of therapists, medical practitioners, and program administrators), provide a remote training workshop on vFBT, and offer ongoing consultation during the initial implementation phase. Therapists will submit videorecordings of their first four vFBT sessions. We propose to study our implementation approach by examining (1) whether the key components of standard FBT are maintained in virtual delivery measured by therapist self-report, (2) fidelity to our vFBT model measured by expert fidelity rating of submitted videorecordings of the first four sessions of vFBT, (3) team and patient/family experiences with vFBT assessed with qualitative interviews, and (4) patient outcomes measured by weight and binge/purge frequency reported by therapists.
To our knowledge, this is the first study to evaluate an implementation strategy for virtually delivered FBT for eating disorders. Challenges to date include confirming site participation and obtaining ethics approval at all locations. This research is imperative to inform the delivery of vFBT in the COVID-19 context. It also has implications for delivery in a post-pandemic era where virtual services may be preferable to patients and families living in remote locations, where access to specialized services is extremely limited.
ClinicalTrials.gov NCT04678843 , registered on December 21, 2020.
新冠疫情对患有饮食失调症的个体产生了负面影响；导致症状加重，以及出现孤独感和焦虑情绪。为了符合社交距离要求，加拿大的门诊饮食失调症治疗正在以虚拟方式进行，但围绕这一变化缺乏指导方针，给从业者、患者及其家庭带来了挑战。因此，迫切需要不仅将包括基于家庭的治疗（FBT）在内的循证护理调整为虚拟形式，而且要研究其在饮食失调症治疗项目中的实施情况。我们提议研究虚拟家庭治疗（vFBT）的初步调整和采用情况，最终目标是改善饮食失调症青少年获得服务的机会。
我们将采用多地点案例研究，并结合前后测混合方法，以检验我们的实施方法对四个儿科饮食失调症治疗项目的影响。我们将在每个地点组建实施团队（由治疗师、医生和项目管理人员组成），提供关于vFBT的远程培训工作坊，并在初始实施阶段提供持续咨询。治疗师将提交他们前四次vFBT治疗的视频记录。我们提议通过以下方式研究我们的实施方法：（1）治疗师自我报告衡量在虚拟治疗中标准FBT的关键组成部分是否得以保留；（2）通过对提交的vFBT前四次治疗视频记录的专家保真度评级来衡量对我们vFBT模式的保真度；（3）通过定性访谈评估团队以及患者/家庭对vFBT的体验；（4）治疗师报告的体重和暴饮暴食/清除频率来衡量患者的治疗结果。
据我们所知，这是第一项评估针对饮食失调症的虚拟FBT实施策略的研究。迄今为止的挑战包括确认各地点的参与情况以及在所有地点获得伦理批准。这项研究对于在新冠疫情背景下提供vFBT至关重要。它对于在大流行后时代的服务提供也具有启示意义，在这个时代，虚拟服务对于居住在偏远地区、获得专业服务极其有限的患者及其家庭而言可能更受欢迎。
ClinicalTrials.gov NCT04678843，于2020年12月21日注册。
