Browsing by Author "Miller, Catherine"

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    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
    (2022-07-26) Couturier, Jennifer; Pellegrini, Danielle; Grennan, Laura; Nicula, Maria; Miller, Catherine; Agar, Paul; Webb, Cheryl; Anderson, Kristen; Barwick, Melanie; Dimitropoulous, Gina; Findlay, Sheri; Kimber, Melissa; McVey, Gail; Paularinne, Rob; Nelson, Aylee; DeGagne, Karen; Bourret, Kerry; Restall, Shelley; Rosner, Jodi; Hewitt-McVicker, Kim; Pereira, Jessica; McLeod, Martha; Shipley, Caitlin; Miller, Sherri; Boachie, Ahmed; Engelberg, Marla; Martin, Samantha; Holmes-Haronitis, Jennifer; Lock, James
    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 .
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    Adapting and adopting highly specialized pediatric eating disorder treatment to virtual care: a protocol for an implementation study in the COVID-19 context
    (2021-04-08) Couturier, Jennifer; Pellegrini, Danielle; Miller, Catherine; Agar, Paul; Webb, Cheryl; Anderson, Kristen; Barwick, Melanie; Dimitropoulos, Gina; Findlay, Sheri; Kimber, Melissa; McVey, Gail; Lock, James
    Abstract Background 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. Methods 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. Discussion 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. Trial registration ClinicalTrials.gov NCT04678843 , registered on December 21, 2020.
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    Canadian practice guidelines for the treatment of children and adolescents with eating disorders
    (2020-02-01) Couturier, Jennifer; Isserlin, Leanna; Norris, Mark; Spettigue, Wendy; Brouwers, Melissa; Kimber, Melissa; McVey, Gail; Webb, Cheryl; Findlay, Sheri; Bhatnagar, Neera; Snelgrove, Natasha; Ritsma, Amanda; Preskow, Wendy; Miller, Catherine; Coelho, Jennifer; Boachie, Ahmed; Steinegger, Cathleen; Loewen, Rachel; Loewen, Techiya; Waite, Elizabeth; Ford, Catherine; Bourret, Kerry; Gusella, Joanne; Geller, Josie; LaFrance, Adele; LeClerc, Anick; Scarborough, Jennifer; Grewal, Seena; Jericho, Monique; Dimitropoulos, Gina; Pilon, David
    Abstract Objectives Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. Methods Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. Results Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. Conclusions Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
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    Correction: 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
    (2022-12-08) Couturier, Jennifer; Pellegrini, Danielle; Grennan, Laura; Nicula, Maria; Miller, Catherine; Agar, Paul; Webb, Cheryl; Anderson, Kristen; Barwick, Melanie; Dimitropoulos, Gina; Findlay, Sheri; Kimber, Melissa; McVey, Gail; Paularinne, Rob; Nelson, Aylee; DeGagne, Karen; Bourret, Kerry; Restall, Shelley; Rosner, Jodi; Hewitt-McVicker, Kim; Pereira, Jessica; McLeod, Martha; Shipley, Caitlin; Miller, Sherri; Boachie, Ahmed; Engelberg, Marla; Martin, Samantha; Holmes-Haronitis, Jennifer; Lock, James
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    The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond
    (2021-04-16) Couturier, Jennifer; Pellegrini, Danielle; Miller, Catherine; Bhatnagar, Neera; Boachie, Ahmed; Bourret, Kerry; Brouwers, Melissa; Coelho, Jennifer S; Dimitropoulos, Gina; Findlay, Sheri; Ford, Catherine; Geller, Josie; Grewal, Seena; Gusella, Joanne; Isserlin, Leanna; Jericho, Monique; Johnson, Natasha; Katzman, Debra K; Kimber, Melissa; Lafrance, Adele; Leclerc, Anick; Loewen, Rachel; Loewen, Techiya; McVey, Gail; Norris, Mark; Pilon, David; Preskow, Wendy; Spettigue, Wendy; Steinegger, Cathleen; Waite, Elizabeth; Webb, Cheryl
    Abstract Objective The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. Methods Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. Results Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. Conclusions Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.