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

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 .
Plain English summary Family-Based Treatment—the leading outpatient treatment for children and adolescents with eating disorders—rapidly transitioned to virtual delivery during the COVID-19 pandemic in many programs. This study qualitatively describes the perceptions and experiences of teams and families related to the first four sessions of Family-Based Treatment delivered via videoconferencing (FBT-V) during the COVID-19 pandemic, using end-of-study focus groups. Our findings suggest that FBT-V is generally well-received amongst these stakeholders. Therapists found that implementing FBT-V was relatively seamless, and families described the convenience and comfort of sessions taking place virtually in their own homes. However, therapists revealed concerns of distractions in family homes impacting sessions, and families had some difficulties in developing therapeutic rapport. As a result, additional modes of delivering Family-Based Treatment should be explored to address challenges present in virtual care. This might include hybrid models of treatment delivery, involving a combination of in-person and virtual sessions.
Journal of Eating Disorders. 2022 Jul 26;10(1):111