RESUMEN

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 .

RESUMEN

Transitions between hospital and community services and from child and adolescent to adult services have been identified as a priority for improvement in the child and adolescent mental health and addictions sector across Canada and internationally. Despite widespread recognition of the issue, there is very little in the way of evidence to guide policy and programming to improve transitions. Transition support workers have been identified as a promising intervention to facilitate successful transitions, and innovative programs involving transition workers are currently operating in the Canadian mental health sector. This commentary presents two case studies of existing transition worker programs in the Greater Toronto Area that link hospital and community mental health sectors for youth ages 12-18. We discuss program characteristics, the transition worker role, recommendations to organizations considering creating a similar service, and areas for future research. The goal of this commentary is to contribute to knowledge exchange and ultimately strengthen the evidence base for the transition worker role in child and adolescent mental health services.

Les transitions des services hospitaliers aux services communautaires, et des services pour enfants et adolescents aux services pour adultes ont été désignées comme étant une priorité pour améliorer le secteur de la santé mentale et des toxicomanies des enfants et des adolescents dans tout le Canada et sur la scène internationale. Malgré que cet enjeu soit largement reconnu, il y a très peu de données probantes pour guider les politiques et les programmes aptes à améliorer les transitions. Les travailleurs de soutien des transitions sont estimés constituer une intervention prometteuse pour faciliter des transitions réussies, et des programmes innovateurs qui emploient ces travailleurs de transition sont actuellement en activité dans le secteur canadien de la santé mentale. Ce commentaire présente deux études de cas de programmes de travailleurs de transition existants dans la région du Grand Toronto qui relient les secteurs hospitaliers et communautaires de la santé mentale pour les adolescents de 12 à 18 ans. Nous présentons les caractéristiques des programmes, le rôle des travailleurs de transition, les recommandations aux organisations qui envisagent de créer un service semblable, et les domaines de la future recherche. Ce commentaire vise à contribuer à l'échange de connaissances et finalement, à étoffer les données probantes concernant le rôle du travailleur de transition dans les services de santé mentale pour enfants et adolescents.