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
Authors: 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 
Published: July 2022

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.