Adapting and adopting highly specialized pediatric eating disorder treatment to virtual care: Implementation research for the COVID-19 context and beyond

The negative impact of COVID-19 and the associated social isolation on mental health has been well-described in terms of heightened anxiety and depression. Literature on the impact on individuals with eating disorders (ED) and their families is only just emerging. In most settings across Canada only urgent outpatient medical visits are currently permitted, with ambulatory mental health care having been suspended. Given the success of our previous CIHR-funded implementation work on Family-Based Treatment (FBT) in Ontario, as well as the COVID-19 crisis, an urgent need to adapt FBT to virtual formats and adopt it in our network of ED care providers was identified. We propose to study the implementation of virtual FBT within six programs in our network, building on our previous work, and further developing capacity in our system. Experts in implementation science, community-based research, standard and virtual FBT use/supervision, and EDs have partnered on this implementation project. Using multi-site case study methodology with a mixed method pre/post design we will examine the impact of our implementation approach. We will develop implementation teams at each site, provide a training workshop on vFBT using Zoom Healthcare, and provide ongoing implementation and clinical consultation during the initial implementation of vFBT. Therapists will submit video-recordings of the first four vFBT sessions which will be rated by experts for fidelity. We propose to examine implementation success by studying fidelity to virtual FBT, as well as team and patient/family experience with virtual care, and patient outcomes. Our team is perfectly positioned to respond to this rapid research funding opportunity with an existing network of clinicians who are keen to adopt virtual FBT. Virtual care is not only important in the COVID-19 context but is vital in the North where access to specialized services is extremely limited.