In Canada, access to timely, evidence-based care for eating disorders is limited, with long wait times and fragmented services. Clinical practice guidelines can improve consistency and quality of care, but successful implementation remains limited. Canadian practice guidelines and a virtual care addendum have been developed for the treatment of youth with eating disorders (EDs). This study aims to qualitatively seek perspectives on the barriers, facilitating factors and implementation strategies from various interested parties. One semi-structured qualitative focus group was conducted in each of nine Canadian provinces. Focus groups consisted of a combination of clinicians, administrators, and individuals with lived experience who elaborated upon barriers and facilitating factors to guideline uptake as well as possible strategies to enhance implementation. Focus group transcripts were analyzed using conventional content analysis. Findings suggested that participants found it difficult to implement guideline recommendations due to a myriad of factors such as a lack of external resources and minimal training in guideline recommended therapies. Facilitating factors of uptake included support from leadership and explicit training on guideline therapies. Potential implementation strategies included the creation of adapted versions for families and healthcare professionals, as well as enhanced education materials. The findings of this study indicate areas within healthcare provision that can be enhanced and expanded upon to further enhance the uptake of the Canadian practice guidelines for children and adolescents with eating disorders. In Canada, many young people with eating disorders face long wait times and uneven access to appropriate care. Although national treatment guidelines have been developed to improve care, these guidelines are often not commonly used in practice. This study explored how these guidelines could be better implemented across the country. Researchers held one focus group discussion in each of nine provinces with clinicians, healthcare administrators, and people with lived experience of eating disorders. Participants shared what makes it difficult or easier to use the guidelines in real-world settings, as well as ideas for improving their use. Participants reported several barriers, including limited resources, long waitlists, and a lack of training in guideline-recommended treatments. Factors that helped implementation included strong support from organizational leadership and eating disorder training. Participants also suggested that the guidelines could be more widely used if they were adapted for different audiences, such as families and various healthcare professionals, and supported by clearer educational materials. Overall, the study highlights practical ways the Canadian eating disorder guidelines could be better supported and more effectively used to improve care for young people.

Background Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. Methods Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8–10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. Discussion Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.

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.

Jennifer Couturier*1, Danielle Pellegrini1, Catherine Miller2, Neera Bhatnagar1, Ahmed Boachie3, Kerry Bourret4, Melissa Brouwers5, Jennifer S. Coelho6, Gina Dimitropoulos7, Sheri Findlay1, Catherine Ford8, Josie Geller6, Seena Grewal3, Joanne Gusella9, Leanna Isserlin5, Monique Jericho7, Natasha Johnson1, Debra K. Katzman3, Melissa Kimber1, Adele Lafrance10, Anick Leclerc11, Rachel Loewen12, Techiya Loewen13, Gail McVey3, Mark Norris5, David Pilon9, Wendy Preskow14, Wendy Spettigue5, Cathleen Steinegger3, Elizabeth Waite13, Cheryl Webb1

Suicide is a major public health concern. In Canada, suicide is the ninth leading cause of death in all ages, with a rate of 10.3 deaths per 100,000 people. In Nova Scotia, Canada, 137 suicides were reported in 2016 [1]. Suicide risk assessment (SRA) and management are clinical competencies required for patient care. Strategies used for SRA include the use of formal self-report measures [2], personalized clinical interview however vital information about suicide risk may be missed during that unstructured assessment [3] and structured tool to supplement the clinical interview.

BackgroundThe World Health Organization (WHO) International Classification of Diseases and Related Health Problems (ICD) is used globally by 194 WHO member nations. It is used for assigning clinical diagnoses, providing the framework for reporting public health data, and to inform the organization and reimbursement of health services. Guided by overarching principles of increasing clinical utility and global applicability, the 11th revision of the ICD proposes major changes that incorporate empirical advances since the previous revision in 1992. To test recommended changes in the Mental, Behavioral, and Neurodevelopmental Disorders chapter, multiple vignette-based case-controlled field studies have been conducted which examine clinicians' ability to accurately and consistently use the new guidelines and assess their overall clinical utility. This manuscript reports on the results from the study of the proposed ICD-11 guidelines for feeding and eating disorders (FEDs).MethodParticipants were 2288 mental health professionals registered with WHO's Global Clinical Practice Network. The study was conducted in Chinese, English, French, Japanese, and Spanish. Clinicians were randomly assigned to apply either the ICD-11 or ICD-10 diagnostic guidelines for FEDs to a pair of case vignettes designed to test specific clinical questions. Clinicians selected the diagnosis they thought was correct for each vignette, evaluated the presence of each essential feature of the selected diagnosis, and the clinical utility of the diagnostic guidelines.ResultsThe proposed ICD-11 diagnostic guidelines significantly improved accuracy for all FEDs tested relative to ICD-10 and attained higher clinical utility ratings; similar results were obtained across all five languages. The inclusion of binge eating disorder and avoidant-restrictive food intake disorder reduced the use of residual diagnoses. Areas needing further refinement were identified.ConclusionsThe proposed ICD-11 diagnostic guidelines consistently outperformed ICD-10 in distinguishing cases of eating disorders and showed global applicability and appropriate clinical utility. These results suggest that the proposed ICD-11 guidelines for FEDs will help increase accuracy of public health data, improve clinical diagnosis, and enhance health service organization and provision. This is the first time in the revision of the ICD that data from large-scale, empirical research examining proposed guidelines is completed in time to inform the final diagnostic guidelines.