Parenting a child with an eating disorder (ED) while also navigating the healthcare system can be complex and overwhelming. Preliminary research indicates that parent-led peer support could be a promising avenue to ease this burden. This study examined the expanding implementation of virtual parent-led peer-support groups (vPLPSGs) for parents of children with EDs. A convergent mixed methods design was used to evaluate the effectiveness of the vPLPSG intervention and success of its implementation. Parents of children who had recovered from an ED, or parent peer support providers (PPSPs), were trained to lead vPLPSGs for parents of children currently ill with an ED. Groups occurred biweekly across two study waves, totalling 12 months. Parents completed measures of caregiver burden, caregiver needs, and caregiver confidence before and after attending vPLPSGs over a three-month period. PPSPs completed weekly ratings of fidelity and pre- and post-implementation measures of readiness for change, attitudes towards evidence-based practice, and perceptions of the effectiveness of the principles guiding this intervention. Using qualitative methods, PPSPs and parents participated in a focus group and individual semi-structured interviews, respectively. At post-intervention, parents (n = 35) reported decreased caregiver burden (MD=-4.69; p = 0.050), an increase in met information and support needs (MD = 5.60; p < 0.001), and increased confidence to support their child with an ED (MD = 8.09; p < 0.01). Qualitative data indicated that parents reported vPLPSGs as a positive, supportive experience. PPSPs (n = 8) experienced a decrease in PPSPs’ attitudes towards evidence-based practices (MD=-0.54; p < 0.01). Around half (50.5

BACKGROUND:Early intervention for eating disorders (EDs) models and services is not formalized in Canada, despite increasing demand for care and well-established clinical, social, and economic benefits of intervening early. PURPOSE:FREEDcan (First Episode Rapid Early Intervention for Eating Disorders-Canada) introduces a community-based model to improve early identification, initial response, and access to evidence-based interventions for young people aged 8-25 years with early-stage EDs. METHODS:FREEDcan was co-adapted from the United Kingdom's evidence-based FREED model for the Canadian context with a multi-partner advisory group of clinicians, community organizations, youth and family advisors, researchers, and an implementation science team. It has three pillars: early identification, initial response, and evidence-based interventions for early-stage EDs. Implementation is supported by intersectoral partnerships, community-driven adaptation, and integrated workforce expansion to build capacity and facilitate sustainable, integrated early intervention. ANTICIPATED OUTCOMES:From a service perspective, FREEDcan aims to improve early detection of EDs, reduce duration of untreated illness through rapid, low-barrier responses, and increase access to stage-appropriate interventions. Additional implementation-based outcomes are anticipated, including evidence for core components, costs, and adaptations relevant to scaling this model in diverse regions across Canada. CONCLUSIONS:FREEDcan has the potential to provide an accessible, youth-centered, developmentally appropriate approach to early ED care within a collaborative, community-driven, integrated care framework. Using a learning health systems approach, it strives for continuous evaluation to support real-time learning, opportunities for model improvement, and evidence-generation for a new integrated model of care for early-stage ED care for young people in Canada.

Brief, accessible screening tools are needed to identify disordered eating and eating disorder (ED) risk across clinical settings and population health surveillance. The Ottawa Disordered Eating Screen (ODES) was developed as a 4-item self-report measure using language applicable across the lifespan. This study describes the development and psychometric evaluation of the ODES, including its scoring guidelines, measurement properties, and applications in both service and surveillance contexts. The tool was developed through multidisciplinary expert consultation and refined using clinical vignettes to capture a range of eating- and body-related concerns. Psychometric testing used retrospective data from 278 participants aged 26–33 years in the Research on Eating and Adolescent Lifestyles 2.0 study. Convergent validity, internal consistency, and classification accuracy were evaluated. To assess utility as a surveillance tool, the ODES was implemented in two Canadian surveillance efforts: the 2024 Mental Health Research Canada (MHRC) Poll 21 (n = 3,213; ages 16–65) and the 2023 Ontario Student Drug Use and Health Survey (OSDUHS; n = 10,145; ages 11–20). A dual scoring approach was supported: a domain-based “traffic light” model for clinical triage that assigns a risk level and recommended next step, employing a communimetric design, and a total score cutoff (≥ 7) for identifying at-risk individuals in surveillance and outcomes monitoring. The ODES demonstrated strong convergent validity with measures of restrained and emotional eating, appearance and weight satisfaction, and internalizing symptoms, alongside acceptable internal consistency and classification accuracy. In population surveillance, elevated disordered eating symptomatology was observed across demographic groups, with higher levels among adolescent girls, racialized individuals, and 2SLGBTQ+ groups. The ODES is a brief, valid, inclusive, and scalable tool suitable for use across age groups in clinical, community, and public health settings. Its dual scoring framework supports both service-level triage and population-level surveillance, facilitating screening efforts, monitoring, public health initiatives, and informed resource planning.

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.

Eating disorders (EDs) are severe mental illnesses with high rates of mortality, morbidity, and reduced quality of life. Their onset occurs during adolescence and early adulthood, coinciding with the critical transition from pediatric to adult care. To address the lack of guidelines to support ED transitions in Canada, this study developed evidence-based guideline recommendations. Scoping review methodology was employed using comprehensive searches across seven databases, supplemented by forward and backward citation chaining to identify records on youth and young adults (YYAs) (16–25 years) with EDs and/or mental health conditions transitioning from pediatric to adult care. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the quality of the evidence for applicable studies. Using a modified Delphi method, the evidence was reviewed by a guideline development panel and consensus was achieved in a single round of voting. After de-duplication, 14,350 records from all sources were screened, with 1817 studies undergoing full-text review. A total of 419 studies were included. Of these, 199 were primary research studies which fell under one or more of the following categories: descriptive (n = 86), qualitative (n = 75), predictors (n = 48), transition interventions (n = 21), measurement tools (n = 8), and key outcomes (n = 3). The certainty of the evidence for specific interventions and tools was generally low. The panel issued strong recommendations for integrated, collaborative transition approaches involving YYAs, families, and providers, and for the use of the Transition Readiness Assessment Questionnaire (TRAQ) to support transition planning. Additional recommendations are included, with an emphasis on future research focused on long-term outcomes such as care continuity and treatment retention. This research addressed the absence of a cohesive approach to transitions for YYAs experiencing EDs and/or mental health conditions, highlighting evidence variability and the need for a unified approach. These guidelines propose actionable steps for improving care transitions for YYAs with EDs and/or mental health conditions by promoting collaborative care models, prioritizing outcome-focused research, and using measurement tools. Young people with eating disorders (EDs) and/or other mental health conditions often face challenges when moving from pediatric to adult care, both in mental health and physical health realms. This transition typically occurs during adolescence or early adulthood which is a critical developmental period when continuation of care and support is essential. In Canada, there are no clear guidelines to help navigate this process. To address this gap, our team developed six recommendations based on a comprehensive scoping review of existing research. In these recommendations, we emphasize the importance of a collaborative approach that involves young people, families, and healthcare providers to ensure continuity and coordination of their care during the transition. In addition, research should prioritize the study of long-term outcomes, such as whether young people stay in treatment, leave early, or achieve successful transitions. Tools like the Transition Readiness Assessment Questionnaire (TRAQ) can help assess how prepared someone is for this change, but these tools need more testing to ensure they work well for people with EDs. These guidelines aim to improve care during this transition and to ensure that young people with EDs and/or other mental health conditions are prepared and supported as they move into adult healthcare services.

BACKGROUND:Guided self-help family-based treatment (GSH-FBT) is emerging as a promising, more efficient alternative to traditional family-based treatment (FBT). The present study is designed to examine the real-world implementation of GSH-FBT at pediatric treatment sites across nine provinces in Canada. METHODS:Implementation teams at each site consisting of a GSH-FBT coach, a medical provider, and a program administrator will be formed. Clinician coaches will be trained in this new modality and supported with weekly GSH-FBT consultation. Each site will recruit ten families with an adolescent with anorexia nervosa and the parents will undergo ten virtual GSH-FBT sessions. The implementation approach will be evaluated using qualitative and quantitative methods. Outcomes of interest include (1) treatment fidelity, (2) treatment wait times, (3) change in adolescent symptoms and parent/caregiver self-efficacy, (4) change in provider readiness, attitudes, and confidence towards the intervention, and (5) the overall experience of the implementation of the intervention from the perspective of the provider teams, and participant families. DISCUSSION:The findings of this study will help to identify factors important to the acceptability and implementation of GSH-FBT in real-world clinical settings. TRIAL REGISTRATION:This study was first registered with clinicaltrials.gov (registration # NCT06851273) on February 12, 2025 (url: https://clinicaltrials.gov/study/NCT06851273?id=NCT06851273&rank=1 ).

This study describes views on the impact of the COVID-19 pandemic on eating disorder symptoms in youth, as well as the impact on care, and the possibility of peer support as a mitigating strategy from the perspectives of youth and parents with lived experience with eating disorders, as well as clinicians and administrators. A national purposive sample was recruited through websites and social media platforms. Those recruited were asked to complete a demographic questionnaire and to partake in an individual, virtual, semi-structured qualitative interview. Guided by a qualitative descriptive approach, interview data was transcribed and analyzed using qualitative content analysis. Fifteen parents (93

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 Screen time and self-esteem have been shown to be important correlates of eating disorders in adolescence. However, there is an absence of longitudinal studies that distinguish between time-varying factors, accounting for parallel developmental changes and common underlying vulnerability. Design A total of 3,801 adolescents were administered self-report measures, annually, over the course of 5 years. The association of screen time (social media use, television watching, video gaming) on eating related symptoms was analyzed using a longitudinal Bayesian multilevel path analysis framework. Self-esteem was examined as a mediating factor in this model. This study investigated direct and indirect associations at between-person, concurrent within-person, and lagged-within-person levels, while controlling for gender. Results The findings revealed that all types of screen time exposure were significantly associated with eating related symptoms at between and within-person levels. A significant association at the lagged-within person level was only revealed for social media use. Self-esteem was found to be a significant mediating factor between screen time and eating related symptoms. Conclusion An increase in social media use one year was associated with increased of eating related symptoms two years later through lower self-esteem. Implications for prevention are discussed.

Background: In a multi-site randomized controlled trial (RCT), the EAAA programme designed for first year university women (17-24 years old) was shown to reduce the likelihood of any (attempted and completed) rape in the next year by 50% (Senn, C. Y., Eliasziw, M., Barata, P. C., Thurston, W. E., Newby-Clark, I. R., Radtke, H. L., & Hobden, K. L. (2015). Efficacy of a sexual assault resistance program for university women. New England Journal of Medicine, 372(24), 2326-2335). Through a non-profit organization, EAAA has been available to universities globally since 2016 using a Train-the-Trainer model. Observations of the 'real world' implementation suggested that universities often altered eligibility criteria (especially year of study and age) in their recruitment.Objective: The current study (2017-2021) evaluated whether EAAA was effective when implemented by universities in Canada outside of the constraints of an RCT.Method: Five universities participated. Women students who signed up to take the EAAA programme on their campuses were recruited for the research. Participants completed surveys at 1-week pre-program and 1-week and 6-months post-programme. Compared to the RCT, participant eligibility was broader, the sample was more diverse in terms of race and sexual identity and had a higher proportion of survivors. Programme fidelity was adequate.Results: Comparisons in this quasi-experimental design, between students who took the programme and students in the control group (i.e. those who signed up but did not attend the programme), confirmed the effectiveness of the EAAA programme. Reduction of any rape exceeded the a priori benchmark of 37.5%. Completed rape was significantly reduced by 57.3% at 6-months. Reduction in attempted rape of 32.9% was lower than in the RCT likely due to the somewhat older (average age 22 vs 18) sample. Positive changes to previously established mediators of the programme effects were all replicated.Conclusions: These findings suggest that the EAAA is highly effective when implemented by universities even when eligibility for students in terms of year of study and age is broadened.

Background: Over 40 years of research implicates perfectionism in eating disorders in childhood and adolescence. However, the nature of this relationship remains understudied. To address this gap, we performed a systematic review and a meta-analysis to quantify the magnitude of the associations between perfectionism (i.e., unidimensional perfectionism, perfectionistic strivings, and perfectionistic concerns) and eating-related symptoms during childhood and adolescence. Methods: The literature search was conducted using five electronic databases in accordance with PRISMA guidelines: MEDLINE, Embase, CINAHL Complete, APA PsycINFO, and EMB Reviews. A total of 904 studies were identified; a total of 126 were included in the systematic review, and 65 in the meta-analysis (N = 29,268). Sensitivity analyses were also carried out to detect potential differences in age and clinical status. Results: All the associations we investigated were both significant and positive. Small effect sizes were found between eating global scores and unidimensional perfectionism, perfectionistic strivings, and perfectionistic concerns (res = 0.19, res = 0.21, res = 0.12, respectively) and remained significant in each age group in both clinical and community samples. Perfectionistic concerns were moderately associated with all eating measures, especially in community samples and samples with a mean age under 14. Conclusions: Psychological interventions specially designed to target perfectionistic concerns in the early stages of development may help prevent the onset or reduce the intensity of eating-related symptoms during childhood and adolescence.

Family-Based Treatment (FBT)—the most widely supported treatment for pediatric eating disorders—transitioned to virtual delivery in many programs due to COVID-19. Using a blended implementation approach, we systematically examined therapist adherence to key components of FBT and fidelity to FBT by videoconferencing (FBT-V), preliminary patient outcomes, and team experiences with our FBT-V implementation approach as well as familial perceptions of FBT-V effectiveness. We examined our implementation approach across four pediatric eating disorder programs in Ontario, Canada, using mixed methods. Participants included therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5; 21 family members in total). We developed implementation teams at each site, provided FBT-V training, and offered clinical and implementation consultation. Therapists submitted video recordings of their first four FBT-V sessions for fidelity rating, and patient outcomes. Therapists self-reported readiness, attitudes, confidence, and adherence to FBT-V. Focus groups were conducted with each team and family after the first four sessions of FBT-V. Quantitative data were analyzed using repeated measures ANOVA. Qualitative data were analyzed using directed and summative content analysis. Therapists adhered to key FBT components and maintained FBT-V fidelity. Changes in therapists’ readiness, attitudes, and confidence in FBT-V over time were not significant. All patients gained weight. Focus groups revealed implementation facilitators/barriers, positives/negatives surrounding FBT-V training and consultation, suggestions for improvement, and effectiveness attributed to FBT-V. Our implementation approach appeared to be feasible and acceptable. Future research with a larger sample is required, furthering our understanding of this approach and exploring how organizational factors influence treatment fidelity.

Background During the COVID-19 pandemic, there was a necessity for eating disorder (ED) outpatient treatment to be delivered virtually. Given this transition, and the surge in new ED cases, there was an urgent need to investigate virtually delivered ED prevention programs. This review aimed to identify the available evidence on virtual ED prevention programs for children, adolescents, and emerging adults. Method Using scoping review methodology, seven databases were searched for studies published from January 2000 to April 2021 reporting on virtually delivered ED prevention interventions for children and adolescents (< 18 years) and emerging adults (18-25 years). Studies were excluded if they contained adults (> 25 years) and individuals with clinical ED diagnoses. Abstracts and full-text papers were reviewed independently by two reviewers. Data was extracted on study type, methodology, age, sample size, virtual intervention, outcomes, and results. In April 2022, we used a forward citation chaining process to identify any relevant articles from April 2021 to April 2022. Results Of 5129 unique studies identified, 67 met eligibility criteria, which included asynchronous (n = 35) and synchronous (n = 18) internet-based programs, other e-technology including mobile apps (n = 3) and text messaging interventions (n = 1), computer-based programs (n = 6), and online caregiver interventions focused on child outcomes (n = 4). Few studies mainly included children and adolescents (n = 18), whereas the vast majority included emerging adults (n = 49). For children and adolescents, the most widely researched programs were Student Bodies and its adapted versions (n = 4), eBody Project (n = 2), and Parents Act Now (n = 2). For emerging adults, the most widely researched programs were Student Bodies and its adapted versions (n = 16), eBody Project (n = 6) and Expand Your Horizon (n = 4). These interventions were effective at reducing various symptoms and ED risk. Some studies demonstrated that virtual prevention intervention efficacy resembled in-person delivery. Conclusion Virtual prevention interventions for EDs can be effective, however more research is needed studying their impact on children and adolescents and on improving access for vulnerable groups. Additional efficacy studies are required, such as for text messaging and mobile app ED prevention interventions. Evidence-based recommendations for virtual ED prevention for children, adolescents, and emerging adults at-risk for EDs should be prioritized. Plain English summary This review aimed to identify all available evidence for virtual eating disorder (ED) prevention interventions for children/adolescents (<18 years) and emerging adults (18-25 years). We reviewed seven databases and found 67 studies for inclusion. Findings were summarized into themes: asynchronous (not in real-time) and synchronous (in real-time) internet-based programs, other e-technology (mobile applications ['apps'], text messages), computer-based programs, and online caregiver interventions focused on child outcomes. Among children and adolescents, the most widely researched programs were Student Bodies (asynchronous internet-based cognitive-behavioural program), eBody Project (synchronous internet-based cognitive-dissonance program), and Parents Act Now, (online caregiver intervention). Among emerging adults, the most widely researched programs were Student Bodies (described above), eBody Project (described above) and Expand Your Horizon (asynchronous internet-based body functionality program). These interventions were effective at reducing symptoms and/or risk of developing EDs. Additional research is needed, including a greater focus on children and adolescents, and text messaging, mobile apps, online cognitive restructuring, and online imagery rescripting ED prevention interventions. Evidence-based recommendations for virtual ED prevention interventions that have been reviewed by a panel and research on improving access to virtual ED prevention services for vulnerable groups should also be prioritized.

Introduction The Enhanced Assess , Acknowledge , Act ( EAAA ) Sexual Assault (SA) Resistance Program is a theoretically sound, evidence-based program providing SA resistance education within a positive sexuality framework. It was shown to substantially reduce sexual assault victimization among university women who participate (Senn et al. in New England Journal of Medicine 372 (24), 2326-2335, 2015 ). Staff training can either enhance or impede successful program scale-up and implementation. In this paper, we evaluate the transfer of training to implementation sites (i.e., postsecondary institutions) using a train-the-trainer model. Methods Using pre- and post-training surveys and post-training interviews conducted from 2016 to 2020 with 33 implementation staff members from multiple sites, we answered the following research questions: 1. Did the training meet its overall goal of preparing implementation staff? 2. What training components were perceived to contribute to training effectiveness and implementation staff preparedness? Results Results suggested that our model of training was effective. Competence, confidence, and knowledge and ability increased significantly after training, and most staff perceived the training to be highly useful and effective (especially for preparing them to address EAAA participant issues). Practice and feedback from trainers through active learning techniques were especially important. Although implementation staff reported being well prepared to deliver the training or program, they reported being less prepared for handling other implementation-related activities and issues (that the training was not necessarily designed to address in-depth). Conclusions Our findings suggest a need to enhance existing training on self-care and supporting program facilitators and for ongoing support and reminders from program purveyors to ensure that implementers are making use of existing resources. This study fills important gaps in the literature as few studies have examined the transfer of training for SA prevention programming.

Abstract Background Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier. Methods Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18–25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review. Results Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns. Conclusions The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone—like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.

BACKGROUND:The COVID-19 pandemic has negatively impacted individuals with eating disorders; resulting in increased symptoms, as well as feelings of isolation and anxiety. To conform with social distancing requirements, outpatient eating disorder treatment in Canada is being delivered virtually, but a lack of direction surrounding this change creates challenges for practitioners, patients, and families. As a result, there is an urgent need to not only adapt evidence-based care, including family-based treatment (FBT), to virtual formats, but to study its implementation in eating disorder programs. We propose to study the initial adaptation and adoption of virtual family-based treatment (vFBT) with the ultimate goal of improving access to services for youth with eating disorders.METHODS:We will use a multi-site case study with a mixed method pre/post design to examine the impact of our implementation approach across four pediatric eating disorder programs. We will develop implementation teams at each site (consisting of therapists, medical practitioners, and program administrators), provide a remote training workshop on vFBT, and offer ongoing consultation during the initial implementation phase. Therapists will submit videorecordings of their first four vFBT sessions. We propose to study our implementation approach by examining (1) whether the key components of standard FBT are maintained in virtual delivery measured by therapist self-report, (2) fidelity to our vFBT model measured by expert fidelity rating of submitted videorecordings of the first four sessions of vFBT, (3) team and patient/family experiences with vFBT assessed with qualitative interviews, and (4) patient outcomes measured by weight and binge/purge frequency reported by therapists.DISCUSSION:To our knowledge, this is the first study to evaluate an implementation strategy for virtually delivered FBT for eating disorders. Challenges to date include confirming site participation and obtaining ethics approval at all locations. This research is imperative to inform the delivery of vFBT in the COVID-19 context. It also has implications for delivery in a post-pandemic era where virtual services may be preferable to patients and families living in remote locations, where access to specialized services is extremely limited.TRIAL REGISTRATION:ClinicalTrials.gov NCT04678843 , registered on December 21, 2020.

INTRODUCTION:Fidelity is an essential component for evaluating the clinical and implementation outcomes related to delivery of evidence-based practices (EBPs). Effective measurement of fidelity requires clinical buy-in, and as such, requires a process that is not burdensome for clinicians and managers. As part of a larger implementation study, we examined fidelity to Family-Based Treatment (FBT) measured by several different raters including an expert, a peer, therapists themselves, and parents, with a goal of determining a pragmatic, reliable and efficient method to capture treatment fidelity to FBT.METHODS:Each therapist audio-recorded at least one FBT case and submitted recordings from session 1, 2, and 3 from phase 1, plus one additional session from phase 1, two sessions from phase 2, and one session from phase 3. These submitted files were rated by an expert and a peer rater using a validated FBT fidelity measure. As well, therapists and parents rated fidelity immediately following each session and submitted ratings to the research team. Inter-observer reliability was calculated for each item using the intraclass correlation coefficient (ICC), comparing the expert ratings to ratings from each of the other raters (parents, therapists, and peer). Mean scale scores were compared using repeated measures ANOVA.RESULTS:Intraclass correlation coefficients revealed that agreement was the best between expert and peer, with excellent, good, or fair agreement in 7 of 13 items from session 1, 2 and 3. There were only four such values when comparing expert to parent agreement, and two such values comparing expert to therapist ratings. The rest of the ICC values indicated poor agreement. Scale level analysis indicated that expert fidelity ratings for phase 1 treatment sessions scores were significantly higher than the peer ratings and, that parent fidelity ratings tended to be significantly higher than the other raters across all three treatment phases. There were no significant differences between expert and therapist mean scores.CONCLUSIONS:There may be challenges inherent in parents rating fidelity accurately. Peer rating or therapist self-rating may be considered pragmatic, efficient, and reliable approaches to fidelity assessment for real-world clinical settings.

In this paper, we describe and evaluate the strategies used to maximize intervention fidelity in a randomized controlled trial to examine the efficacy of a sexual assault resistance intervention. The EAAA program was based on the best available theory and evidence on how women can successfully resist sexual coercion from male acquaintances. Extensive protocols for hiring, training, and supervising facilitators were established a priori. Detailed intervention manuals were developed that clearly described program goals, learning objectives, core elements, troubleshooting tips, sections that must be delivered verbatim, adaptations that could be made if necessary, and the ideal and minimum dose. Program sessions were audio-recorded, and a subsample of recordings were scored for adherence to the manuals using detailed Intervention Fidelity Checklists (IFC) developed specifically for this research. The Gearing et al. (2011) Comprehensive Intervention Fidelity Guide (CFIG) was employed retrospectively to provide objectivity to our analysis and help identify what we did well and what we could have done better. The SARE (Sexual Assault Resistance Education) Trial received high scores (38 out of 44 (86%) from each of the first two authors on the CFIG, suggesting a high level of intervention fidelity. Although a potential for bias on the part of the two raters was an obvious limitation, as was our neglection to include measures of implementation receipt, which Gearing et al. (2011) recommended, our analysis underscores the utility in employing methods recommended to enhance intervention fidelity when developing and evaluating evidence-based interventions.

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.