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Wood MD, Smith JL, Healey H, Görges M, Lokker C. Enhanced recovery support for people with eating disorders during the COVID-19 pandemic: quality improvement using a web-based, stepped-care programme in Canada. BMJ Open Qual 2023; 12:e002366. [PMID: 37935516 PMCID: PMC10632883 DOI: 10.1136/bmjoq-2023-002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, the number of individuals struggling with eating disorders (EDs) increased substantially. Body Brave (a not-for-profit) created and implemented a web-based stepped-care Recovery Support Programme (RSP) to improve access to community-based ED services. This quality improvement study describes the RSP and assesses its ability to deliver timely access to treatment and platform engagement. METHODS We conducted a retrospective cohort study comparing access to, and use of Body Brave services 6 months before and 12 months after implementation of the RSP platform (using 6-month increments for two postimplementation periods). Primary programme quality measures included registration requests, number of participants onboarded and time to access services; secondary measures included use of RSP action plans, attendance for recovery sessions and workshops, number of participants accessing treatment and text-based patient experience data. RESULTS A substantial increase in registration requests was observed during the first postimplementation period compared with the preimplementation period (176.5 vs 85.5; p=0.028). When compared with the preimplementation period, the second postimplementation observed a significantly larger percentage of successfully onboarded participants (76.6 vs 37.9; p<0.01) and a reduction in the number of days to access services (2 days vs 31 days; p<0.01). Although participant feedback rates were low, many users found the RSP helpful, easy to access, user-friendly and were satisfied overall. Users provided suggestions for improvement (eg, a platform instructional video, offer multiple times of day for live sessions and drop-in hours). CONCLUSIONS Although clinical benefit needs to be assessed, our findings demonstrate that the RSP enabled participants to quickly onboard and access initial services and have informed subsequent improvements. Understanding initial programme effects and usage will help assess the feasibility of adapting and expanding the RSP across Canada to address the urgent need for low-barrier, patient-centred ED care.
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Affiliation(s)
- Michael D Wood
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
- Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Hannah Healey
- Department of Health and Rehabilitation Sciences, Health Professional Education, Western University, London, Ontario, Canada
| | - Matthias Görges
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
- Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Cynthia Lokker
- Department of Health Research, Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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2
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Wilksch SM. Toward a more comprehensive understanding and support of parents with a child experiencing an eating disorder. Int J Eat Disord 2023. [PMID: 36942822 DOI: 10.1002/eat.23938] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The majority of eating disorder (ED) carer research has been conducted with parents of adult patients, using qualitative methodologies, focusing on carer burden and distress during treatment. This article aimed to use results from a large, national, quantitative survey of parents of child or adolescent patients as a springboard for encouraging a more comprehensive investigation of parent experiences. METHODS The online survey assessed treatment experiences and parent distress (DASS-21) but also less commonly investigated topics including symptom detection, experiences with primary care providers, and impacts on parent physical and psychological health, romantic relationship, finances, and employment. RESULTS Key findings included parents (N = 439; 91.6% female): were the first person to notice the ED symptoms in 81.8% of cases; had only a 14.7% chance of a helpful experience with both the first general practitioner and first therapist they saw; needed to see M = 3.55 therapists before finding one that could help; reported worse than normal psychological health (96.0%), physical health (70.5%), and romantic relationship (92.7%); required M = 70.06 days leave from work to care for their child (per household); and 91.8% accessed treatment in the private sector with median out-of-pocket expenses of AUD 10,0001-AUD 20,000. DISCUSSION Recommendations to address research and practice gaps include: increased focus on supporting initial symptom detection; improving primary care and treatment experiences; and, increasing the number of ED treatment providers. Urgently needed are solutions to the overwhelming demand for services and clearly, more support for parents. Such strategies are vital for reducing the overall burden of EDs. PUBLIC SIGNIFICANCE Most eating disorder (ED) caregiver research has focused on experiences of supporting adult patients during treatment. This article used a large national survey to explore parent experiences of their child or adolescent's ED in less commonly investigated areas, such as detection, primary care, impact on parent physical and psychological health, romantic relationship, employment and finances. Findings suggested mixed experiences with health care providers and a very significant toll of the illness on the domains measured. Recommendations were provided for how these important areas can be addressed.
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Affiliation(s)
- Simon M Wilksch
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
- Advanced Psychology Services, Adelaide, South Australia, Australia
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Migliorini C, Lam DSM, Harvey C. Supporting family and friends of young people with mental health issues using online technology: A rapid scoping literature review. Early Interv Psychiatry 2022; 16:935-957. [PMID: 34729912 DOI: 10.1111/eip.13230] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/20/2021] [Accepted: 10/19/2021] [Indexed: 12/25/2022]
Abstract
AIM Family and friends are often the first and/or only support options used by young people (12-25 years) struggling with mental health issues. The overarching aim of this literature review is to map current practice in online interventions specifically targeting family and friends of young people with mental health issues, especially relevant in light of the current worldwide COVID-19 pandemic. METHODS A rapid scoping literature review was conducted searching health and psychology databases for online interventions targeting family and friends supporting a young person (12-25 years) struggling with a mental health issue. The search strategy was comprehensive and expert librarian endorsed. The final synthesis comprised 13 articles. RESULTS Identified articles were few, reporting a disparate range of research aims, intervention content and delivery modes. Studies addressing caregivers of adolescents with a mental health diagnosis were small-scale, although suggested virtual modalities are positively received and viable alternatives to other delivery methods with potential for equivalent outcomes. Five randomized control trials involving caregivers of 'at-risk' adolescents reported improved parental knowledge, but mixed effects on family functioning. CONCLUSIONS Preliminary evidence suggests flexible online options including professional and peer support, to respond to carers' busy lives are needed to maximize benefits. Content that is sufficiently individualized and targeted to address the diverse needs of parents, as well as other caregivers, is also required. Well-being and self-care, in addition to parenting skills should be given more consideration in online interventions. Examination of the value of support from peers is also warranted.
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Affiliation(s)
- Christine Migliorini
- Psychosocial Research Centre, NorthWestern Mental Health Service, Coburg, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Carol Harvey
- Psychosocial Research Centre, NorthWestern Mental Health Service, Coburg, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
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Yim SH, Spencer L, Gordon G, Allen KL, Musiat P, Schmidt U. Views on online self-help programmes from people with eating disorders and their carers in UK. Eur J Public Health 2021; 31:i88-i93. [PMID: 34240155 PMCID: PMC8495677 DOI: 10.1093/eurpub/ckab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Digitalizing the healthcare system has been declared a priority by the UK
government. People with eating disorders (EDs), especially those with
bulimia nervosa (BN) or binge eating disorder (BED), and ED carers may
benefit from online self-help programmes, due to the shame and stigma
associated with EDs and barriers in accessing treatment, skills-training or
support. Qualitative studies are needed to explore stakeholders’
needs, attitudes to and views about online self-help, to optimize
intervention design and delivery. Methods Focus groups and telephone interviews were conducted with people with BN or
BED, and carers of people with anorexia nervosa, between March and September
2018 in the UK. Results People with EDs and carers perceived online self-help positively in the
context of barriers to seeking and accessing treatment and support, despite
some seeing it as inferior to face-to-face support. Most reported little
experience with online interventions. Participants thought the disadvantages
of online interventions could be overcome by reminders, progress summaries,
regular engagement and engaging with peers. Receiving guidance was seen as
an important functionality in the intervention by people with EDs. Conclusions People with EDs and their carers are aware of the potential benefits of
online self-help despite having little experience with this form of
intervention. A stepped-care approach that utilizes technology-based
interventions as a first step and makes such interventions available
directly to the consumer may fit the attitudes and needs of stakeholders.
The study provides a foundation for future research on design and delivery
of ED online self-help.
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Affiliation(s)
- See Heng Yim
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy Spencer
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gemma Gordon
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karina L Allen
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Musiat
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
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Nitsch M, Waldherr K, Zeiler M, Klesges L, Jacobi C. Stakeholder consultation to facilitate implementation of interventions for prevention and promotion in mental health in Europe: introducing the design of the ICare Stakeholder Survey. Eur J Public Health 2021; 31:i48-i54. [PMID: 34240158 PMCID: PMC8266536 DOI: 10.1093/eurpub/ckab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Online interventions to prevent mental health problems have proven to be effective. However, knowledge about their implementation in real-world practice as well as for dissemination to the target groups in different settings is scarce. The goal of the 'ICare' network is to establish a comprehensive model of eMental-health service delivery in and across different European countries. Since implementation and dissemination are influenced by many contextual factors, in the first phase of ICare a stakeholder survey was conducted. The survey aim was to explore stakeholders' experiences, needs and attitudes regarding Internet-based prevention of mental health problems and hindering and fostering factors for implementation and dissemination. This article is part of a supplement and describes the design of the stakeholder survey. Survey results are published in separate articles in the same supplement. METHODS Based on a literature review and the individual characteristics of the ICare interventions, stakeholder groups were identified in different settings across six European countries. The RE-AIM framework guided the development of the research questions and survey instruments. A concurrent mixed methods design was applied comprising focus groups with the intended target groups of ICare interventions, an online questionnaire with potential facilitators/delivery staff and semi-structured interviews with policy makers. CONCLUSION The challenge was to develop a design that allowed flexibility but at the same did not jeopardize the validity of the study. Implications drawn from this survey are not restricted to specific preventive interventions but will provide general information on how online mental illness prevention can be best implemented in various settings.
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Affiliation(s)
- Martina Nitsch
- Ferdinand Porsche FernFH—Distance-Learning University of Applied Sciences, Vienna, Austria
| | - Karin Waldherr
- Ferdinand Porsche FernFH—Distance-Learning University of Applied Sciences, Vienna, Austria
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lisa Klesges
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Corinna Jacobi
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
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Basedow LA, Kuitunen-Paul S, Eichler A, Roessner V, Golub Y. Diagnostic Accuracy of the Drug Use Disorder Identification Test and Its Short Form, the DUDIT-C, in German Adolescent Psychiatric Patients. Front Psychol 2021; 12:678819. [PMID: 34149570 PMCID: PMC8212997 DOI: 10.3389/fpsyg.2021.678819] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/10/2021] [Indexed: 01/07/2023] Open
Abstract
Background A common screening instrument for substance use disorders (SUDs) is the Drug Use Disorders Identification Test (DUDIT) which includes a short form regarding only drug consumption (DUDIT-C). We aim to assess if a German version of the DUDIT, adapted for adolescents, is a suitable screening instrument in a sample of adolescent psychiatric patients. Methods N = 124 (54 female) German adolescent (M = 15.6 + 1.5 years) psychiatric patients completed the DUDIT and received a diagnostic interview (MINI-KID) assessing DSM-5 SUD criteria. A confirmatory factor analysis (CFA), receiver operating characteristic (ROC) curves, the area under the curve (AUC), and Youden’s Index were calculated. Results A two-factor model of the DUDIT shows the best model fit (CFI = 0.995, SRMR = 0.055, RMSEA = 0.059, WRMR = 0.603). The DUDIT as well as the DUDIT-C show high diagnostic accuracy, with AUC = 0.95 and AUC = 0.88, respectively. For the DUDIT a cut-off value of 8.5 was optimal (sensitivity = 0.93, specificity = 0.91, J = 0.84), while for the DUDIT-C the optimal cut-off value was at 1.5 (sensitivity = 0.86, specificity = 0.84, J = 0.70). Conclusion This is the first psychometric evaluation of the DUDIT in German, adolescent psychiatric outpatients, using the DSM-5 diagnostic criteria. The DUDIT as well as the DUDIT-C are well suited for use in this population. Since in our sample only few patients presented with a mild or moderate SUD, our results need to be replicated in a sample of adolescents with mild SUD.
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Affiliation(s)
- Lukas A Basedow
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Zeiler M, Philipp J, Truttmann S, Wittek T, Franta C, Imgart H, Zanko A, Auer‐Welsbach E, Kahlenberg L, Wagner G, Karwautz A. A German version of the Caregiver Skills scale for caregivers of patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 29:257-268. [PMID: 33332684 PMCID: PMC7986839 DOI: 10.1002/erv.2817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate acceptance, reliability, convergent validity, factor structure and sensitivity to change of a German translation of the Caregiver Skills (CASK) scale measuring skills related to caring for patients with eating disorders. METHODS Two hundred and thirty-three parents (76% female) of adolescent patients (mean age 15.1) with anorexia nervosa (AN) completed the 27 items of the CASK. We calculated item/scale characteristics, internal consistencies and bivariate correlations with other measures of caregiving burden. We evaluated goodness-of-fit of the 6-factor model using confirmatory factors analysis and explored the sensitivity to change following two skills-based trainings. RESULTS The fit of the 6-factor model was acceptable (Root Mean Square Error of Approximation: 0.077, Standard Root Mean Square Residual: 0.080). Cronbach's alpha was excellent for the total (.94) and acceptable for all subscales (0.73-0.85). The total CASK score was 68.04 (max. 100) showing relatively high self-rated caregiver skills. Non-completion rates of most items were low (<3%) indicating high acceptance. Convergent validity was found with measures of psychological distress, depression, anxiety and expressed emotion. The total score significantly increased following an 8-week workshop/online skills training (d = 0.70) and a 2-day multi-family intervention (d = 0.47). DISCUSSION The German CASK version is a useful instrument to assess caregiver skills in parents of patients with AN and to evaluate outcomes of skills-based trainings.
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Affiliation(s)
- Michael Zeiler
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Julia Philipp
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Stefanie Truttmann
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Tanja Wittek
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Claudia Franta
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Hartmut Imgart
- Parkland ClinicClinic for Psychosomatic Medicine and PsychotherapyBad WildungenGermany
| | - Annika Zanko
- Parkland ClinicClinic for Psychosomatic Medicine and PsychotherapyBad WildungenGermany
| | - Ellen Auer‐Welsbach
- Department for Neurology and Psychiatry of Children and AdolescentsKlagenfurt am WörtherseeAustria
| | - Leonie Kahlenberg
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Gudrun Wagner
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Andreas Karwautz
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
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Görlich D, Faldum A. Implementing online interventions in ICare: A biostatistical perspective. Internet Interv 2019; 16:5-11. [PMID: 30775259 PMCID: PMC6364454 DOI: 10.1016/j.invent.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 11/22/2022] Open
Abstract
The implementation of research studies is a highly complex process. All decisions with respect to the study design impact the statistical analyses and interpretation of the results. Within the ICare research project (EU H2020 Grant agreement 634757) seven research trials are conducted to generate evidence on efficacy, effectiveness and the dissemination potential of online interventions targeting eating disorders, common mental health problems and resilience. Within the project a central biometrical unit was established to manage and coordinate data collection, processing and statistical data analysis. This allows for harmonized trial planning, conduct, data management processes and analysis strategies. The purpose of this article is to describe the common concepts underlying all seven ICare trials. This includes development of (adaptive sequential) study designs, handling of missing values, general data management and processing as well as data protection aspects.
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Affiliation(s)
- Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institute of Biostatistics and Clinical Research, Schmeddingstraße 56, D-48149 Münster, Germany
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