Moving online: young people and parents’ experiences of adolescent eating disorder day programme treatment during the COVID-19 pandemic

Abstract

Background This study examined the experiences of young people and their parents who attended an intensive day treatment programme for eating disorders online during the global COVID-19 pandemic. Methods Online questionnaires were completed by 14 adolescents (12–18 years) and their parents (n = 19). The questionnaires included a mixture of rating questions (Likert scale) and free text responses. Free text responses were analysed using reflexive thematic analysis. Results Three main themes were identified: 1) New discoveries, 2) Lost in translation and 3) The best of a bad situation. This study provides insight into the benefits and pitfalls of online treatment delivery in the adolescent day programme context, which has rapidly had to become part of the everyday therapeutic practice. Results indicate that there are advantages and disadvantages to this, and that parents and young people’s views differed. Conclusions This study suggests that the increased accessibility provided by online working does not necessarily translate to increased connection. Given the importance of therapeutic alliance in treatment outcomes, this will be an important consideration for future developments of online intensive treatments.

A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

“…Nine studies gathered data on patient perceptions of treatment during the pandemic period (Brothwood et al, 2021 ; Fernandez‐Aranda et al, 2020 ; Lewis et al, 2021 ; Raykos et al, 2021 ; Schlegl, Maier, et al, 2020 ; Schlegl, Meule, et al, 2020 ; Spigel et al, 2021 ; Stewart et al, 2021 ; Termorshuizen et al, 2020 ). Five studies (55%) found that a sizeable percentage of participants (28–74%) reported that the pandemic had significantly disrupted or negatively impacted their treatment (Lewis et al, 2021 ; Schlegl, Maier, et al, 2020 ; Schlegl, Meule, et al, 2020 ; Spigel et al, 2021 ; Termorshuizen et al, 2020 ).…”

“…For studies assessing treatment experiences and outcomes, evidence was similarly limited, inconsistent, and based on small sample sizes. While studies showed that some patients were accepting of being transferred from face‐to‐face to telehealth treatment modalities (Raykos et al, 2021 ; Stewart et al, 2021 ), others showed that many patients reported dissatisfaction with online treatment services and a desire to return to traditional delivery modes as soon as possible (Brothwood et al, 2021 ; Lewis et al, 2021 ). Despite this dissatisfaction, three uncontrolled pilot studies showed large symptom improvement following the forced transition to online treatment (Levinson et al, 2021 ; Plumley et al, 2021 ; Raykos et al, 2021 ).…”

Is this the ‘new normal’? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic

“…All clinicians were qualified family therapists, psychiatrists, nurse therapists or clinical psychologists with training and experience in treating eating disorders. The young person and parent experience of moving day programme treatment to virtual working in the same service is presented elsewhere [ 18 ].…”

“…Overall, the literature suggests that patients were willing to undertake virtual therapy and recounted largely positive experiences with their eating disorder treatment [ 1 , 17 , 18 ]. Some studies further suggested unforeseen benefits of the adapted method of working, such as a greater level of familial involvement in treatment [ 18 , 19 ] and advocated for its use beyond the pandemic to facilitate greater access for individuals in rural areas [ 20 ]. In one UK based CEDS-CYP, treatment satisfaction was higher for young people ( n = 12) and parents/carers ( n = 19) compared to clinicians ( n = 12), regarding online working during the pandemic [ 1 ].…”

Review of Ireland’s First Year of the COVID-19 Pandemic Impact on People Affected by Eating Disorders: ‘Behind Every Screen There Was a Family Supporting a Person with an Eating Disorder’

“…Carers reported noticing that their family member who is unwell is withdrawn, irritable, depressive and engages in restrictive eating. The Maudsley Centre for Child and Adolescent Eating Disorders, which transitioned to online treatment delivery during COVID-19, found that parents (n = 19) generally felt more comfortable than young people (n = 14) in online groups and they tended to feel more positive about the online format overall [51]. In Israel, home-based online treatment during the pandemic brought mixed experiences, including patients' reluctance to take part, a lack of access to technological devices, the impact of family and religious circumstances, whilst conversely, the virtual option was more positive for some patients and their parents [52].…”