Is this the \u2018new normal\u2019? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic

Catherine Stewart,Anna Konstantellou,Rachel Bryant-Waugh,Julian Baudinet,Fatema Kassamali,Darren Cutinha,Mima Simic,Ivan Eisler,Natalie Mclaughlin

doi:10.1186/s40337-021-00429-1

Catherine Stewart, Anna Konstantellou + Show 7 more

Open Access

https://doi.org/10.1186/s40337-021-00429-1

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Abstract

IntroductionPrior to the COVID-19 pandemic, research in virtual care for young people with eating disorders was preliminary and implementation rare. This study explored the experience of young people, parents and clinicians when therapy was transitioned to virtual provision as a result of the UK lockdown in March 2020.MethodsA mixed-method approach was used in this study. Online questionnaires that included a mixture of rating (Likert scale) and free-text response questions were completed by 53 young people with any eating disorder, 75 parents and 23 clinicians. Questions focused on the experience of online treatment as well as the impact on engagement, perceived treatment efficacy and preferences around treatment mode in the future. Likert scale questions were analysed using a summary approach. Free-text responses were analysed qualitatively using reflexive thematic analysis.ResultsResponses to rating scale questions indicate satisfaction with treatment, good engagement and ability to manage technology. Young people who had transitioned care, rather than started care virtually in lockdown, rated therapy as less effective. However, individual accounts of experience were more varied. Reflexive thematic analysis of free-text responses identified key themes of 1) Making it work, 2) Home as a therapeutic space, and 3) Disrupted connection and 4) Into the future.ConclusionsThese results have implications for ongoing care during the pandemic and for future implementation of virtual care in the treatment of young people with eating disorders. Particular issues arising are the trade-off between accessibility and therapeutic engagement and depth and need for consideration of equal access to treatment in socially unequal societies.

Highlights

Prior to the COVID-19 pandemic, research in virtual care for young people with eating disorders was preliminary and implementation rare
This study looked at what that was like for the young people, their parents and clinicians engaged in treatment in a large specialist eating disorder service in London, UK
Particular issues arising are the trade-off between accessibility and the potential impact on the therapeutic relationship

Summary

Introduction

Prior to the COVID-19 pandemic, research in virtual care for young people with eating disorders was preliminary and implementation rare. Research conducted prior to the pandemic suggests that online psychological interventions can achieve satisfactory feasibility, acceptability and treatment outcomes for young people with restrictive eating disorders [9], albeit with very small sample sizes and in the context of expanding opt-in care to rural or remote areas in North America. This is clearly markedly different to an enforced pivot to virtual care during a pandemic in the UK, where access to Community Eating Disorders Services for Children and Young People (CEDS-CYP) has been a focus of nationwide development in recent years [10]

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