Browsing by Author "Brouwers, Melissa"

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    A study protocol for implementing Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders
    (2024-01-05) Couturier, Jennifer L.; Kimber, Melissa; Ford, Catherine; Coelho, Jennifer S.; Dimitropoulos, Gina; Kurji, Ayisha; Boman, Jonathan; Isserlin, Leanna; Bond, Jason; Soroka, Chelsea; Dominic, Anna; Boachie, Ahmed; McVey, Gail; Norris, Mark; Obeid, Nicole; Pilon, David; Spettigue, Wendy; Findlay, Sheri; Geller, Josie; Grewal, Seena; Gusella, Joanne; Jericho, Monique; Johnson, Natasha; Katzman, Debra; Chan, Natalie; Grande, Chloe; Nicula, Maria; Clause-Walford, Drew; Leclerc, Anick; Loewen, Rachel; Loewen, Techiya; Steinegger, Cathleen; Waite, Elizabeth; Webb, Cheryl; Brouwers, Melissa
    Abstract 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.
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    Canadian practice guidelines for the treatment of children and adolescents with eating disorders
    (2020-02-01) Couturier, Jennifer; Isserlin, Leanna; Norris, Mark; Spettigue, Wendy; Brouwers, Melissa; Kimber, Melissa; McVey, Gail; Webb, Cheryl; Findlay, Sheri; Bhatnagar, Neera; Snelgrove, Natasha; Ritsma, Amanda; Preskow, Wendy; Miller, Catherine; Coelho, Jennifer; Boachie, Ahmed; Steinegger, Cathleen; Loewen, Rachel; Loewen, Techiya; Waite, Elizabeth; Ford, Catherine; Bourret, Kerry; Gusella, Joanne; Geller, Josie; LaFrance, Adele; LeClerc, Anick; Scarborough, Jennifer; Grewal, Seena; Jericho, Monique; Dimitropoulos, Gina; Pilon, David
    Abstract Objectives Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. Methods Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. Results Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. Conclusions Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
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    Screening for depression in children and adolescents in primary care or non-mental health settings: a systematic review update
    (2024-01-31) Beck, Andrew; Dryburgh, Nicole; Bennett, Alexandria; Shaver, Nicole; Esmaeilisaraji, Leila; Skidmore, Becky; Patten, Scott; Bragg, Heather; Colman, Ian; Goldfield, Gary S.; Nicholls, Stuart G.; Pajer, Kathleen; Meeder, Robert; Vasa, Priya; Shea, Beverley J.; Brouwers, Melissa; Little, Julian; Moher, David
    Abstract Background The transition from childhood to adolescence is associated with an increase in rates of some psychiatric disorders, including major depressive disorder, a debilitating mood disorder. The aim of this systematic review is to update the evidence on the benefits and harms of screening for depression in primary care and non-mental health clinic settings among children and adolescents. Methods This review is an update of a previous systematic review, for which the last search was conducted in 2017. We searched Ovid MEDLINE® ALL, Embase Classic+Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and CINAHL on November 4, 2019, and updated on February 19, 2021. If no randomized controlled trials were found, we planned to conduct an additional search for non-randomized trials with a comparator group. For non-randomized trials, we applied a non-randomized controlled trial filter and searched the same databases except for Cochrane Central Register of Controlled Trials from January 2015 to February 2021. We also conducted a targeted search of the gray literature for unpublished documents. Title and abstract, and full-text screening were completed independently by pairs of reviewers. Results In this review update, we were unable to find any randomized controlled studies that satisfied our eligibility criteria and evaluated the potential benefits and harms of screening for depression in children and adolescents. Additionally, a search for non-randomized trials yielded no studies that met the inclusion criteria. Conclusions The findings of this review indicate a lack of available evidence regarding the potential benefits and harms of screening for depression in children and adolescents. This absence of evidence emphasizes the necessity for well-conducted clinical trials to evaluate the effectiveness of depression screening among children and adolescents in primary care and non-mental health clinic settings. Systematic review registration PROSPERO CRD42020150373 .
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    The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond
    (2021-04-16) Couturier, Jennifer; Pellegrini, Danielle; Miller, Catherine; Bhatnagar, Neera; Boachie, Ahmed; Bourret, Kerry; Brouwers, Melissa; Coelho, Jennifer S; Dimitropoulos, Gina; Findlay, Sheri; Ford, Catherine; Geller, Josie; Grewal, Seena; Gusella, Joanne; Isserlin, Leanna; Jericho, Monique; Johnson, Natasha; Katzman, Debra K; Kimber, Melissa; Lafrance, Adele; Leclerc, Anick; Loewen, Rachel; Loewen, Techiya; McVey, Gail; Norris, Mark; Pilon, David; Preskow, Wendy; Spettigue, Wendy; Steinegger, Cathleen; Waite, Elizabeth; Webb, Cheryl
    Abstract 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.