Browsing by Author "Geller, Josie"
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Item Open Access A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol(2023-01-23) Ball, Geoff D. C.; O’Neill, Marcus G.; Noor, Rafat; Alberga, Angela; Azar, Rima; Buchholz, Annick; Enright, Michelle; Geller, Josie; Ho, Josephine; Holt, Nicholas L.; Lebel, Tracy; Rosychuk, Rhonda J.; Tarride, Jean-Eric; Zenlea, IanAbstract Background Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families’ access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children’s and caregivers’ acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. Methods In our 2.5-year study, 108 6–17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families’ barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. Discussion Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. Trial registration This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).Item Open Access 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, MelissaAbstract 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.Item Open Access 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, DavidAbstract 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.Item Open Access Responsiveness of the Eating Disorders Quality of Life Scale (EDQLS) in a longitudinal multi-site sample(BioMed Central, 2010-08-11) Adair, Carol E.; Marcoux, Gisele C.; Bischoff, Theanna F.; Cram, Brian S.; Ewashen, Carol J.; Pinzon, Jorge; Gusella, Joanne L.; Geller, Josie; Scattolon, Yvette; Fergusson, Patricia; Styles, Lisa; Brown, Krista E.Item Open Access 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, CherylAbstract 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.Item Open Access The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: study protocol(2017-04-11) Ball, Geoff D C; Spence, Nicholas D; Browne, Nadia E; O’Connor, Kathleen; Srikameswaran, Suja; Zelichowska, Joanna; Ho, Josephine; Gokiert, Rebecca; Mâsse, Louise C; Carson, Valerie; Morrison, Katherine M; Kuk, Jennifer L; Holt, Nicholas L; Kebbe, Maryam; Gehring, Nicole D; Cesar, Melody; Virtanen, Heidi; Geller, JosieAbstract Background Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth. Methods From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13–17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children’s hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined. Discussion As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families’ needs.