Table 1 Adaptations to family-based treatment (FBT) for virtual delivery
Component of FBT | What is the adaptation? | Why was the adaptation made? | Was the adaptation planned or unplanned? | What are the implications for fidelity? |
|---|---|---|---|---|
Weighing | Therapist weighs patient virtually with patient at home instead of in clinic (home scale is required). | Patient is unable to come into the clinic for in-person visits. | Planned (proactive adaptation). | The patient’s weight is captured as intended. The process of weighing is maintained. |
Time spent alone with adolescent | Parents are asked to leave the room for the first 10 min of the session so that individual time can be spent between the adolescent and therapist. | In a clinic setting, the adolescent is taken from the waiting room. In virtual therapy, family members often come on screen together, so parents must be asked gently and respectfully to leave. | Planned (proactive adaptation). | Time spent alone with adolescent is maintained. |
Sharing the weight graph | Therapist plots the weight graph and shares it over the screen by holding up the sheet of paper. Weight graph is reviewed together virtually. The graph could also be plotted electronically by therapist and they could use the “share screen” feature. | Usually the graph is easily shared in person. Virtually, it can be difficult for the family to see the graph on paper; therefore, using the “share screen” feature can be helpful. | Planned (proactive adaptation). | The weight graph is shared and reviewed as intended. |
Family meal | Family meal (observed by the therapist) is completed virtually, with the ability of parents to gather additional food items if needed (since they are in their own homes). | When done in person, the option of additional food items is limited. With the family at home they have many more options available to them. | Planned (proactive adaptation). | Family meal is conducted as intended. |
Therapeutic principles | All sessions are to be completed virtually and with the same principles as in-person treatment with emphasis on externalization and agnosticism. Externalization can be depicted by drawing on the “white board” feature of the virtual platform. | Drawing on a white board or piece of paper is typically done in clinic to depict externalization. This can be done on some platforms with the “white board” and/or share screen feature. | Planned (proactive adaption). | Therapeutic principles are maintained in virtual delivery. |