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Table 15 Good Practice Points to Consider for Virtual Care

From: 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

Practical/Technical Issues: Practitioner and patient preference, experience level, and organizational capacity should be considered when choosing a virtual platform, but reliable, secure video-call platforms should be favoured over the use of audio calls (e.g. to conduct a visual assessment of a patient). Prior to commencing online sessions, clinicians should prepare and share with patients a written plan detailing what to do in the event of technological failure (e.g. who should first attempt to re-establish a lost connection, when to attempt alternate technologies, how long to wait before presuming that a connection cannot be re-established).
Inclusivity: Virtual delivery poses a potential barrier to care for those without home internet access, or an electronic device, so alternatives such as books and workbooks for patients and caregivers should be encouraged where necessary. Language, sight/hearing impairment, and technological experience should also be considered (e.g. involving an interpreter in the care of non-English speaking individuals).
Confidentiality: Lack of privacy in homes may impact patient engagement in virtual therapy; headphones or establishing a ‘time-out signal’ can help to increase the level of privacy during sessions. End-to-end encryption should be prioritized, and passwords should be used regularly. Clinicians should inform patients of the measures being taken to protect their privacy and security.
Managing Medical and Psychological Safeguarding Risks: Clinicians providing virtual care must continue to practice within the jurisdiction in which they are licensed and according to their insurance coverage for malpractice. Crisis management plans should be available for every patient involved in virtual treatment. These plans can include patient-specific local resources (e.g. crisis lines, hospitals, emergency services). Clinicians must be able to coordinate care with local crisis resources if they are required (e.g. in case of high suicidality risk) and should be familiar with local mental health laws in responding to crises obligations (e.g. duty to call child protective services, when to call police). Creating a network with local providers may also be beneficial in the case of an emergency. Clinicians should also determine if the family context and home environment are considered safe and non-triggering for virtual contacts.
Managing Intensity, Difficult Family Dynamics, or Overwhelming Emotions: Clinicians should be vigilant to any violence or maltreatment that may be occurring in the family home. Follow-up with participants of virtual sessions that become highly intense, and when necessary, referral to additional health resources, is encouraged.
Length of Sessions: Duration of sessions may need to be changed, depending on the patient (e.g. briefer sessions may be more effective for younger patients/siblings with shorter attention spans).
Cultural and Socio-Economic Factors: The needs of equity-seeking groups should be acknowledged before and during treatment and reducing barriers to care should be of high priority. Clinicians and patients engaging in virtual therapy from their respective homes may result in feelings of blurred boundaries. To counteract this, participants should be encouraged to create a particular space in the home for virtual care. Involvement of parents should be explicitly discussed, as it is important to devise a plan outlining how family members will be involved (e.g. reserving time, being present when needed, and clarifying roles in treatment).