TABLE 1.

Common TeleHealth family‐based treatment (FBT) challenges and solutions

TeleHealth FBT consideration	Challenge	Solution
Medical monitoring	No eyes on patient	Regular coordination with medical providers through various methods such as secure messaging, encrypted email, phone calls, faxes, and use of patient's electronic medical record
Obtaining session weights	Patient not physically present in office for weighing	Patient weigh at home Parents weigh patient Therapist joins patient virtually for weighing Weights obtained at medical providers
	Scale at home	Provide psychoeducation to parents/patient about weighing Recommend parents limit scale access
	Accuracy of home weights	Focus on changes session‐to‐session, not exact weights
Patient one‐on‐one check‐in	Privacy	Confirm patient privacy Patient takes device to private space inside home or outside Use of headphones, fans, or “white noise” machine
	Family re‐join session	Ask patient to re‐join family Set a time with family members to re‐join Use a “waiting room” feature, which is particularly helpful for blended or divorced families using multiple devices and screens
Rapport building	Displaying warmth and positive regard at a distance	Use visuals in home environment to connect with patient Exaggerate facial cues Greater reliance on verbal communication as opposed to subtle body language cues Look at the camera rather than the screen to promote “eye contact”
Communicating FBT expectations	Family involvement Therapy in the home environment	Require participation from all family members Set clear expectations about participation Address family members by name when asking direct questions Limit distractions in the home environment whenever possible Ask family members to arrange themselves in a circle or semi‐circle rather than a straight line to promote greater communication among family members
Setting the intense scene	Impact of intense scene may be muted when delivered at a distance	Greater use of verbal communication than body language Use intonation and cadence of voice to communicate severity Grave and concerned facial expressions; may need to be intensified to communicate over video Hold emotional tenure of session regardless of distractions within family home Strategic use of silence, given expectations to talk when on screen
Family meal	Difficulty seeing the meal over video	Work with family members to position camera appropriately to maximize visualization of the meal and patient eating Ask more clarifying questions about food served and eaten Ask for explicit descriptions of the meal
	Empower parents in re‐nourishment efforts	Reframe as opportunity to practice re‐nourishment efforts within the home context Discuss changes of where family members sit during mealtimes before and after the eating disorder Access to additional food and supplies at home Impact of family pets may be addressed
Managing in‐session behaviors	Patient leaves session	Continue session, as long as safety concerns are adequately addressed Manage as if behaviors occurred in office setting (e.g., support parent management of behaviors without telling them what to do) Ask patient to rejoin session when ready
	Patient refuses to be on video	Ask patient to join by voice until ready
	Patient disconnects video session	Have family contact information handy for all video sessions Attempt to re‐connect with family Establish back‐up method of communicating (e.g., call on another device, phone call to help family problem‐solve and re‐start video session)