A primary care modification of family-based treatment for adolescent restrictive eating disorders

Lebow, Jocelyn; O’Brien, Jennifer; Mattke, Angela; Narr, Cassandra; Geske, Jennifer R.; Billings, Marcie; Clark, Matthew M.; Jacobson, Robert M.; Phelan, Seán; Grange, Daniel Le; Sim, Leslie

doi:10.1080/10640266.2019.1656468

Cited by 14 publications

(10 citation statements)

References 29 publications

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“…By focusing on key element in the family therapy model we also hope to make it easier to implement. This has been tested in a primary care setting in a study where it seems to be a feasible way (10).…”

Section: Aim Of the Studymentioning

confidence: 99%

Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care

Wallin¹,

Saha

2020

Front. Psychiatry

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Background: Restrictive eating disorders with pronounced starvation are serious psychiatric conditions that often begin during childhood or adolescence. An early and efficient intervention is crucial to minimize the risk of the illness becoming longstanding and to limit the consequences. There is good evidence that weight gain during the first month of treatment provides a better prognosis. Only a limited amount of young people suffering from severe restrictive eating disorder receive an evidence-based treatment at present in Sweden. The ROCKETLAUNCH project intends to implement key components of the evidence-based family therapy during the first month of treatment in child and adolescent psychiatric outpatient care.Methods: From the southern part of Sweden, 12 local child and adolescent psychiatric outpatient services will take part. All patients with a restrictive eating disorder and pronounced starvation together with their families will be asked to take part in the study. We expect that one hundred 50 patients will be assessed every year. The patients and their families will receive 1 month of intense manualized treatment. Body weight, days in inpatient care, eating disorder, and other psychopathology-related symptoms, will be evaluated after one month and at 12-month follow-up. Economic evaluation of ROCKETLAUNCH will also be carried out alongside the intervention. At each outpatient clinic, data from the 10 previous patients will be gathered to compare the treatment provided at ROCKETLAUNCH with the standard treatment in Sweden.Discussion: We expect that by implementing the key components of the evidence-based family therapy during the first month of treatment, the prognosis of young newly diagnosed patients with severe restrictive eating disorders, primarily anorexia nervosa will improve, which, in turn, will reduce the need for psychiatric inpatient care.

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Section: Aim Of the Studymentioning

confidence: 99%

Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care

Wallin¹,

Saha

2020

Front. Psychiatry

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“…FBT-PC maintains core principles of FBT including emphasizing weight restoration, supporting caregivers to implement meal monitoring, separating the illness from the adolescent, and reducing caregiver and adolescent guilt and blame. A study examining the feasibility of FBT-PC for 15 patients who received this adaptation found a significant increase in BMI and comparable levels of retention (86.7%) at 3 months to treatment studies of standard FBT [22].…”

Section: Introductionmentioning

confidence: 91%

“…In light of the primary care setting's potential to enhance access to evidence-based treatment, our team developed a modification of FBT, Family-Based Treatment for Primary Care (FBT-PC), for delivery in primary care by primary care providers (pediatric and family physicians, nurse practitioners, and physician's assistants) [22]. While we preserved the main principles of FBT, we modified several aspects to improve its feasibility for delivery by primary care providers [22]. Precedent has been established for the majority of these adaptations in another modification of FBT, Parent-Focused Treatment, which has comparable efficacy to standard FBT [4].…”

Section: Introductionmentioning

confidence: 99%

Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study

et al. 2021

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Background Family-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. However, access to this treatment is limited. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices. Methods This retrospective clinical cohort study evaluated 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. We examined improvement in BMI percentile, reduction in weight suppression, and clinical benchmarks of eating disorder recovery including weight restoration to > 95% of expected body weight (EBW) and resolution of DSM-5 criteria for eating disorders. Results In both groups, effect sizes for increased BMI percentile exceeded Cohen’s convention for a large effect (FBT-PC: d = .94; standard FBT: d = 1.15) as did effect sizes for reduction in weight suppression (FBT-PC: d = 1.83; standard FBT: d = 1.21). At the end of treatment, 80% of the FBT-PC cohort and 87% in the standard FBT group achieved > 95%EBW and 67% in the FBT-PC group and 60% in the standard FBT group no longer met DSM-5 criteria for an eating disorder. There were no cohort differences in the number of treatment drop-outs or referrals to a more intensive level of eating disorder treatment. Conclusions Findings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these results, more rigorous testing of the FBT-PC model is warranted.

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“…Of the 27 families who completed 12-month follow-up measures, weight gain was significantly higher in the intervention group, although risk profile was no different between groups. Another study was found which examined the use of modified FBT in a primary care setting (19). This study described the treatment of 15 adolescents with low-weight and/or restrictive eating disorders with a mean weight loss of 11.6 kg.…”

Section: Introductionmentioning

confidence: 99%

“…Patients received a mean of 9.2 sessions over 3 months. At the end of the study patients had gained an average of 6.76 kg and demonstrated a significant increase in their BMI percentile (19). Thus, these and other strategies for early treatment of EDs are actively being studied, yet to date there remains no evidence-based treatment guidelines for early intervention in adolescent EDs.…”

Section: Introductionmentioning

confidence: 99%

A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series

et al. 2020

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Background: Family-based treatment (FBT), an outpatient treatment which is typically offered for 6-12 months by specially trained therapists, is currently the first line treatment for adolescent anorexia nervosa and bulimia nervosa. The success of FBT for adolescents with moderate to severe eating disorders indicates a potential use for a short course of modified FBT which could be offered as an early intervention by nonspecialized community mental health counselors to adolescents with mild or subsyndromal eating disorders. Methods: In 2016, seven adolescents with mild eating disorders underwent a brief intervention in the form of five FBT-inspired therapy sessions (called 'DREAMS' sessions). The DREAMS sessions consisted of five replicable family sessions given over 6 weeks, each with a specific area of focus for treatment, such as nutrition and eating disorder symptoms, mood, relationships and anxiety. Charts of these seven patients were reviewed in 2019 to determine whether this treatment might be worthy of further study. Results: Based on a review of the progress notes, all seven patients reported an improvement in intake, a decrease in ED symptoms and an improvement in mood by the end of the sessions. All seven families reported that the sessions had been beneficial. Conclusion: Early intervention is recommended for adolescents who present in the early stages of an eating disorder, yet there are no guidelines to recommend which treatment should be offered to this population. Further research is required to determine whether a short course of modified FBT, such as these five FBT-inspired 'DREAMS' sessions, may be an effective intervention to offer to youth who present with mild eating disorders.

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A primary care modification of family-based treatment for adolescent restrictive eating disorders

Cited by 14 publications

References 29 publications

Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care

Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care

Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study

A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series

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