Home treatment as an add‐on to family‐based treatment in adolescents with anorexia nervosa: A pilot study

Abstract

Objective: This pilot study examines the feasibility and the effectiveness of add-on home treatment (HT) to family-based treatment (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialised nurses and aims at supporting patients and parents to re-establish family meals in the home environment. Method:We performed a 3-month study in AN patients with a waiting-list control design comparing 45 (43 females, 2 males) adolescents receiving FBT augmented with HT compared to 22 (21 females, 1 male) participants receiving FBT alone on the waiting list for additional HT. Eating disorder diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI-2) and clinical parameters (BMI, menstrual status, level of over-exercising) at baseline and after 3 months. Results: After 3 months of treatment, both treatment groups showed a significant early weight gain, a reduction in the rate of AN diagnoses assessed with the EDE interview and a reduction in EDI-2 total scores. The combined HT/FBT group showed a significantly greater increase in BMI than the FBTonly group. In the combined HT/FBT group, none of the patients had to be admitted to hospital, while three (13.6%) of the FBT-only group had to be referred to inpatient treatment. Discussion: Our results suggest that HT augmented FBT might be useful compared to FBT alone in terms of early weight gain and might reduce the risk of hospital admission in adolescent AN.

Home treatment as an add-on to family-based treatment for adolescents with anorexia nervosa compared with standard family-based treatment and home-based stress reduction training: study protocol for a randomized clinical trial

“…This study protocol builds on the hypothesis of FBT-HT functioning as a well-accepted and effective supplement to FBT [ 9 , 17 , 30 ]. By comparing FBT-HT to both standard outpatient FBT and FBT-MBSR, we can examine the extent to which the different treatment approaches differentially affect treatment outcomes as measured by (1) a change in BMI, (2) eating disorder psychopathology and (3) interfamilial stress experience and communication.…”

“…Outreach services generally offer greater flexibility in terms of time and location, enabling the support of family structures in their ordinary environment, which minimizes the burden on all family members [ 6 ]. Such services are generally used to intensify treatment during a severe course of illness [ 24 ] and, in treatment for eating disorders, to prevent inpatient hospital admissions [ 30 ]. Transferring treatment strategies to the home setting is the key challenge to achieving sustained symptom reversal and long-term success in childhood and adolescent mental health treatment [ 36 ].…”

“…Transferring treatment strategies to the home setting is the key challenge to achieving sustained symptom reversal and long-term success in childhood and adolescent mental health treatment [ 36 ]. Specifically for adolescents with eating disorders, incorporating home treatment (HT) has been shown to be feasible and acceptable [ 9 , 17 ], with a significant increase in treatment effects [ 30 ]. FBT is particularly well suited as a supplement to HT because the specific eating situations observed in FBT as possible maintaining factors [ 10 ] require effective management in the home setting.…”

Involuntary Treatment for Child and Adolescent Anorexia Nervosa—A Narrative Review and Possible Advances to Move Away from Coercion

“…In recent years, specific home treatment programs have been developed in the field of child and adolescent AN [71,[78][79][80][81]. These programs either aim at preventing hospitalization (augmented outpatient interventions) [78][79][80][81][82] or at shortening hospital stays (stepped-care interventions) [71].…”

“…In recent years, specific home treatment programs have been developed in the field of child and adolescent AN [71,[78][79][80][81]. These programs either aim at preventing hospitalization (augmented outpatient interventions) [78][79][80][81][82] or at shortening hospital stays (stepped-care interventions) [71]. Focusing on preventing (in)voluntary hospital admissions, different research groups around the world are aiming to improve the existing outpatient approach and develop home treatment programs as supportive add-ons to outpatient FBT [77][78][79][80][81][82].…”