Abstract
BackgroundFamily-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth. Adapting FBT may facilitate “scale-out” for Medicaid-insured youth served in publicly-funded settings and potentially improve outcomes for more diverse populations.MethodsThis mixed methods effectiveness-implementation Hybrid Type 3 pilot study protocol included a planning period in collaboration with the San Francisco Department of Public Health, culminating in a two-day in-person FBT training for 25 therapists in the county, followed by the opportunity to engage in one year of weekly supervision. The training incorporated FBT adaptations intended to improve fit for low-income families within community-based settings. Treatment appropriateness and acceptability will be measured immediately post-training. Following the training, cases referred for FBT will only be assigned to the trained clinicians who voluntarily opted into long-term group supervision. Clinicians treating at least one FBT case during the supervision period will report on implementation, adaptations, and patient weight gain. Finally, semi-structured interviews with clinician participants will be conducted, focused on implementation challenges and facilitators, local treatment adaptations, and overall satisfaction with FBT.DiscussionLearning about clinician adaptations will advance knowledge about treatment of eating disorders in publicly-funded community clinics, which serve a racially/ethnically and socioeconomically diverse group of youth. This project is designed to accelerate FBT implementation in publicly-funded mental health systems, and inform service improvements for underserved youth with eating disorders.
Highlights
Family-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth
Implementation science can improve the uptake of effective treatments into routine clinical settings [3]
Preliminary outcome data will be presented. This hybrid protocol is designed to “scale out” standard FBT—adapting training and the intervention itself for clinicians in publiclyfunded community settings working with more diverse service populations, with the ultimate goal of increasing access to acceptable and appropriate evidence-based eating disorder treatment for underserved youth
Summary
Family-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth. Despite a number of evidence-based psychosocial treatments for mental health disorders, implementation is lagging, with a delay of 17 years for treatments to move from research to community-based settings. Disadvantaged youth have poor access to evidence-based treatments, and their implementation is more complex because these treatments are often not tested with low-income, racially/ethnically diverse patients served in the public sector [4]. Implementation science approaches have been applied infrequently to youth with lower base rate disorders, including those with eating disorders. Youth with eating disorders do not typically receive evidence-based treatment [13], leaving them more vulnerable to hospitalization
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