Implementation Of Family-based Treatment Research Articles

Adaptation of family-based treatment within an inpatient medical stabilization program for children with eating disorders.

Eating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family-based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting. The present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting. The use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed. Though anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings. This article describes how a children's hospital has adopted family-based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings.

Introduction of family-based treatment to Japan with adaptations to optimize the cultural acceptability and advance current traditional treatments of adolescent anorexia nervosa.

Given the lack of clear consensus on effective treatment models for adolescent anorexia nervosa in Japan, treatment programs offered to this population vary widely between treatment facilities with limited testing of outcomes. Importantly, families have traditionally been left out of the core treatment process, as they are commonly viewed as being powerless in renourishing their child. The purpose of this commentary was to report the authors' preliminary efforts to introduce and implement family-based treatment (FBT) in Japan so that, on par with international standards of practice, FBT may become the first-line treatment option for Japanese families. This commentary will describe the systemic and cultural barriers which posed as challenges in introducing FBT to Japan in its manualized standard format and how these were addressed by introducing FBT during the patient's hospital admission and by assigning the father with a role which resembles the traditional gender role within the Japanese family culture. Authors have thus far observed that these adaptations led to increased accessibility of FBT and improved outcomes such as reduced number of hospitalizations and shorter time taken to reach 85-90% EBW. Further considerations for the broad dissemination and implementation of FBT in Japan are also presented.

Family-based treatment: Where are we and where should we be going to improve recovery in child and adolescent eating disorders.

Family therapy has long been advocated as an effective intervention for eating disorders. A specific form of family therapy, one that utilizes family resources, has proven especially effective for adolescents with anorexia or bulimia nervosa (AN and BN). First developed in London, a behaviorally focused adaptation, called family-based treatment (FBT), has been manualized and systematically studied in six randomized clinical trials for adolescent AN and two for adolescent BN. This Commentary focuses on manualized FBT; what we know, what we do not know (yet), and what we hope for. We do know that efficacy data for FBT, especially adolescent AN, are quite robust, even though remission rates remain elusive for more than half of all cases. While preliminary, moderators of FBT for adolescent AN have been identified and could aid us in determining the most (or least) responsive patient groups. And weight gain (∼2.5kg) by week four has been confirmed as an early predictor of remission at end-of-treatment. What we do not know, yet, is whether specific adaptations to manualized FBT will confer improved remission rates. Finally, and in terms of what is hoped for, we highlight the promise of improved access, dissemination, and implementation of FBT.

Themes arising during implementation consultation with teams applying family-based treatment: a qualitative study

BackgroundThis study describes themes arising during implementation consultation with teams providing Family-Based Treatment (FBT) to adolescents with eating disorders.MethodsParticipants were implementation teams (one lead therapist, one medical practitioner and one administrator) at four sites. These teams agreed to support the implementation of FBT, and participated in monthly consultation calls which were audio-recorded, transcribed verbatim and coded for themes. Twenty percent of the transcripts were double-coded to ensure consistency. Fundamental qualitative description guided the sampling and data collection.ResultsTwenty-five (average per site = 6) transcripts were coded using thematic content analysis. Six major themes emerged: 1) system barriers and facilitators 2) the role of the medical practitioner, 3) research implementation, 4) appropriate cases, 5) communication, and 6) program impact.ConclusionsImplementation themes aligned with previous research examining the adoption of FBT, and provide additional insight for clinical programs seeking to implement FBT, emphasizing the importance of role clarity, and team communication.

Family-based treatment of eating disorders in adolescents: current insights.

Eating disorders are serious illnesses associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention for adolescents with anorexia nervosa, and preliminary evidence suggests that it may be efficacious in the treatment of adolescents with bulimia nervosa. Multifamily therapy for anorexia nervosa provides a more intensive experience for families needing additional support. This review outlines the three phases of treatment, key tenets of family-based treatment, and empirical support for FBT. In addition, FBT in higher levels of care is described, as well as challenges in the implementation of FBT and recent adaptations to FBT, including offering additional support to eating-disorder caregivers. Future research is needed to identify families for whom FBT does not work, determine adaptations to FBT that may increase its efficacy, develop ways to improve treatment adherence among clinicians, and find ways to support caregivers better during treatment.

What difference does FBT make? Results of a service audit following the implementation of FBT

Manualised Family Based Treatment (FBT) is considered the best evidenced treatment for adolescents with Anorexia Nervosa. However, the replication of outcome data from research trials into treatment in a general clinical setting can be a challenge. Following on from the presentation entitled 'Overcoming challenges of implementation of FBT at the Regional Eating Disorders Service (REDS) in Auckland, New Zealand', the results of the implementation of the delivery of FBT at Auckland's Regional Eating Disorders Service (REDS) are presented. Results are based on a clinical audit of treatment outcomes in the year preceding the implementation of FBT. Data will be presented of the period of 18 months while FBT was established, and the 6 months afterwards. A comparison of these different periods will be made with respect to weight recovery and psychometrics as well as effects on length of admission and re-admission rate to the paediatric hospital. This abstract was presented in the Service Initiatives: Child and Adolescent Refeeding and FBT stream of the 2014 ANZAED Conference.