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Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model

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Katie Richards, Michaela Flynn, Amelia Austin, Katie Lang, Karina Allen, Ranjeet Bassi, Danielle Glennon, Nina Grant, Ulrike Schmidt

Original languageEnglish
Article numbere98
JournalBJPsych Open
Issue number3
Accepted/In press7 Apr 2021
Published7 May 2021

Bibliographical note

Funding Information: This work was supported by the Shine and Scaling Up Improvement Award from the Health Foundation (GIFTS 7294/CRM 1216). K.L.R. is supported by a PhD studentship from the Health Foundation. Both A.A. and M.F. are funded by King's College London International Postgraduate Research Scholarships. K.L.A. received support through an NHS Innovation Accelerator Fellowship. U.S. receives salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience at King's College London, and is also supported by an NIHR Senior Investigator Award. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the UK Department of Health. Publisher Copyright: Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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Background The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model is associated with significant reductions in wait times and improved clinical outcomes for emerging adults with recent-onset eating disorders. An understanding of how FREED is implemented is a necessary precondition to enable an attribution of these findings to key components of the model, namely the wait-time targets and care package. Aims This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study. Method Participants were 259 emerging adults (aged 16-25 years) with an eating disorder of <3 years duration, offered treatment through the FREED care pathway. Patient journey records documented patient care from screening to end of treatment. Adherence to wait-time targets (engagement call within 48 h, assessment within 2 weeks, treatment within 4 weeks) and care package, and differences in adherence across diagnosis and treatment group were examined. Results There were significant increases (16-40%) in adherence to the wait-time targets following the introduction of FREED, irrespective of diagnosis. Receiving FREED under optimal conditions also increased adherence to the targets. Care package use differed by component and diagnosis. The most used care package activities were psychoeducation and dietary change. Attention to transitions was less well used. Conclusions This study provides an indication of adherence levels to key components of the FREED model. These adherence rates can tentatively be considered as clinically meaningful thresholds. Results highlight aspects of the model and its implementation that warrant future examination.

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