Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model
Open accessAbstract
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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Early intervention in EDs is associated with better outcomes.
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- Authors
- Richards, K. L., Flynn, M., Austin, A., Lang, K., Allen, K. L., Bassi, R., Brady, G., Brown, A., Connan, F., Franklin-Smith, M., Glennon, D., Grant, N., Jones, W. R., Kali, K., Koskina, A., Mahony, K., Mountford, V. A., Nunes, N., Schelhase, M., Serpell, L., & Schmidt, U.
- Affiliations
- King's College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Central and North West London NHS Foundation Trust (GB)
- Leeds and York Partnership NHS Foundation Trust (GB)
- North East London NHS Foundation Trust (GB)
- Corresponding author
- Schmidt, Ulrike
- ORCID
- Venue
- BJPsych Open
- Publisher
- Royal College of Psychiatrists
- Published
- 2021-05
- Volume
- 7
- Issue
- 3
- Pages
- e98-e98
- ISSN
- 2056-4724 (ISSN-L)
- PMC
- PMC8142541
- OpenAlex
- W3158512258
- Cited by
- 16
- References
- 29
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 9 · 2023: 2 · 2022: 1
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BJPsych Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (NF-SI-0616-10075)
- King's College London
- University College London
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London
- Menzies Centre for Australian Studies, King's College London, University of London
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- implementation fidelity, eating disorders, emerging adults, care packages, psychoeducation, dietary change, care transitions
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