Family Based Treatment via Telemedicine for Regional and Rural Young People with Anorexia Nervosa

Status

Completed

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12620001107910

Acronym

FBT-TRRAN

Enrollment

Registered

2020-10-26

Start date

2020-07-13

Completion date

2022-01-21

Last updated

2025-01-06

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Anorexia nervosa (AN) is a serious, debilitating psychiatric disorder, with numerous physical and psychological health impacts (Lock, 2012; Katzman, 2005). Typically diagnosed in young people, individuals with AN are 12 times more likely to die and 57 times more likely to commit suicide compared to same-age peers (Keel et al., 2003). Illness duration may extend to over 20 years for more than half of those afflicted (Fichter et al., 2017), highlighting marked chronicity. It is essential that evidence-based treatment for this disorder is delivered efficiently and effectively. Family-based treatment (FBT) is the most efficacious treatment currently available for young people with AN (Le Grange et al., 2016; Lock & Le Grange, 2019). FBT is an outpatient behavioural treatment which emphasises the parents as the primary resource in the recovery of young people with AN (Anderson et al., 2017). However, there is a concerning inequity in access and treatment outcomes for people with AN, particularly among those in regional and rural populations. Telehealth offers a viable, scalable solution to this critical issue, and preliminary research in the USA demonstrated equivalent outcomes for FBT delivered via telehealth compared to face-to-face therapy (Anderson et al., 2017). The proposed study sets out to build on this vital research, testing the efficacy, feasibility, acceptability and cost-effectiveness of delivering FBT via telehealth to 30 young people and their families living in regional and rural New South Wales. This pioneering study brings together a multidisciplinary team of national and international experts to address both the treatment needs of regional and rural families; and the needs of regional and rural health services. Further, it will inform future efforts designed to improve the health of all Australians impacted by this debilitating disorder.

Interventions

18 sessions of Family Based Treatment (FBT) will be delivered to young people diagnosed with Anorexia Nervosa (AN) and their families. Materials used: Online survey (via REDCap), Videoconferencing platform, digital scales. Procedures: After consent and before meeting with the therapist, a member of the research team will contact the family to perform a technology check, to troubleshoot any technology issues (i.e., video camera not working, teleconferencing platform issues or connection/speed issues), and offer education and training support concerning the videoconferencing platform. Before commencing therapy, the family will have a brief session with the therapist (online or face to face within the service). The purpose of this session is to orientate the family to the treatment format, describe the treatment process and discuss logistics that will enhance the therapy experience. Before each scheduled session, the young person will be weighed using the same scales and in the same location of the house by the parent/guardian. As soon as the parents/guardians have measured the young person’s weight, they will send the weight to the therapist via email or text. As per the FBT manual, the young person will be weighed wearing light indoor clothing, no shoes and after voiding their bladder. The parents/guardians will be instructed by the therapist how to do this during the first session. The therapist will initiate the therapy session, and begin with an individual meeting with the young person. Following a review of the weekly weight and check in with the young person, the remaining family members will join the young person and therapist. FBT comprises of three treatment phases. In phase 1, the parents are charged with the responsibility of managing eating behaviours and weight gain. In phase 2, parents gradually transition the responsibility of eating back to the adolescent in an age-appropriate manner. In phase 3, adolescent developmental issues (such as peer friendships or managing school/studies) become the focus of treatment. Due to the seriousness of AN, FBT requires all family members to attend sessions, and that appointments are at least weekly for the first several months. This frequency of appointments generally reduces as the young person becomes progressively well. Who will deliver: Experience mental health professionals employed by NSW Health trained in FBT Mode: Online via telemedicine (i.e., Pexip or Skype for Business) Number of times delivered: 18 sessions over 9 months. Sessions will initially be on a weekly basis for the first three months, and then fortnightly and then monthly, as determined by consultation between the clinician and their families. Location/setting: Online. The family will be in their home and therapist will be in their mental health service. Fidelity: Treatment fidelity will be managed by therapists completing two workshops and weekly supervision with Investigator and co-author of the FBT treatment manual. Furthermore, therapists will complete a brief checklist after each session and will use these to guide supervision discussions.

Study design

Allocation

Non-randomised trial

Primary purpose

Treatment

Eligibility

Sex/Gender

All

Age

12 Years to No maximum

Healthy volunteers

Inclusion criteria

In relation to the young person diagnosed with AN: • Diagnosis of AN as defined by the DSM-5 • Age: 12 to 18 years old • Living with primary caregiver • Medically stable for outpatient treatment according to the recommended thresholds of the NSW Health Guidelines for the Admission of Children and Young People with an Eating Disorder (2014), as verified by their treating general practitioner (GP) • Commitment from the family to engage in FBT • Not engaged in any other psychological or dietetic treatment external to mental health service In relation to the other family members (parents/guardians, siblings) * Aged over 12 years of age * Not currently under a mental health act * Commitment to engage in Family Based Treatment

Exclusion criteria

In relation to the young person diagnosed with AN: • Currently pregnant • Current manic episode or psychosis • Current alcohol, substance abuse or dependence • Acute suicidality • Significant medical or neurological disorders not relating to their primary diagnosis of AN • GP unable to provide medical clearance • Under the Mental Health Act or under compulsory treatment orders

Outcome results