Table 1 Comparison of FREED service model with treatment as usual (TAU) as delivered before the introduction of FREED (adapted from Fukutomi et al., [26])
Characteristic | Service Model | |
|---|---|---|
FREED | TAU | |
Target group | Prioritisation of patients aged 16–25 years old with duration of ED of less than 3 years | No prioritisation according to illness stage Priority determined by diagnosis and severity |
Referral and engagement | Person-centred, user-friendly, flexible approach reaching out to young people and families | Barriers to access seen as useful gatekeeping / test of patient motivation |
Actively remove barriers to access | Initial appointment communicated via letter | |
Engagement call within 48 h of referral from FREED clinician | Patient’s responsibility to contact service prior to assessment | |
Multiple methods of contact (e.g. text; emails) | Strict discharge policy if not engaging | |
Flexible approach to initial and subsequent appointments (e.g. accommodating cancellations) | ||
Waiting times | Target of 2 weeks from referral to assessment and 4 weeks from referral to treatment | Statutory waiting time targets |
Assessment | Assessment of biopsychosocial needs, including focus on young person’s strengths and priorities | Assessment of biopsychosocial needs Assessment is separate from treatment |
Explore social media use as potential illness maintaining factor | Patient prepared to wait between assessment and treatment, focus on staying safe during this time | |
Psychoeducation using personal feedback and information about malleable changes to brain, body and behaviour to encourage early action on change | Limited psychoeducation at assessment Variable involvement of family and friends | |
Instil a sense of hope for recovery and at the same time of urgency of action to make changes now (e.g. through goal setting) | ||
Assessment is seen as part of treatment | ||
Active involvement of family and friends | ||
Treatment | Evidence-based psychological therapy tailored to stage of illness and emerging adulthood | One-size-fits-all; standard packages of evidence-based treatment determined by diagnosis and severity |
Early dietitian involvement with focus on nutritional change | Medical and dietetic input when necessary | |
Emphasis on transitions (e.g. moving to university) with flexible, supportive transition arrangements to provide a safety net. If necessary, continuation of treatment via distance methods (e.g. email, skype) with joint management arrangements with university-based services | Variable focus on nutritional change. Variable family involvement. Variable use of technology. Discharge to other services at transition of care | |
Encourage joint sessions (e.g. with a family member) | ||