Table 5 Core elements of family-based treatment (FBT) for restrictive eating disorders delivered in the office-based and home-based settings
| Â | Core functions and forms | Office-based FBT | Home-based FBT |
|---|---|---|---|
Participants | Support parental empowerment and leverage family support | Entire family (including siblings and extended family members living in the home) attends each session | Family attends a portion of sessions with remaining sessions devoted to individual work with the adolescent on distress tolerance and coping skills |
Treatment dose | Support parental empowerment while simultaneously supporting the needs of the adolescent | Weekly (Phase I), bi-weekly (Phase II), or monthly (Phase III) sessions lasting 45–50 min each, for a total of 16–20 h of treatment over 6–12 months | Multiple sessions per week totaling 3–6 h of weekly clinical care for the family, for a total of 30–96 h of treatment over 10–16 weeks |
Family meal | Identify ways in which the eating disorder is interfering with caregiver attempts to refeed; allow caregivers to experience success in refeeding or highlight the difficulties in refeeding that lay ahead | Occurs once at the beginning of treatment with entire family Constrained by limits of office-based setting (e.g., limited dining space, utensils, appliances) Therapist refrains from eating | Occurs multiple times, often weekly Entire family may participate, or therapist may provide one-on-one meal coaching to the adolescent Conducted in the family home or in the community, with typical amenities available in those settings Therapist may choose to partake in the meal when culturally appropriate |
Gathering information on family interactions related to food/home food environment | Problem-solve ways to help caregivers effectively and efficiently refeed the adolescent | Occurs through focused questioning of caregivers and detailed recall of the prior week(s) | Therapist directly observes interactions through multiple family meals Therapist directly assesses the home food environment (e.g., surveys the pantry, observes meal preparation, grocery shops with adolescent and/or caregivers) |
Coordination of care | Ensure consistent messaging among treatment providers; facilitate implementation of FBT across multiple settings | Communication with medical team usually occurs via phone if medical team is offsite, or occurs in the context of medical rounds when team is onsite Therapist may encourage family to seek special services, provide supporting documentation to school | Therapist attends medical appointments with the family Therapist works closely with school (including in-person interactions) to provide psychoeducation regarding meal supervision, provision of other support services |