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Article ; Online: Understanding Eating Disorders Across Samples and Stages.

Allen, Karina L

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2019 Volume 64, Issue 2, Page(s) 143–144

MeSH term(s)	Adolescent ; Binge-Eating Disorder ; Feeding and Eating Disorders ; Female ; Humans ; Prevalence
Language	English
Publishing date	2019-01-16
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2018.11.005
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Article: Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study.

Richards, Katie L / Phillips, Matthew / Grycuk, Luiza / Hyam, Lucy / Allen, Karina / Schmidt, Ulrike

Journal of eating disorders

2024 Volume 12, Issue 1, Page(s) 45

Abstract: Background: The First Episode Rapid Early Intervention for Eating Disorders (FREED) service has been shown to reduce the wait for care and improve clinical outcomes in initial evaluations. These findings led to the national scaling of FREED in England. ... ...

Abstract	Background: The First Episode Rapid Early Intervention for Eating Disorders (FREED) service has been shown to reduce the wait for care and improve clinical outcomes in initial evaluations. These findings led to the national scaling of FREED in England. To support this scaling, we conducted a mixed method evaluation of the perceptions and experiences of clinicians in the early phases of scaling. The Normalisation Process Theory (NPT) was used as a conceptual lens to understand if and how FREED becomes embedded in routine practice. Methods: The convergent mixed method evaluation included 21 semi-structured interviews with clinicians from early adopter sites and 211 surveys administered to clinicians before, immediately after and 3 months after the FREED training. The interview guide and survey included questions evaluating attitudes towards early intervention for eating disorders (EDs) and NPT mechanisms. Interview data were analysed using an inductive thematic analysis. The NPT was applied to the inductively derived themes to evaluate if and how NPT domains impacted the implementation. Survey data were analysed using multilevel growth models. Results: Six themes and 15 subthemes captured barriers and facilitators to implementation at the patient, clinician, service, intervention, implementation and wider system levels. These interacted with the NPT mechanisms to facilitate or hinder the embedding of FREED. Overall, clinicians were enthusiastic and positive towards early intervention for EDs and FREED, largely because of the expectation of improved patient outcomes. This was a considerable driver in the uptake and implementation of FREED. Clinicians also had reservations about capacity and the potential impact on other patients, which, at times, was a barrier for its use. The FREED training led to significant improvements in positive attitudes and NPT mechanisms that were largely maintained at the 3-month follow-up. However, negative attitudes did not significantly improve following training. Conclusions: Positive attitudes towards early intervention for EDs increased enthusiasm and engagement with the model. Features of the model and its implementation were effective at developing adopter commitment and capabilities. However, there were aspects of the model and its implementation which require attention in the future (e.g., capacity and the potential impact on the wider service).
Language	English
Publishing date	2024-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2699357-0
ISSN	2050-2974
ISSN	2050-2974
DOI	10.1186/s40337-024-01000-4
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Article ; Online: Clinical staging across eating disorders: a scoping review protocol.

Hyam, Lucy Elizabeth / Phillips, Matthew / Gracie, Lara / Allen, Karina / Schmidt, Ulrike

BMJ open

2023 Volume 13, Issue 11, Page(s) e077377

Abstract: Introduction: Clinical staging models in psychiatry assert that there are earlier, less severe or more malleable forms of illness that are distinguishable from later, more chronic forms of illness, and that these stages may have different prognostic and ...

Abstract	Introduction: Clinical staging models in psychiatry assert that there are earlier, less severe or more malleable forms of illness that are distinguishable from later, more chronic forms of illness, and that these stages may have different prognostic and treatment implications. Previous reviews on clinical staging in eating disorders (EDs) suggest a staging heuristic could be useful for anorexia nervosa, but less research is available on how this applies to other EDs. An up-to-date review is required to synthesise new and heterogenous avenues of research. This scoping review aims to explore the extent and types of evidence in relation to illness staging for EDs and how these concepts are associated with treatment response and outcomes. Methods and analysis: This protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. We will consider any documents providing evidence for clinical staging such as those which describe full or partial staging models, for all EDs, across various domains of assessment and functioning. Participants will include clinical or non-clinical population samples with full-syndrome EDs or disordered eating behaviour. PubMed, PsycINFO, MEDLINE and Web of Science databases will be systematically searched for relevant literature. Two authors will export documents and screen titles, abstracts and full texts. Data will be extracted into a charting form drafted by the authors. A narrative summary of the documents will be conducted in line with the study aims. Finally, clinical and research recommendations will be outlined. Ethics and dissemination: Ethical approval will not be required to synthesise published and unpublished literature. The study will be published in a peer-reviewed journal and shared at conferences, via social media, and in other communications.
MeSH term(s)	Humans ; Feeding and Eating Disorders/therapy ; Anorexia Nervosa ; Academies and Institutes ; Checklist ; Communication ; Research Design ; Systematic Reviews as Topic ; Review Literature as Topic
Language	English
Publishing date	2023-11-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-077377
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Article ; Online: A Delphi study to explore clinician and lived experience perspectives on setting priorities in eating disorder services.

Richards, Katie L / Woolrych, Isabel / Allen, Karina L / Schmidt, Ulrike

BMC health services research

2022 Volume 22, Issue 1, Page(s) 788

Abstract: Background: Due to scarce resources and high demand, priority setting in mental health services is necessary and inevitable. To date, no study has examined priority setting in eating disorder (ED) services specifically. Here, we evaluate the level of ... ...

Abstract	Background: Due to scarce resources and high demand, priority setting in mental health services is necessary and inevitable. To date, no study has examined priority setting in eating disorder (ED) services specifically. Here, we evaluate the level of consensus and perceived relative importance of factors used to determine patient prioritisation in ED services, amongst clinicians and individuals with lived experience (LE) of an ED. Methods: A three round Delphi study and a ranking task were used to determine the level of consensus and importance. Consensus was defined as > 80% agreement or disagreement. Items that reached consensus for agreement were ranked in order of importance from most to least important. Participants were 50 ED clinicians and 60 LE individuals. Participant retention across rounds 2, 3, and 4 were 92%, 85%, and 79%, respectively. Results: Over three iterative rounds, a total of 87 statements about patient prioritisation were rated on a 5-point Likert-scale of agreement. Twenty-three items reached consensus in the clinician panel and 20 items reached consensus in the LE panel. The pattern of responding was broadly similar across the panels. The three most important items in both panels were medical risk, overall severity, and physical health deteriorating quickly. Clinicians tended to place greater emphasis on physical risk and early intervention whereas the LE panel focused more on mental health and quality of life. Conclusions: Eating disorder services tend to prioritise patients based upon medical risk and severity, and then by the order in which patients are referred. Our findings align in some respects with what is observed in services, but diverge in others (e.g., prioritising on quality of life), providing important novel insights into clinician and LE opinions on waiting list prioritisation in EDs. More research is warranted to validate these findings using multi-criterion decision techniques and observational methods. We hope these findings provide a foundation for future research and encourage evidence-based conversations around priority setting in ED services.
MeSH term(s)	Consensus ; Delphi Technique ; Feeding and Eating Disorders/therapy ; Humans ; Mental Health Services ; Quality of Life ; Surveys and Questionnaires
Language	English
Publishing date	2022-06-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-08170-4
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Article ; Online: The impact of the COVID-19 pandemic on referral numbers, diagnostic mix, and symptom severity in Eating Disorder Early Intervention Services in England.

Hyam, Lucy / Richards, Katie L / Allen, Karina L / Schmidt, Ulrike

The International journal of eating disorders

2022 Volume 56, Issue 1, Page(s) 269–275

Abstract: Objective: First Episode Rapid Early Intervention for Eating Disorders (FREED) is a service model and care pathway which aims to provide timely, well-coordinated, developmentally informed and evidence-based care for young people with eating disorders ( ... ...

Abstract	Objective: First Episode Rapid Early Intervention for Eating Disorders (FREED) is a service model and care pathway which aims to provide timely, well-coordinated, developmentally informed and evidence-based care for young people with eating disorders (EDs). This article investigates the impact of the COVID-19 pandemic on FREED patient presentations and service provision in England. Method: Data from three services spanning the pre- to post-pandemic period were included (January 2019-September 2021; n = 502 patients). Run charts were created to analyze changes in monthly baseline patient data (e.g., referral numbers, duration of an untreated ED, diagnostic mix, and average body mass index for patients with anorexia nervosa [AN]). Results: Significant increases in referral numbers were found from September 2020 onward, coinciding with the end of the first UK national lockdown. The percentage of AN presentations significantly increased after the onset of the first national lockdown (April 2020-December 2020). No other significant change patterns were identified. Discussion: There have been substantial increases in referral numbers and presentations of AN to FREED services whereas illness severity seems largely unchanged. Together, this suggests that increased referrals cannot be attributed to milder presentations being seen. Implications for the implementation, funding, and sustainability of the model are discussed. Public significance: Our research suggests that early intervention eating disorder services across England faced significant increases in patient referrals and presentations of anorexia nervosa over the COVID-19 pandemic. This increase in referrals is not due to a rise in milder eating disorder cases, as baseline symptom severity remained stable across the pandemic. Investment in early intervention for eating disorders must therefore match increased referral trends.
MeSH term(s)	Humans ; Adolescent ; COVID-19 ; Pandemics ; Communicable Disease Control ; England/epidemiology ; Referral and Consultation ; COVID-19 Testing
Language	English
Publishing date	2022-10-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603170-5
ISSN	1098-108X ; 0276-3478
ISSN (online)	1098-108X
ISSN	0276-3478
DOI	10.1002/eat.23836
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Article: Eating Disorders During Emerging Adulthood: A Systematic Scoping Review.

Potterton, Rachel / Richards, Katie / Allen, Karina / Schmidt, Ulrike

Frontiers in psychology

2020 Volume 10, Page(s) 3062

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-01-31
Publishing country	Switzerland
Document type	Systematic Review
ZDB-ID	2563826-9
ISSN	1664-1078
ISSN	1664-1078
DOI	10.3389/fpsyg.2019.03062
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Article ; Online: Management of fraudulent participants in online research: Practical recommendations from a randomized controlled feasibility trial.

Davies, Molly R / Monssen, Dina / Sharpe, Helen / Allen, Karina L / Simms, Beki / Goldsmith, Kimberley A / Byford, Sarah / Lawrence, Vanessa / Schmidt, Ulrike

The International journal of eating disorders

2023

Abstract: Objective: Fraudulent participation is an escalating concern for online clinical trials and research studies and can have a significant negative impact on findings. We aim to shed light on the risk and to provide practical recommendations for detecting ... ...

Abstract	Objective: Fraudulent participation is an escalating concern for online clinical trials and research studies and can have a significant negative impact on findings. We aim to shed light on the risk and to provide practical recommendations for detecting and managing such instances. Methods: The FREED-Mobile (FREED-M) study is an online, randomized controlled feasibility trial to assess a digital early intervention for young people (aged 16-25) in England or Wales with eating problems. The trial involved baseline (week 0), post-intervention (week 4), and follow-up (week 12) surveys, alongside weekly modules provided over 4 weeks on the study website. Study completers were compensated with £20 shopping vouchers. Despite the complexity of the trial design, two instances of fraudulent sign-ups occurred in January and March 2023. To counter this, we developed a "fraudulent participants protocol" following internal investigations and discussions with collaborators. Results: The implementation of prevention measures such as reCAPTCHA updates, IP address review, and changes in reimbursement effectively halted further fraudulent sign-ups. Our protocol facilitated the systematic identification and withdrawal of suspected or clear fraudsters and was demonstrably robust at distinguishing between fraudsters and genuine responders. Discussion: All remote, online trials or studies are at risk of fraudulent participation. Drawing from our experience and existing literature, we offer practical recommendations for researchers considering online recruitment and data collection. Vigilance and the integration of deterrents, and data quality checks into the study design from the outset are advised to safeguard research integrity. Public significance: Fraudulent participation in digital research can have asignificant impact on research findings, potentially leading to biased resultsand misinformed decisions. We developed an effective protocol for theprevention, identification, and management of fraudulent participants. Bysharing our insights and recommendations, we hope to raise awareness of thisissue and provide other researchers with the knowledge and strategies necessaryto safeguard research integrity moving forward.
Language	English
Publishing date	2023-11-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	603170-5
ISSN	1098-108X ; 0276-3478
ISSN (online)	1098-108X
ISSN	0276-3478
DOI	10.1002/eat.24085
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Article ; Online: Early intervention services for non-psychotic mental health disorders: a scoping review protocol.

Richards, Katie / Austin, Amelia / Allen, Karina / Schmidt, Ulrike

BMJ open

2019 Volume 9, Issue 12, Page(s) e033656

Abstract: Introduction: Worldwide mental health disorders are associated with a considerable amount of human suffering, disability and mortality. Yet, the provision of rapid evidence-based care to mitigate the human and economic costs of these disorders is ... ...

Abstract	Introduction: Worldwide mental health disorders are associated with a considerable amount of human suffering, disability and mortality. Yet, the provision of rapid evidence-based care to mitigate the human and economic costs of these disorders is limited. The greatest progress in developing and delivering early intervention services has occurred within psychosis. There is now growing support for and calls to extend such approaches to other diagnostic groups. The aim of this scoping review is to systematically map the emerging literature on early intervention services for non-psychotic mental health disorders, with a focus on outlining how services are structured, implemented and scaled. Methods and analysis: The protocol was developed using the guidance for scoping reviews in the Joanna Briggs Institute manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. A systematic search for published and unpublished literature will be conducted using the following databases: (1) MEDLINE, (2) PsycINFO, (3) HMIC, (4) EMBASE and (5) ProQuest. To be included, documents must describe and/or evaluate an early intervention service for adolescents or adults with a non-psychotic mental health disorder. There will be no restrictions on publication type, study design and date. Title and abstract, and full-text screening will be completed by one reviewer, with a proportion of articles screened in duplicate. Data analysis will primarily involve a qualitatively summary of the early intervention literature, the characteristics of early intervention services and key findings relating to their evaluation and implementation. Ethics and dissemination: The synthesis of published and unpublished articles will not require ethical approval. The results of this scoping review will be published in a peer-reviewed journal and disseminated via social media, conference presentations and other knowledge translation activities.
MeSH term(s)	Adolescent ; Adult ; Early Medical Intervention/methods ; Female ; Humans ; Male ; Mental Disorders/therapy ; Review Literature as Topic ; Young Adult
Language	English
Publishing date	2019-12-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2019-033656
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Article: "FREED instils a bit of hope in the eating disorder community… that things can change.": an investigation of clinician views on implementation facilitators and challenges from the rapid scaling of the First Episode Rapid Early Intervention for Eating Disorders programme.

Hyam, Lucy / Yeadon-Ray, Olivia / Richards, Katie / Semple, Amy / Allen, Karina / Owens, Jill / Jackson, Aileen / Semple, Laura / Glennon, Danielle / Di Clemente, Giulia / Griffiths, Jess / Mills, Regan / Schmidt, Ulrike

Frontiers in psychiatry

2024 Volume 15, Page(s) 1327328

Abstract: Introduction: First Episode Rapid Early Intervention for Eating Disorders (FREED) is the leading eating disorder (ED) early intervention model for young people. Research has shown that it reduces the duration of untreated illness, improves clinical ... ...

Abstract	Introduction: First Episode Rapid Early Intervention for Eating Disorders (FREED) is the leading eating disorder (ED) early intervention model for young people. Research has shown that it reduces the duration of untreated illness, improves clinical outcomes, and has cost savings. However, less is known about the experience of implementing FREED. This study aimed to investigate the views and experiences of adopting, implementing, and sustaining FREED from the perspective of clinical staff. Methods: Seven focus groups were conducted involving 26 clinicians. Thematic analysis was used, with the Non-Adoption, Abandonment and Challenges to Scale-up, Spread and Sustainability (The NASSS framework) framework being applied to organise subthemes and determine facilitators and barriers. The NASSS framework was also used to rate the complexity of themes as either simple (straightforward, predictable, few components), complicated (multiple interrelating components), or complex (dynamic, unpredictable, not easily divisible into constituent components). Results: There were 16 subthemes identified under seven broader themes representing each domain of the NASSS framework. Key barriers and areas of complexity included factors related to EDs as an illness (e.g., high acuity and prevalence), and organisational complexity (e.g., staffing shortages, lack of managerial/team support). Key facilitators included positive clinician/adopter attitudes, a supportive national network, and the ability for FREED to be flexible/adaptable over time. Conclusion: The FREED model appears to be desirable to clinical staff. Wider team and managerial support was perceived to be particularly important to its successful implementation, as were the national network and supervision. Key areas of complexity include staffing issues and high ED acuity/prevalence. These barriers to implementation need to be managed and investment continued to expand and improve early intervention for EDs further.
Language	English
Publishing date	2024-03-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2024.1327328
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Article ; Online: "Early intervention isn't an option, it's a necessity": learning from implementation facilitators and challenges from the rapid scaling of an early intervention eating disorders programme in England.

Hyam, Lucy / Torkelson, Claire / Richards, Katie / Semple, Amy / Allen, Karina L / Owens, Jill / Jackson, Aileen / Semple, Laura / Glennon, Danielle / Di Clemente, Giulia / Schmidt, Ulrike

Frontiers in health services

2024 Volume 3, Page(s) 1253966

Abstract: Introduction: The First Episode Rapid Early Intervention for Eating Disorders (FREED) service has shown promising outcomes for young people with an eating disorder, leading to national scaling and implementation across England. Between 2020 and 2023, ... ...

Abstract	Introduction: The First Episode Rapid Early Intervention for Eating Disorders (FREED) service has shown promising outcomes for young people with an eating disorder, leading to national scaling and implementation across England. Between 2020 and 2023, the national implementation of FREED was supported by the Academic Health Science Networks (AHSNs), which are publicly funded organisations with the mission to spread innovations at scale and pace. This study aimed to investigate the views and experiences of AHSN programme leads on the national roll-out of FREED and the perceived sustainability of the model. Methods and results: Semi-structured interviews were conducted with 13 programme leads across the AHSNs with direct experience supporting the national implementation of FREED. Thematic analysis was adopted using a critical realist approach. Initial sub-themes were inductively generated and then organised under seven larger themes representing the domains of the Non-adoption, Abandonment, and Challenges to Scale-Up, Spread and Sustainability (NASSS) framework. Each sub-theme was classified as a facilitator and/or barrier and then each larger theme/domain was assessed for its complexity (simple, complicated, complex). Data analysis revealed 28 sub-themes, 10 identified as facilitators, 13 as barriers, and five as both. Two domains were classed as simple, three as complicated, and two as complex. Sub-themes ranged from illness-related complexities to organisational pressures. Key facilitators included a high-value proposition for FREED and a supportive network. Key barriers included staffing issues and illness-related factors that challenge early intervention. Discussion: Participants described broad support for FREED but desired sustained investment for continued provision and improving implementation fidelity. Future development areas raised by participants included enlarging the evidence base for early intervention, increasing associated training opportunities, and widening the reach of FREED. Results offer learning for early intervention in eating disorders and the scaling of new health initiatives.
Language	English
Publishing date	2024-01-18
Publishing country	Switzerland
Document type	Journal Article
ISSN	2813-0146
ISSN (online)	2813-0146
DOI	10.3389/frhs.2023.1253966
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