Crest Peyton, Vendlinski Siena S, Borges Renee, Landsverk John, Accurso Erin C
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
Rhodes College, Memphis, TN, USA.
J Eat Disord. 2024 Oct 22;12(1):167. doi: 10.1186/s40337-024-01124-7.
Family-based treatment (FBT), the leading intervention for adolescents with anorexia nervosa (AN), is severely understudied in outpatient care settings that serve publicly-insured populations. Many individuals with public insurance are lower-income, racially and ethnically diverse, and experience barriers to accessing evidence-based interventions for eating disorders (EDs).
Semi-structured interviews were conducted with ten interdisciplinary providers who provide specialty care to youth with EDs in an inpatient and/or outpatient medical setting. Interview questions were focused on the interdisciplinary providers' experiences of caring for individuals with EDs, with a focus on differences in care for those with private insurance compared to public insurance. The interviews took place two years after training in FBT was delivered to mental health providers in San Francisco County, which created opportunities to explore provider perspectives on collaborating with newly-trained mental health providers in the community implementing FBT with publicly-insured youth.
Content analysis converged on three themes: the critical importance of supporting mental health treatment within the context of medical care, complex challenges when helping patients and their families navigate publicly-funded health care systems, and the overall positive impact of the FBT rollout in San Francisco County. Participants emphasized greater confidence in patient outcomes when collaborating with FBT providers and noted discord when working with providers not trained in EDs or FBT. Referral systems, weight-based stigma, and a lack of appropriate services were highlighted as significant barriers to care. To facilitate treatment engagement in publicly-insured populations, participants stressed the importance of clinicians providing psychoeducation and providing services with a high degree of cultural competence. Participants expressed that patients' ability to access FBT and providers' ability to collaborate on cases markedly improved following the county training, increasing their sense of efficacy in delivering adequate patient care.
The discussed themes highlight the importance of access to FBT for individuals in underserved communities, which can significantly reduce both provider and patient burden. Despite various barriers to utilizing FBT in publicly-funded settings, clinicians stressed that cultural adaptations increase the implementation of and facilitate family engagement in FBT, which is consistent with previous literature examining evidence-based intervention implementation science.
基于家庭的治疗（FBT）是神经性厌食症（AN）青少年的主要干预措施，但在为公共保险人群提供服务的门诊护理环境中，对其研究严重不足。许多有公共保险的人收入较低，种族和民族多样，在获得饮食失调（ED）的循证干预措施方面存在障碍。
对十名跨学科提供者进行了半结构化访谈，他们在住院和/或门诊医疗环境中为患有ED的青少年提供专科护理。访谈问题集中在跨学科提供者对照顾ED患者的经验上，重点是与有私人保险的患者相比，为有公共保险的患者提供护理的差异。访谈在向旧金山县的心理健康提供者提供FBT培训两年后进行，这为探讨提供者对与社区中新培训的心理健康提供者合作的看法创造了机会，这些心理健康提供者在为有公共保险的青少年实施FBT。
内容分析集中在三个主题上：在医疗护理背景下支持心理健康治疗的至关重要性、帮助患者及其家庭应对公共资助医疗系统时的复杂挑战，以及FBT在旧金山县推出的总体积极影响。参与者强调与FBT提供者合作时对患者结果更有信心，并指出与未接受过ED或FBT培训的提供者合作时存在分歧。转诊系统、基于体重的耻辱感和缺乏适当的服务被强调为护理的重大障碍。为了促进公共保险人群的治疗参与，参与者强调临床医生提供心理教育并以高度的文化能力提供服务的重要性。参与者表示，在县培训后，患者获得FBT的能力和提供者在病例上合作的能力明显提高，增强了他们提供充分患者护理的效能感。
所讨论的主题凸显了服务不足社区的个人获得FBT的重要性，这可以显著减轻提供者和患者的负担。尽管在公共资助环境中使用FBT存在各种障碍，但临床医生强调文化适应增加了FBT的实施并促进了家庭参与，这与之前研究循证干预实施科学的文献一致。
