3 - (SYM 103) Adapting Family-based Treatment for Pediatric Eating Disorders in the Home Environment

Family-based treatment (FBT) for adolescents with restrictive eating disorders has a strong evidence base, yet implementation is low outside of specialty research and private practice settings. Families with fewer resources and/or those from racial/ethnic minority backgrounds may have difficulties accessing treatment in these settings due to transportation constraints, costs, stigma, language barriers, and conflicting schedules which make family attendance challenging. In addition, FBT demands intensive engagement from caregivers which might be difficult for those who have less flexible work schedules, work multiple jobs, single-parent, or are unable to take a leave of absence from work. A home-based model of care, which involves implementing treatment in the home and other naturalistic settings multiple times per week to provide a bridge between higher levels of care (e.g., hospital-based treatment) and standard, office-based outpatient treatment, may be a viable alternative for families of diverse backgrounds for whom standard outpatient FBT is not feasible. We will provide a brief introduction to the tenets of home-based treatment and specific adaptations needed to implement FBT within a home-based treatment model to improve its fit for families from underrepresented socioeconomic and racial/ethnic backgrounds.  We will then describe empirical and qualitative data from a pilot open trial of home-based FBT (FBT-HB), followed by an overview of our ongoing hybrid type I effectiveness-implementation RCT comparing FBT-HB to home-based usual care. We hope to provide real-world insights on implementing FBT-HB with diverse populations in an effort to improve FBT’s reach, feasibility and fit, and to generate discussions around adapting FBT for other novel settings and underserved populations.