Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders
Abstract Background 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 divers...
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| Format: | Article |
| Language: | English |
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BMC
2024-10-01
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| Series: | Journal of Eating Disorders |
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| Online Access: | https://doi.org/10.1186/s40337-024-01124-7 |
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| author | Peyton Crest Siena S. Vendlinski Renee Borges John Landsverk Erin C. Accurso |
| author_facet | Peyton Crest Siena S. Vendlinski Renee Borges John Landsverk Erin C. Accurso |
| author_sort | Peyton Crest |
| collection | DOAJ |
| description | Abstract Background 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). Methods 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. Results 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. Conclusions 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. |
| format | Article |
| id | doaj-art-c4ccc2bea39b41f6bbb2c532a825e9c1 |
| institution | Kabale University |
| issn | 2050-2974 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Eating Disorders |
| spelling | doaj-art-c4ccc2bea39b41f6bbb2c532a825e9c12024-11-17T12:05:48ZengBMCJournal of Eating Disorders2050-29742024-10-0112111210.1186/s40337-024-01124-7Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disordersPeyton Crest0Siena S. Vendlinski1Renee Borges2John Landsverk3Erin C. Accurso4Department of Psychiatry and Behavioral Sciences, University of CaliforniaDepartment of Psychiatry and Behavioral Sciences, University of CaliforniaUniversity of San FranciscoOregon Social Learning CenterDepartment of Psychiatry and Behavioral Sciences, University of CaliforniaAbstract Background 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). Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s40337-024-01124-7Care coordinationFamily-based treatment (FBT)ImplementationAnorexia nervosaPublic insurancePrivate insurance |
| spellingShingle | Peyton Crest Siena S. Vendlinski Renee Borges John Landsverk Erin C. Accurso Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders Journal of Eating Disorders Care coordination Family-based treatment (FBT) Implementation Anorexia nervosa Public insurance Private insurance |
| title | Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders |
| title_full | Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders |
| title_fullStr | Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders |
| title_full_unstemmed | Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders |
| title_short | Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders |
| title_sort | interdisciplinary perspectives on accessing specialty evidence based treatment for medicaid insured adolescents with eating disorders |
| topic | Care coordination Family-based treatment (FBT) Implementation Anorexia nervosa Public insurance Private insurance |
| url | https://doi.org/10.1186/s40337-024-01124-7 |
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