Weight
The patient’s weight (in pounds) was taken by parents twice weekly, and communicated via text from parents to Equip’s HIPAA compliant platform. Parents also provided a weight update at four weeks post discharge. Target weight was calculated using expected weight data from each patient’s CDC BMI-for-age Growth Charts.
Results:
Patient characteristics and outcome data are reported in Table 1. In terms of our primary outcome, both patients gained at least 1 pound per week over the course of the trial (6.4 and 4.2 lbs in four weeks respectively). For secondary outcomes, scores for EDE-QS decreased by 7 and 12 points, suggesting a marked decrease in eating disorder symptoms. Relatively little change was noted in PHQ-9 and GAD-7 scores, with one participant scoring ‘mild’ at baseline and discharge on both assessments, and the other scoring ‘moderate’ at baseline and discharge on both assessments. Patients and parents attended 18 and 16 sessions, respectively, though parents of patient 2 engaged with the team via the ‘chat’ feature at a much higher frequency. Both parents and patients reported that they would ‘definitely recommend’ Equip to a friend or family.
Discussion:
The beta trial patients demonstrated a positive response to Equip’s treatment model, as both patients gained at least one pound per week during the trial.  In terms of secondary outcomes, there was a decrease in EDE-QS scores for both patients however GAD-7 and PHQ-9 remained stable and subclinical over the course of treatment.  Further, both patients continued to progress with weight restoration after treatment ended. Patients and parents were both highly engaged during the trial with both traditional providers (therapist and dietitian) as well as mentors.  This was promising given potential for loss of rapport or connection when care is virtually delivered. Having the additional support from the ‘lived experience’ vantage point with the addition of mentors to the treatment team may overcome perceived limitations related to virtual care. Parents and patients were very satisfied with the approach overall, and verbally expressed finding great value in the unique support received from all four team members.
This case study’s results are limited by the short intervention period and use of non-validated measurement tools in regard to satisfaction and engagement scores. Further, we have limited data post-discharge (weight only). Engagement and satisfaction may be influenced by treatment being at no cost, and thus expectations of paid patients may differ. Additionally, further investigation is needed to ensure that other patients show similar improvements with the treatment approach, although the report of these two cases is promising.
These findings offer preliminary support for achieving meaningful clinical outcomes using Equip’s virtually delivered augmented FBT model.   If future studies of this approach that include larger samples, longer follow-up periods, and comparison treatments replicate the outcomes from these cases, the treatment approach could be crucial for addressing limitations in access to care for families living far from trained FBT specialists.
Author Contributions
Megan Hellner’s primary contributions were as follows:
-Conception of the study; review of literature; data analysis and interpretation; initial draft of the manuscript; critical revision of manuscript and approval of final version prior to submitting for publication.
Sam Kolander’s primary contributions were as follows:
-Interpretation of data; initial draft of the manuscript; critical revision of the manuscript and approval of the final version prior to submitting for publication.
Cara Bohon’s primary contributions were as follows:
-Review of literature; Interpretation of data; critical revision of the manuscript and approval of the final version of the manuscript prior to submitting for publication.
Erin Parks’ primary contributions were as follows:
-Conception of the study; collection of data; final approval of the version of the manuscript prior to submitting for publication.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Anderson, K. E., Byrne, C. E., Crosby, R. D., & Le Grange, D. (2017). Utilizing Telehealth to deliver family-based treatment for adolescent anorexia nervosa. The International Journal of Eating Disorders ,50 (10), 1235–1238. https://doi.org/10.1002/eat.22759
Centers for Disease Control and Prevention. (2020, August 14).  Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. Morbidity and Mortality Weekly Reports , 69(32), 1049–1057. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry , 13 (2), 153–160. https://doi.org/10.1002/wps.20128
Couturier, J., Kimber, M., & Szatmari, P. (2012). Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 46 (1), 3-11. doi:10.1002/eat.22042
Gideon, N., Hawkes, N., Mond, J., Saunders, R., Tchanturia, K., & Serpell, L. (2018). Development and psychometric validation of the EDE-QS, a 12 Item short form of the Eating Disorder Examination Questionnaire (EDE-Q): Correction. PLoS ONE, 13 (11), Article e0207256. https://doi.org/10.1371/journal.pone.0207256
Lock, J. (2018). Family therapy for eating disorders in youth: current confusions, advances, and new directions. Current Opinion in Psychiatry, 31 (6), 431-435. DOI: 10.1097/yco.0000000000000451.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine , 16 (9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Matheson, B. E., Bohon, C., & Lock, J. (2020). Family-based treatment via videoconference: Clinical recommendations for treatment providers during COVID-19 and beyond. The International Journal of Eating Disorders , 53 (7), 1142–1154. https://doi.org/10.1002/eat.23326
Pitt, V., Lowe, D., Hill, S., Prictor, M., Hetrick, S. E., Ryan, R., & Berends, L. (2013). Consumer-providers of care for adult clients of statutory mental health services. The Cochrane Database of Systematic Reviews , (3), CD004807. https://doi.org/10.1002/14651858.CD004807.pub2
Ranzenhofer, L. M., Wilhelmy, M., Hochschild, A., Sanzone, K., Walsh, B. T., & Attia, E. (2020). Peer mentorship as an adjunct intervention for the treatment of eating disorders: A pilot randomized trial. The International Journal of Eating Disorders , 53 (5), 497–509. https://doi.org/10.1002/eat.23258
Rhodes, P, Baillee, S, Brown, J & Madden, S. (2008).  Can parent‐to‐parent consultation improve the effectiveness of the Maudsley model of family‐based treatment for anorexia nervosa? A randomized control trial. Journal of Family Therapy, 30 (1): 96-108.  https://doi.org/10.1111/j.1467-6427.2008.00418.x
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7.Archives of Internal Medicine , 166 (10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Sproch, L. E., & Anderson, K. P. (2019). Clinician-Delivered Teletherapy for Eating Disorders. The Psychiatric Clinics of North America , 42 (2), 243–252. https://doi.org/10.1016/j.psc.2019.01.008
Ulfvebrand, S., Birgegård, A., Norring, C., Högdahl, L., & von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from a large clinical database.Psychiatry Research , 230 (2), 294–299. https://doi.org/10.1016/j.psychres.2015.09.008
Von Ranson, K. M., Wallace, L. M., & Stevenson, A. (2013). Psychotherapies provided for eating disorders by community clinicians: Infrequent use of evidence-based treatment. Psychotherapy Research, 23 (3), 333–343. https://doi.org/10.1080/10503307.2012.735377
Waller, G. (2016). Treatment Protocols for Eating Disorders: Clinicians’ Attitudes, Concerns, Adherence and Difficulties Delivering Evidence-Based Psychological Interventions. Current Psychiatry Reports , 18 (4):36. doi:10.1007/s11920-016-0679-0
Woodside, B. D., & Staab, R. (2006). Management of psychiatric comorbidity in anorexia nervosa and bulimia nervosa. CNS Drugs ,20 (8), 655–663. https://doi.org/10.2165/00023210-200620080-00004