"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

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

doi:10.3389/frhs.2023.1253966

"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

Front Health Serv. 2024 Jan 18:3:1253966. doi: 10.3389/frhs.2023.1253966. eCollection 2023.

Authors

Lucy Hyam¹, Claire Torkelson², Katie Richards³, Amy Semple⁴, Karina L Allen^{1

5}, Jill Owens⁴, Aileen Jackson⁴, Laura Semple⁶, Danielle Glennon⁵, Giulia Di Clemente⁵, Ulrike Schmidt^{1

5}

Affiliations

¹ Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
² Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
³ Centre for Implementation Science, King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
⁴ Health Innovation Network, Academic Health Science Network South London, London, United Kingdom.
⁵ South London and Maudsley NHS Foundation Trust, London, United Kingdom.
⁶ Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom.

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.

Keywords: National Health Services; early medical intervention; emerging adulthood; feeding and eating disorders; implementation research; mental health services.

Grants and funding

The author(s) declare the following support was received at the time of the study conduction/preparation of the manuscript. LH is supported by a PhD studentship from the Health Foundation. US receives salary support from the National Institute of Health Research (NIHR) Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust (SLaM) and King's College London (KCL). KA and US are supported by UK Research and Innovation as part of the EDIFY programme (grant number: MR/W002418/1). KR is funded by King's Improvement Science, which is a King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust) funded research programme. The views expressed are those of the authors and not necessarily those of the Health Foundation, NHS, the NIHR or the Department of Health.