To Fidelity and Beyond: Development of an Implementation Fidelity Tool for Early Intervention for Eating Disorders...

Area of Science:

• Psychiatry
• Clinical Psychology
• Healthcare Management

Background:

• Eating disorders are serious mental health conditions affecting young people.
• Early intervention is crucial for improving outcomes in recent-onset eating disorders.
• The First Episode Rapid Early Intervention for Eating Disorders (FREED) model targets this critical window.

Purpose of the Study:

• To develop and pilot test an implementation fidelity tool for the FREED model.
• To assess the feasibility and efficiency of the fidelity tool.
• To explore changes in implementation fidelity over time.

Main Methods:

• Iterative consultation within the FREED national team to define core components.
• Development of a 35-item fidelity tool with a scoring rubric.
• Pilot testing in a London-based FREED service using routine data and interviews, with dual independent rating and inter-rater reliability assessment.

Main Results:

• The tool comprises two components: rapid access and adherence to the FREED care package.
• Overall fidelity scores were 60-63% ('lower' fidelity).
• Rapid access scored 'not satisfactory,' while care package components showed 'medium fidelity.' Inter-rater reliability was almost perfect.

Conclusions:

• This is the first fidelity tool for early intervention eating disorder services, demonstrating feasibility and efficiency.
• Pilot data suggest variable fidelity, with a need for enhanced support, particularly for rapid access.
• Further psychometric evaluation and testing in diverse services are recommended to support fidelity improvement.