The objectives of this career development award are to acquire knowledge, develop skills, and gain practical experience that enable the applicant to pursue independent research in dissemination and implementation (D&I) of evidence-based treatments (EBTs) in underresourced settings for youth with eating disorders (EDs), particularly by leveraging technology to increase EBT adoption. Youth with EDs are poorly served in the public sector due to lack of EBT training, leaving such youth vulnerable to medical complications, hospitalization, and a prolonged course of illness. Under the mentorship of implementation scientist Joseph Guydish, PhD, MPH and a team of expert co-mentors and consultants, the applicant will pursue training designed to 1) learn implementation science models, methodology, and analytic techniques to increase EBT adoption, implementation, and sustainability for underserved youth; 2) gain expertise in developing and testing technologies that improve EBT implementation; and 3) build expertise in minority health and health disparities research. The proposed research includes two aims that build on each other to support these training goals.
Aim 1 will study adaptations to family-based treatment (FBT) for youth with anorexia nervosa and atypical anorexia nervosa by examining implementation by five clinicians with fifteen families in a county mental health system. The primary implementation outcomes are fidelity and adaptations, which will be used to further adapt FBT for Aim 2. Semi-structured interviews will explore provider experiences (n = 5) in implementing FBT for youth with EDs (e.g., implementation challenges, rationale for treatment adaptations), as well as caregivers' experiences (n = 8) receiving FBT. These projects support treatment refinement and adaptations for Aim 2, which will develop and pilot test the acceptability, utilization, and preliminary effectiveness of a web-based training (n = 9) compared to in-person training (n = 9) in the adapted FBT model. The study results will serve as pilot data for an R01 study focused on cost-effective training models to support EBT implementation for youth with EDs, particularly informing efforts to improve access to care across diverse, underserved youth. This proposal aligns with NIMH Strategic Objectives (4.1, 4.2) to improve the ?effectiveness of existing mental health services? and the ?dissemination, implementation, and continuous improvement of evidence-based mental health services? through research and research-practice partnerships, particularly for ?underserved populations.? The carefully-assembled mentoring team, exceptional scientific environment, and proposed training and research activities will support the candidate's career development to ultimately improve publicly- funded clinical care for high-risk, understudied youth with EDs.
Given the mortality rate and the significant costs associated with a prolonged course of illness with medical complications and hospitalizations, individuals with eating disorders (EDs) represent a high-priority clinical population. This study will use implementation science theory and methods to first identify needed adaptations to family-based treatment (FBT) for youth with anorexia nervosa and atypical anorexia nervosa in publicly- funded settings, and then refine and pilot adapted FBT to determine its preliminary effectiveness. By increasing the implementation of an FBT for underserved diverse youth, this study has considerable potential to improve outcomes for youth with EDs, thereby reducing costs for this high-risk understudied population.
