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Background: First Episode Rapid Early Intervention for Eating Disorders (FREED) is a service model and care pathway for emerging adults aged 16 to 25‐years with a recent onset eating disorder (ED) of <3 years. A previous single‐site study suggests that FREED significantly improves clinical outcomes compared to treatment‐as‐usual (TAU). The present study (FREED‐Up) assessed the scalability of FREED. A multi‐centre quasi‐experimental pre‐post design was used, comparing patient outcomes before and after implementation of FREED in participating services. Methods: FREED patients (n = 278) were consecutive, prospectively ascertained referrals to four specialist ED services in England, assessed at four time points over 12 months on ED symptoms, mood, service utilization and cost. FREED patients were compared to a TAU cohort (n = 224) of similar patients, identified retrospectively from electronic patient records in participating services. All were emerging adults aged 16–25 experiencing a first episode ED of <3 years duration. Results: Overall, FREED patients made significant and rapid clinical improvements over time. 53.2% of FREED patients with anorexia nervosa reached a healthy weight at the 12‐month timepoint, compared to only 17.9% of TAU patients (X2 [1, N = 107] = 10.46, p <.001). Significantly fewer FREED patients required intensive (i.e., in‐patient or day‐patient) treatment (6.6%) compared to TAU patients (12.4%) across the follow‐up period (X2 [1, N = 40] = 4.36, p =.037). This contributed to a trend in cost savings in FREED compared to TAU (−£4472, p =.06, CI −£9168, £233). Discussion: FREED is robust and scalable and is associated with substantial improvements in clinical outcomes, reduction in inpatient or day‐patient admissions, and cost‐savings. [ABSTRACT FROM AUTHOR]

Background: Duration of untreated eating disorder (DUED), that is, the time between illness onset and start of first evidence‐based treatment, is a key outcome for early intervention. Internationally, reported DUED ranges from 2.5 to 6 years for different eating disorders (EDs). To shorten DUED, we developed FREED (First Episode Rapid Early Intervention for EDs), a service model and care pathway for emerging adults with EDs. Here, we assess the impact of FREED on DUED in a multi‐centre study using a quasi‐experimental design. Methods: Two hundred and seventy‐eight patients aged 16–25, with first episode illness of less than 3 years duration, were recruited from specialist ED services and offered treatment via FREED. These were compared to 224 patients, of similar age and illness duration, seen previously in participating services (treatment as usual [TAU]) on DUED, waiting times and treatment uptake. Results: FREED patients had significantly shorter DUED and waiting times than TAU patients. On average, DUED was reduced by ∼4 months when systemic delays were minimal. Furthermore, 97.8% of FREED patients took up treatment, versus 75.4% of TAU. Discussion: Findings indicate that FREED significantly improves access to treatment for emerging adults with first episode ED. FREED may reduce distress, prevent deterioration and facilitate recovery. Highlights: This study is a large‐scale replication of an earlier single‐centre pilot study of First Episode Rapid Early Intervention for Eating Disorders (FREED). Findings indicate that, as in the pilot study, FREED significantly reduces duration of untreated eating disorder and is associated with significantly shorter wait times for both assessment and treatment when implemented at scaleDifferences between groups were more pronounced when systemic delays were minimalThe proportion of FREED patients taking up treatment was significantly higher than in treatment as usual, suggesting that a shorter interval between help‐seeking from primary care and an offer of specialist assessment/treatment has clear down‐stream benefits [ABSTRACT FROM AUTHOR]

Aims: Eating disorders are serious psychiatric disorders with high rates of morbidity and mortality. Early intervention can improve treatment outcomes and reduce disruption to psychosocial development. However, early intervention is not well established in the eating disorder field. First episode rapid early intervention for eating disorders (FREED) was developed to address barriers to early, effective eating disorder treatment in emerging adults aged 16 to 25 years. Since 2014, FREED has progressed from a single‐site research project to an evidence‐based care approach in nine eating disorder services. This paper aims to summarize key learning from the scaling of FREED to date, with attention to how this learning may generalizes to other models of care. Methods: We describe the development, scaling and implementation of FREED with reference to the RE‐AIM (reach; effectiveness/efficacy; adoption; implementation; maintenance) framework. We also summarize challenges and learning in each of the RE‐AIM domains. Results: FREED has demonstrated real‐world validity across diverse clinical contexts, geographical regions and populations. Key outcomes are seen for each of the RE‐AIM domains. Conclusions: FREED provides an example of effective, non‐commercial scaling of an early intervention eating disorder care pathway. This work is likely to be particularly relevant to others looking to scale‐up early intervention models and for those working in secondary and tertiary mental health settings. [ABSTRACT FROM AUTHOR]

Aim: We describe 2‐year outcomes of a novel first episode early intervention service for young adults with a recent onset eating disorder (FREED). Outcomes in FREED patients with anorexia nervosa (AN) were compared with those from patients previously seen in our service [treatment as usual (TAU) cohort], matched for age, illness duration and diagnosis. Methods: Electronic case records of FREED‐AN (n = 22) and TAU‐AN patients (n = 35) were examined to identify service utilisation and clinical outcomes over 24 months. Results: Outpatient service utilisation was similar in both groups, but FREED‐AN patients needed intensive (in‐ or day‐patient) treatment less frequently than TAU‐AN (23% vs 32%). FREED‐AN patients had a higher estimated mean body mass index [19.2 kg/m2; 95% CI (18.21, 20.16)] than TAU patients [18.0 kg/m2; 95% CI (16.90, 19.15)] at last contact. Conclusion: Introduction of FREED led to a more complete recovery in patients with AN at 24 months. [ABSTRACT FROM AUTHOR]