Family-Based Therapy via Telehealth
Family-Based Treatment (FBT), also known as the Maudsley method or Maudsley approach, is widely considered the treatment of choice for adolescents with eating disorders. Numerous studies have demonstrated the effectiveness of FBT, and indeed, at The Emily Program, we have found that adolescent clients who participate in FBT have the best outcomes of any treatment modality we utilize for this age group.
FBT is based on the understanding that families know their children better than anyone else and is anchored by the idea that parents are often fully capable of feeding their children. In the FBT model, parents have control of their child’s weight restoration and are actively involved in their child’s recovery process. The role of the professional is to support the family as they work toward restoring their child’s health.
FBT is traditionally used in outpatient settings, where the child can remain at home and participate in normal family life. However, many children with eating disorders are not able to fully recover in an outpatient setting. This is not because the parents, child, or therapist are doing FBT wrong. It is because of the complexity of the child’s illness. Even with approaches like FBT, eating disorders are extremely difficult to treat.
As a result of this, children with eating disorders often require higher levels of care, including residential treatment and partial hospitalization/intensive day programs (PHP/IDP). Since the goal of FBT is for a child to overcome their eating disorder in the context of family life, FBT can sometimes be challenging to navigate in more intensive care settings.
New opportunities for family involvement with FBT via telehealth
In response to the coronavirus pandemic, PHP treatment has moved from in-person to telehealth delivery. Prior to the pandemic, coverage for higher levels of care via telehealth was not in place, but was quickly adjusted by insurance companies to facilitate continuity of care within the pandemic stay-at-home orders. Thus, in the early weeks of the pandemic, providers were able to navigate multiple factors regarding payment, confidentiality, and other regulatory matters in order to deliver PHP via telehealth. Leadership at The Emily Program expanded technology resources, redesigned programming, and reconfigured staffing and training in a matter of days in order to enable telehealth intensive programming.
We have worked hard to incorporate FBT into the Virtual Treatment we are currently offering for adolescent PHP. Through telehealth PHP, adolescents are now receiving intensive care that also involves the family and integrates FBT principles.
The child is living at home, which we want. Parents are providing food and meals, which we want. Parents are always aware of what is happening, which we want. And parents are able, if they want, to speak directly to their child’s care providers. Treatment teams and families can work together in supporting the child, more closely than would be possible if the child were at a treatment center. With telehealth, we can also extend the reach much farther into all the areas we serve.
We are very excited about involving families and incorporating FBT into a more intensive level of adolescent care. We feel optimistic that this combination of treatment elements will be even more effective than other approaches have been.
Effective treatment of adolescent eating disorders is so important. Though eating disorders can and do affect people across the lifespan, many are developed in adolescence and early adulthood. It is therefore crucial that we get treatment to as many people as possible in this age group.
While we are only just beginning to offer telehealth to adolescents, we are grateful that parents and care teams are able to work together more closely in many cases. We are excited for the future possibilities of adolescent telehealth, and we will continuously collect data on the approach and hone the virtual care we offer.
Even in this time of terrible tragedy, we are hopeful that this new application of treatment will ultimately prove to be helpful for many.
If you believe your child may be struggling with an eating disorder, please consider completing a brief eating disorder assessment or calling The Emily Program at 1-888-364-5977. A how-to guide for parents and other resources are also available on our website.
ABOUT THE AUTHOR
Mark Warren, MD
Mark Warren is the Chief Medical Officer of The Emily Program. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.