Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model

Richards, K., Flynn, M., Austin, A., Lang, K., Allen, K., Bassi, R., . . . Schmidt, U.

BJPsych Open



The First Episode Rapid Early Intervention for Eating Disorders
(FREED) service model is associated with significant reductions in wait
times and improved clinical outcomes for emerging adults with
recent-onset eating disorders. An understanding of how FREED is
implemented is a necessary precondition to enable an attribution of
these findings to key components of the model, namely the wait-time
targets and care package.


This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study.


Participants were 259 emerging adults (aged 16–25 years) with an
eating disorder of <3 years duration, offered treatment through the
FREED care pathway. Patient journey records documented patient care from
screening to end of treatment. Adherence to wait-time targets
(engagement call within 48 h, assessment within 2 weeks, treatment
within 4 weeks) and care package, and differences in adherence across
diagnosis and treatment group were examined.


There were significant increases (16–40%) in adherence to the
wait-time targets following the introduction of FREED, irrespective of
diagnosis. Receiving FREED under optimal conditions also increased
adherence to the targets. Care package use differed by component and
diagnosis. The most used care package activities were psychoeducation
and dietary change. Attention to transitions was less well used.


This study provides an indication of adherence levels to key
components of the FREED model. These adherence rates can tentatively be
considered as clinically meaningful thresholds. Results highlight
aspects of the model and its implementation that warrant future

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