National roll-out of early intervention for eating disorders: Process and clinical outcomes from first episode rapid early intervention for eating disorders

Aim: First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention model for young people with recent-onset eating disorders (ED). Promising results from a previous single-centre study and a four-centre study (FREED-Up) have led to the rapid national scaling of FREED to ED services in England (FREED-4-All). Our aim was to evaluate duration of an untreated ED (DUED), wait time target adherence, and clinical outcomes in FREED-4-All and compare these to the (benchmark) findings of the earlier FREED-Up study. Method: FREED services submit de-identified data to the central FREED team quarterly. The current study covers the period between September 2018 and September 2021. This FREED-4-All dataset includes 2473 patients. These were compared to 278 patients from the FREED-Up study. Results: DUED was substantially shorter in the FREED-4-All dataset relative to the FREED-Up study (15 vs. 18 months). Adherence to the wait time targets was comparable in both cohorts (similar to 85% of engagement calls attempted in <2 days, similar to 50%-60% of assessments offered in <14 days, similar to 40% of treatment offered in <28 days). Patients in the FREED-4-All dataset experienced significant improvements in ED and general psychological symptoms from pre- to post-treatment that were comparable to the FREED-Up study. These findings should be interpreted cautiously as only 6% of FREED-4-All patients had post-treatment data. Conclusions: Data from the FREED-4-All evaluation suggest that FREED is replicating at scale. However, these data are flawed, uncertain, proximate, and sparse and should therefore be used carefully alongside other evidence and clinical experience to inform decision making.

Automated summary

This study evaluated the duration of untreated eating disorders, adherence to wait time targets, and clinical outcomes in FREED-4-All and compared them to the findings of the earlier FREED-Up study. The results showed that DUED was shorter in FREED-4-All, adherence to wait time targets was comparable in both cohorts, and patients in FREED-4-All experienced significant improvements in symptoms similar to the FREED-Up study.