A qualitative evaluation of the pathway for eating disorders and autism developed from clinical experience (PEACE): clinicians' perspective.

Introduction: The Pathway for Eating disorders and Autism developed from Clinical Experience (PEACE pathway) is a clinical pathway of adapted treatment for individuals with eating disorders and autism in the UK. This study aims to investigate multidisciplinary clinicians' views of the strengths and challenges of PEACE pathway adaptations, while identifying areas where further improvement is needed. Method: Semi-structured interviews were conducted with 16 clinicians who worked on the PEACE pathway. Themes relevant to the benefits, challenges and areas of improvement were identified, and a thematic map was produced. Results: PEACE Pathway brought clinical benefits such as improved understanding of patients' perspective, improved flexibility and individualisation in clinicians' approach, increased patient engagement, and provision of resources that are helpful to all patients with or without autism. Benefits to the service included increase in autism awareness, clinicians' confidence, and team collaboration. Challenges were also identified, including difficulties in incorporating autism adaptations into existing treatment protocol, implementing PEACE at different levels of care, staff schedule conflicts, and increased pressure to meet patients' needs. Overall, there is a need for systemic improvement in aftercare and community support for autism, more suitable autism screening tool, and more structured guidelines for making adaptations. Conclusions and implications: PEACE Pathway has brought clinical and service benefits, while also bringing practical challenges rooted in the difficulty in distinguishing between autism and eating disorder in comorbid population. Future areas of improvement are highlighted for PEACE resources as well as in the national support system for autistic individuals.

A crisis planning and monitoring intervention to reduce compulsory hospital readmissions (FINCH study): protocol for a randomised controlled feasibility study.

BACKGROUND: Rates of compulsory (also known as involuntary) detention under mental health legislation have been rising over several decades in countries including England. Avoiding such detentions should be a high priority given their potentially traumatic nature and departure from usual ethical principles of consent and collaboration. Those who have been detained previously are at high risk of being detained again, and thus a priority group for preventive interventions. In a very sparse literature, interventions based on crisis planning emerge as having more supporting evidence than other approaches to preventing compulsory detention. METHOD: We have adapted and manualised an intervention previously trialled in Zürich Switzerland, aimed at reducing future compulsory detentions among people being discharged following a psychiatric admission that has included a period of compulsory detention. A co-production group including people with relevant lived and clinical experience has co-designed the adaptations to the intervention, drawing on evidence on crisis planning and self-management and on qualitative interviews with service users and clinicians. We will conduct a randomised controlled feasibility trial of the intervention, randomising 80 participants to either the intervention in addition to usual care, or usual care only. Feasibility and acceptability of the intervention and trial procedures will be assessed through process evaluation (including rates of randomisation, recruitment, and retention) and qualitative interviews. We will also assess and report on planned trial outcomes. The planned primary outcome for a full trial is repeat compulsory detention within one year of randomisation, and secondary outcomes include compulsory detention within 2 years, and symptoms, service satisfaction, self-rated recovery, self-management confidence, and service engagement. A health economic evaluation is also included. DISCUSSION: This feasibility study, and any subsequent full trial, will add to a currently limited literature on interventions to prevent involuntary detention, a goal valued highly by service users, carers, clinicians, and policymakers. There are significant potential impediments to recruiting and retaining this group, whose experiences of mental health care have often been negative and traumatising, and who are at high risk of disengagement. TRIAL REGISTRATION: ISRCTN, ISRCTN11627644. Registered 25th May 2022, https://www.isrctn.com/ISRCTN11627644 .

Virtually delivered guided self-help for binge eating disorder and bulimia nervosa: findings from a service evaluation.

BACKGROUND: Timely intervention is beneficial to the effectiveness of eating disorder (ED) treatment, but limited capacity within ED services means that these disorders are often not treated with sufficient speed. This service evaluation extends previous research into guided self-help (GSH) for adults with bulimic spectrum EDs by assessing the feasibility, acceptability, and preliminary effectiveness of virtually delivered GSH using videoconferencing. METHOD: Patients with bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding and eating disorders (OSFED) waiting for treatment in a large specialist adult ED out-patient service were offered virtually delivered GSH. The programme used an evidence-based cognitive behavioural self-help book. Individuals were supported by non-expert coaches, who delivered the eight-session programme via videoconferencing. RESULTS: One hundred and thirty patients were allocated to a GSH coach between 1 September 2020 and 30 September 2022; 106 (82%) started treatment and 78 (60%) completed treatment. Amongst completers, there were large reductions in ED behaviours and attitudinal symptoms, measured by the ED-15. The largest effect sizes for change between pre- and post-treatment were seen for binge eating episode frequency (d = -0.89) and concerns around eating (d = -1.72). Patients from minoritised ethnic groups were over-represented in the non-completer group. CONCLUSIONS: Virtually delivered GSH is feasible, acceptable and effective in reducing ED symptoms amongst those with bulimic spectrum disorders. Implementing virtually delivered GSH reduced waiting times, offering a potential solution for long waiting times for ED treatment. Further research is needed to compare GSH to other brief therapies and investigate barriers for patients from culturally diverse groups.

A systematic review of influences on implementation of supported self-management interventions for people with severe mental health problems in secondary mental health care settings.

PURPOSE: There is robust evidence for offering supported self-management interventions for people with severe mental illness (SMI) throughout secondary mental health services, but their availability remains patchy. The aim of this systematic review is to synthesise the evidence on barriers and facilitators to implementing self-management interventions for people with SMI in secondary mental health care settings. METHODS: The review protocol was registered with PROSPERO (CRD42021257078). Five databases were searched to identify relevant studies. We included full-text journal articles with primary qualitative or quantitative data on factors which affect the implementation of self-management interventions for people with SMI in secondary mental health services. The included studies were analysed using narrative synthesis, using the Consolidated Framework for Implementation Research and an established taxonomy of implementation outcomes. RESULTS: Twenty-three studies from five countries met eligibility criteria. The barriers and facilitators identified in the review were mainly on the organisational level, but included some individual-level influences. Facilitators included high feasibility, high fidelity, a strong team structure, sufficient number of staff, support from colleagues, staff training, supervision, the presence of an implementation champion and adaptability of the intervention. Barriers to implementation include high staff turnover, staff shortage, lack of supervision, lack of support for staff delivering the programme, staff struggling with their increased workload, a lack of senior clinical leadership, and programme content perceived as irrelevant. CONCLUSION: The findings from this research suggest promising strategies to improve implementation of self-management interventions. For services providing support for people with SMI, organisational culture should be considered, as well as the adaptability of interventions.

Pilot study of facial and bodily feedback.

BACKGROUND: The modulation hypothesis of facial feedback has not adequately examined how combining facial expressions and bodily postures might influence our experience of emotional stimuli. This pilot study examined a new method for manipulating both face and body together, which is important in furthering our understanding of how face and body interact to influence emotional experiences in the real world. METHODS: Using a within-subjects design, 30 participants viewed positive film clips under four conditions: (1) positive face with positive body (PP), (2) positive face with neutral body (PN), (3) neutral face with positive body (NP) and (4) neutral face with neutral body (NN). Measures of positive and negative affect were taken before and after each clip, to assess the subjective emotional experience. RESULTS: Repeated-measures analysis of variance (ANOVA) was conducted to examine differences in the emotional experience under each condition. Post hoc pairwise comparisons demonstrated that positive affect in the PP condition was significantly higher than in the NP and NN conditions. There was no significant difference between the PP and NN conditions. CONCLUSION: Whilst the study findings are difficult to interpret, this pilot study generated a number of important methodological learnings that are relevant to future research of this kind.

How to support adults with anorexia nervosa and autism: Qualitative study of clinical pathway case series.

Introduction: Previous research has explored the overlapping presentation between autism and eating disorders (ED). This study aims to summarize the clinical challenges associated with co-occurring autism and anorexia nervosa (AN) based on clinicians' case notes and minutes from case discussions, to understand how to better support people with the comorbidity. Method: Thematic analysis was conducted on de-identified notes on 20 cases with AN and autistic characteristics and minutes from case discussions. Themes relevant to clinical challenges in supporting those with the comorbidity were identified, and a thematic map was produced to visually represent the results. Results: The key challenges faced by clinicians when treating patients with AN and autism included: communication difficulties, maintaining boundaries, autism screening, presence of other comorbidities, sensory difficulties, atypical presentation of eating difficulties, cognitive rigidity, and emotional difficulties. Adaptations to resolve some of these difficulties included exposure-based food experiments, keeping a record of patients' self-reported communication preferences, individual-level modification of communication style, and providing tools for patients to identify emotions. Conclusions and implications: Further exploration to establish the effectiveness of the adaptations is warranted. Furthermore, tools for differentiating between ED, autism and other comorbidities are needed to help clinicians clarify the cause of a presenting symptom, and help them to best support and maintain boundaries with patients.