{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T14:14:24Z","timestamp":1764080064708,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K23","MH120347"],"award-info":[{"award-number":["K23","MH120347"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Family-based treatment (FBT) is the leading intervention for adolescents with anorexia nervosa (AN); however, it is under researched in socioeconomically disadvantaged and racially diverse youth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Semi-structured interviews were completed with ten FBT clinicians who practice in publicly-funded settings. Interview questions were focused on implementation challenges, overall acceptability and appropriateness of FBT, and naturally-occurring treatment adaptations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Content analysis revealed common themes relating to the implementation of FBT in publicly-funded, community-based settings: acceptability and appropriateness, complexity and learnability, perceived core components of FBT, cultural adaptations, socioeconomic factors, logistical considerations, organizational and systemic barriers, training acceptability, participant\u2019s self-efficacy, and telehealth accommodations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The discussed themes offer insights into the implementation of FBT for settings with limited resources, aligning with prior research on clinical adaptations for multicultural patients. Recognizing these themes can guide clinical adjustments and refine the adapted treatment model in real-world settings for patients facing systemic barriers.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2024.1389652","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T11:40:50Z","timestamp":1726227650000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Adaptations to family-based treatment for Medicaid-insured adolescents with anorexia nervosa"],"prefix":"10.3389","volume":"15","author":[{"given":"Renee","family":"Borges","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peyton","family":"Crest","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Landsverk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin C.","family":"Accurso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1080\/10640266.2017.1330319","article-title":"Adaptation and implementation of family-based treatment enhanced with dialectical behavior therapy skills for anorexia nervosa in community-based specialist clinics","volume":"26","author":"Accurso","year":"2018","journal-title":"Eat. Disord."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1001\/jamapediatrics.2021.2081","article-title":"Youth insured by Medicaid with restrictive eating disorders-underrecognized and underresourced","volume":"175","author":"Accurso","year":"2021","journal-title":"JAMA Pediatr."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/j.jaac.2023.08.019","article-title":"Exploring demographic and clinical characteristics of racially and ethnically diverse youth with eating disorders using California Medicaid claims data","volume":"63","author":"Accurso","year":"2024","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s40337-021-00454-0","article-title":"Adaptation to family-based treatment for Medicaid-insured youth with anorexia nervosa in publicly-funded settings: protocol for a mixed methods implementation scale-out pilot study","volume":"9","author":"Accurso","year":"2021","journal-title":"J. Eat. Disord."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1001\/jamapsychiatry.2014.1025","article-title":"Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial","volume":"71","author":"Agras","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1377\/hlthaff.2016.0029","article-title":"Removing obstacles to eliminating racial and ethnic disparities in behavioral health care","volume":"35","author":"Alegr\u00eda","year":"2016","journal-title":"Health Aff. (Millwood)"},{"volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013","key":"ref7"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1001\/archgenpsychiatry.2011.74","article-title":"Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies","volume":"68","author":"Arcelus","year":"2011","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s40337-021-00498-2","article-title":"An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service","volume":"9","author":"Bentz","year":"2021","journal-title":"J. Eat. Disord."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1002\/eat.24144","article-title":"Examining clinicians' perceptions and experiences working with diverse families in family-based treatment: common adaptations and considerations for treatment engagement","volume":"57","author":"Dimitropoulos","year":"2024","journal-title":"Int. J. Eat. Disord."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.psc.2019.01.004","article-title":"Family-based treatment of eating disorders: a narrative review","volume":"42","author":"Gorrell","year":"2019","journal-title":"Psychiatr. Clin."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1037\/0033-3204.43.4.531","article-title":"Culturally adapted mental health intervention: a meta-analytic review","volume":"43","author":"Griner","year":"2006","journal-title":"Psychotherapy"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"820043","DOI":"10.3389\/fpsyt.2022.820043","article-title":"A plea for diversity in eating disorders research","volume":"13","author":"Halbeisen","year":"2022","journal-title":"Front. Psych."},{"volume-title":"Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access to Care Could Be An Indication of Future Results","year":"2015","author":"Hayes","key":"ref15"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual. Health Res."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"101548","DOI":"10.1016\/j.eatbeh.2021.101548","article-title":"Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders","volume":"43","author":"Huryk","year":"2021","journal-title":"Eat. Behav."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1002\/eat.23405","article-title":"Introduction of family-based treatment to Japan with adaptations to optimize the cultural acceptability and advance current traditional treatments of adolescent anorexia nervosa","volume":"54","author":"Iguchi","year":"2021","journal-title":"Int. J. Eat. Disord."},{"key":"ref19","first-page":"533","article-title":"Management of adult patients with anorexia nervosa: a literature review","volume":"30","author":"Jassogne","year":"2018","journal-title":"Psychiatr. Danub."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1111\/j.1468-2850.2006.00042.x","article-title":"Making the case for selective and directed cultural adaptations of evidence-based treatments: examples from parent training","volume":"13","author":"Lau","year":"2006","journal-title":"Clin. Psychol. Sci. Pract."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1016\/j.jaac.2015.08.008","article-title":"Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa","volume":"54","author":"Le Grange","year":"2015","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1001\/archgenpsychiatry.2010.128","article-title":"Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa","volume":"67","author":"Lock","year":"2010","journal-title":"Arch. Gen. Psychiatry"},{"volume-title":"Treatment Manual for Anorexia Nervosa: A Family-Based Approach","year":"2015","author":"Lock","key":"ref22"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1002\/eat.20787","article-title":"Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders","volume":"44","author":"Marques","year":"2011","journal-title":"Int. J. Eat. Disord."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e002646","DOI":"10.1136\/bmjopen-2013-002646","article-title":"The incidence of eating disorders in the UK in 2000-2009: findings from the general practice research database","volume":"3","author":"Micali","year":"2013","journal-title":"BMJ Open"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-14-943","article-title":"The changing demographic profile of eating disorder behaviors in the community","volume":"14","author":"Mitchison","year":"2014","journal-title":"BMC Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12968\/hmed.2020.0099","article-title":"Anorexia nervosa in adolescents","volume":"81","author":"Neale","year":"2020","journal-title":"Br. J. Hosp. Med."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/01.NURSE.0000580640.43071.15","article-title":"Anorexia nervosa in adolescents: an overview","volume":"49","author":"Peterson","year":"2019","journal-title":"Nursing"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e027339","DOI":"10.1136\/bmjopen-2018-027339","article-title":"Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study","volume":"9","author":"Petkova","year":"2019","journal-title":"BMJ Open"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1176\/appi.ajp.159.8.1284","article-title":"The outcome of anorexia nervosa in the 20th century","volume":"159","author":"Steinhausen","year":"2002","journal-title":"Am. J. Psychiatry"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"100","DOI":"10.5430\/jnep.v6n5p100","article-title":"Theme development in qualitative content analysis and thematic analysis","volume":"6","author":"Vaismoradi","year":"2016","journal-title":"J. Nurs. Educ. Pract."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1097\/YCO.0000000000000739","article-title":"Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa","volume":"34","author":"van Eeden","year":"2021","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1037\/pro0000244","article-title":"Clinical treatment and practice recommendations for disordered eating in Asian Americans","volume":"50","author":"Yu","year":"2019","journal-title":"Prof. Psychol. Res. Pract."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2024.1389652\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T11:41:33Z","timestamp":1726227693000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2024.1389652\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,13]]},"references-count":32,"alternative-id":["10.3389\/fpsyg.2024.1389652"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2024.1389652","relation":{},"ISSN":["1664-1078"],"issn-type":[{"type":"electronic","value":"1664-1078"}],"subject":[],"published":{"date-parts":[[2024,9,13]]},"article-number":"1389652"}}