# Implementation, Outcome and Mechanisms of Family-Based Treatment for Adolescent Anorexia Nervosa Adapted for the Home Setting: A Pilot Effectiveness Trial

> **NIH NIH R34** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2024 · $232,642

## Abstract

PROJECT SUMMARY/ABSTRACT
Anorexia nervosa (AN) is a serious psychiatric illness that affects ~1% of adolescents and is associated with
high rates of morbidity and mortality. Family-based treatment (FBT), which involves empowering caregivers to
take control of refeeding to restore the adolescent to a normative weight and eating trajectory, is postulated to
operate via increasing caregiver self-efficacy related to refeeding, and decreasing adolescent distress through
repeated exposure to eating- and weight-related stimuli. Although FBT is currently considered the “first line”
treatment for adolescent AN, it is underutilized in community settings and is unavailable to many families for a
multitude of practical reasons (e.g., costs of treatment, limited availability of trained providers in many regions
of the country), particularly those from underrepresented sociodemographic groups. Furthermore, a substantial
subset of families do not optimally respond to FBT, which may be due to failure of newly acquired intervention
skills to generalize outside of the (typically office-based) treatment context. Home-based treatment is an
alternative to traditional office-based outpatient treatment that can reduce many pragmatic barriers to treatment
uptake and engagement, and may enhance generalizability of treatment skills as it is delivered in multiple
naturalistic settings where refeeding often occurs (e.g., home, school, community). Although home-based
models have been successfully applied to other psychiatric conditions, home-based treatments for AN have
never been tested. Moreover, FBT has undergone limited investigation in “real world” settings outside of
specialty academic and clinical environments dedicated to eating disorders. As a result, much of what is known
about FBT is based on relatively homogeneous samples with limited representation from individuals from lower
income and racial/ethnic minority backgrounds. Furthermore, it is unclear if putative FBT mechanisms apply in
the effectiveness context. The proposed R34 pilot effectiveness trial will assess outcomes, implementation,
and mechanisms of FBT for adolescent AN adapted for the home setting (FBT-HB), delivered in the context of
two community-based behavioral health agencies that serve a primarily lower-income, racially and ethnically
diverse clientele. Adolescents with AN-spectrum disorders (n=50) and their caregivers will be randomly
assigned to either FBT-HB or home-based usual care (integrated family therapy approach). Caregivers and
adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-
efficacy, adolescent distress, and generalizability of treatment skills. Implementation constructs will be
measured among providers and participating families. Overall aims are to assess preliminary effects of FBT-
HB on adolescent eating and weight outcomes; FBT-HB acceptability, appropriateness, feasibility, and fidelity;
and caregiver- and adolescent-l...

## Key facts

- **NIH application ID:** 10437726
- **Project number:** 5R34MH123589-03
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Andrea Beth Goldschmidt
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $232,642
- **Award type:** 5
- **Project period:** 2021-10-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10437726

## Citation

> US National Institutes of Health, RePORTER application 10437726, Implementation, Outcome and Mechanisms of Family-Based Treatment for Adolescent Anorexia Nervosa Adapted for the Home Setting: A Pilot Effectiveness Trial (5R34MH123589-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10437726. Licensed CC0.

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