Intensive community and home-based treatments for eating disorders: a scoping review

Abstract

Background

Intensive community treatment (ICT) and home-based treatment (HBT) have emerged as valuable alternatives to institution-based intensive treatments (inpatient or day patient) for severe mental illnesses. Although potential benefits of ICT and HBT for eating disorders (EDs) have been proposed, this area of research remains largely unexplored.

Method

A scoping review was conducted to map the available literature. Four databases (PubMed, PsycInfo, MEDLINE, Web of Science), grey literature, and trial registries were searched. Sources were included if they presented treatments offering more than two planned therapeutic contacts per week for at least part of the program, excluding physical monitoring contacts, for patients diagnosed with any ED across all ages.

Results

Forty-six sources met the inclusion criteria (ICT: n = 31; HBT: n = 15), with most studies from Europe (n = 23) and the USA (n = 18). Among these, 28 reported quantitative data, six reported qualitative data, and three employed a mixed-methods approach. The remainder were either protocol papers or service descriptions only. The majority focused on anorexia nervosa (AN) or mixed EDs, with varying study designs and predominantly low to moderate evidence quality. There were no randomized controlled trials. HBTs primarily targeted children and adolescents with AN, emphasizing family-based approaches, while ICTs exhibited greater variability in age groups and diagnoses, frequently combining cognitive behavioral and dialectical behavioral therapies, often alongside family-based components for children and adolescents. Despite high variability in design, quality, and measurements, studies frequently reported improvements in clinical outcomes. Programs were often described as feasible and acceptable, noting patient satisfaction, strong adherence, and cost-effectiveness due to reduced hospital admissions.

Conclusions

Even though there was variability in implementation and methodologies, ICTs and HBTs appear to be promising alternatives to traditional institution-based intensive treatments. Future research requires higher-quality large-scale randomized trials with improved reporting of treatment characteristics and outcomes to enable robust investigations of effectiveness.

Plain English summary

This scoping review aims to investigate intensive community-based (ICT) and home-based treatments (HBT) as alternatives to traditional hospital care for eating disorders (EDs). We searched four major databases to identify studies where patients with ED received more than two therapeutic contacts weekly for at least part of the program, excluding physical monitoring appointments. Forty-six sources were included, mostly from Europe and the USA. HBTs often focused on children and adolescents with anorexia nervosa, emphasizing family involvement. ICTs varied more by target age and diagnosis, frequently cognitive behavioral and dialectical behavioral therapies, often alongside family-based components for children and adolescents. Despite differences in study designs, these studies often reported improved patient outcomes, high satisfaction, and cost savings due to fewer hospital admissions. While the evidence quality is currently low to moderate with no randomized controlled trials, ICTs and HBTs seem to be promising interventions. Future research in this area needs to design higher-quality studies with clearer descriptions of treatment ingredients and more consistent reporting of how well treatments work.