Bridging inpatient and community treatment: feasibility, acceptability, and short-term outcomes of step care, a virtual CBT-E pathway for adults with severe eating disorders.
Transitions between inpatient and community care carry a high risk of disengagement or relapse for adults with severe eating disorders. Step Care was developed to address this gap by adapting intensive enhanced cognitive behavioural therapy (CBT-E) for remote, multidisciplinary delivery in patients' homes. The virtual service operates through three pathways, Starting Well, Staying Well, and Working Towards Recovery, and aims to improve engagement, reduce hospitalisation, and prevent relapse.
This paper describes the Step Care service innovation and reports a prospective service evaluation examining its feasibility, acceptability, and short-term outcomes. All patients referred between June 2023 and June 2025 were included. Quantitative outcomes included body mass index (BMI), Eating Disorder Examination Questionnaire (EDE-Q), Clinical Impairment Assessment (CIA), Patient Health Questionnaire-9 (PHQ-9), and Generalised Anxiety Disorder-7 (GAD-7), measured at admission and discharge. Illustrative qualitative feedback from patients, carers, and staff is presented.
Of the 124 referrals, 66 patients commenced treatment (Starting Well, n = 34; Staying Well, n = 22; Working Towards Recovery, n = 10). The mean age was 32.1 years (SD = 12.0), and the mean illness duration was 12.9 years (SD = 11.0); 90% were female and 94% were White British. Completion rates were between 80 and 94% across pathways. In Starting Well, significant improvements were observed in BMI, eating disorder symptoms, psychosocial impairment, and depressive symptoms (all p < 0.01). In Staying Well, BMI was maintained with improved psychosocial functioning (CIA, p = 0.048). In Working Towards Recovery, BMI change was limited, but psychosocial impairment improved (CIA, p = 0.024). Overall, 77% were discharged to community care, 14% required planned admission to hospital, and one required an unplanned admission.
Step Care is a feasible, acceptable, and effective virtual model for delivering intensive CBT-E at key transition points between inpatient and community care. Engagement and completion were high, including among patients with severe and long-standing illness. Short-term improvements were observed in weight and psychosocial functioning, alongside consistently positive feedback from patients, carers, and staff. These findings support further evaluation of long-term outcomes and cost-effectiveness.
This paper describes the Step Care service innovation and reports a prospective service evaluation examining its feasibility, acceptability, and short-term outcomes. All patients referred between June 2023 and June 2025 were included. Quantitative outcomes included body mass index (BMI), Eating Disorder Examination Questionnaire (EDE-Q), Clinical Impairment Assessment (CIA), Patient Health Questionnaire-9 (PHQ-9), and Generalised Anxiety Disorder-7 (GAD-7), measured at admission and discharge. Illustrative qualitative feedback from patients, carers, and staff is presented.
Of the 124 referrals, 66 patients commenced treatment (Starting Well, n = 34; Staying Well, n = 22; Working Towards Recovery, n = 10). The mean age was 32.1 years (SD = 12.0), and the mean illness duration was 12.9 years (SD = 11.0); 90% were female and 94% were White British. Completion rates were between 80 and 94% across pathways. In Starting Well, significant improvements were observed in BMI, eating disorder symptoms, psychosocial impairment, and depressive symptoms (all p < 0.01). In Staying Well, BMI was maintained with improved psychosocial functioning (CIA, p = 0.048). In Working Towards Recovery, BMI change was limited, but psychosocial impairment improved (CIA, p = 0.024). Overall, 77% were discharged to community care, 14% required planned admission to hospital, and one required an unplanned admission.
Step Care is a feasible, acceptable, and effective virtual model for delivering intensive CBT-E at key transition points between inpatient and community care. Engagement and completion were high, including among patients with severe and long-standing illness. Short-term improvements were observed in weight and psychosocial functioning, alongside consistently positive feedback from patients, carers, and staff. These findings support further evaluation of long-term outcomes and cost-effectiveness.
Authors
Gardner Gardner, Ryan Ryan, Tomkova Tomkova, Moreton Moreton, Hamadi Hamadi, Fila Fila, Ayton Ayton
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