Equip Treatment: How we took the best eating disorder treatment option available—FBT—and improved it
JD is Equip's Director of Mentorship. She is an educator turned Family Mentor whose youngest child developed anorexia in 2012; they received cutting edge, evidence-based treatment at UC San Diego, igniting JD’s passion to ensure all families have access to evidence-based care. She became active in online family support communities, writing, and began attending and speaking at conferences. She is a board member for FEAST.
Your most pressing question is likely, “How do I help my loved one and my family beat this eating disorder—for good?”
Equip took the most effective treatment model available for eating disorders—Family Based Treatment (FBT)—and gathered experts in the field, including those with lived experience, to build upon it in order to help you do just that.
Why do we need better treatment? Of patients who attend a residential treatment program, 50% need to be readmitted within a year—and only 35% of those with eating disorders fully recover in today’s current treatment landscape. (1) At Equip we believe we can change those numbers drastically by changing everything about the way eating disorders treatment is delivered. Those statistics reflect the lives of real people who deserve the chance to fulfill their potential and live lives free of the disruptive and often tragic impact of an eating disorder. Equip builds on fundamental principles of FBT and powerfully enhances it for better, longer-lasting results.
FBT produces the best results because it prioritizes nutritional rehabilitation and includes and trains families to make consistent nutrition happen.(2) Where traditional treatments focus on talk therapy to encourage choosing to eat and cease behaviors, FBT recognizes that malnourished brains cannot (versus will not) make these choices (3), and that compassionate, insistent, and trained families are best equipped to renourish their loved one. In fact, given that a core feature of eating disorders is lack of awareness of how sick one is, and ambivalence about recovery (4) , and that a core feature of eating disorder treatment is facing your greatest fear every day, multiple times a day, Equip believes that individual treatment is setting our patients up to fail.
Equip follows the principles of Family Based Treatment by:
- Empowering family caregivers. Families are willing and capable of doing hard work if it produces results.
- Beginning treatment by prioritizing nutritional rehabilitation and cessation of eating disorder behaviors
- Moving forward versus cataloguing patient history
To address the needs of families and get patients into long-term recovery, the Equip model includes important additions:
- A multidisciplinary team of highly-trained professionals, as well as peer and family mentors. This team provides wraparound support for families—because eating disorders are complex and affect more than just patients. We also incorporate lived experience because nobody knows better what families need than those who have been there.
- Care at home on your schedule, to make it possible to involve everyone in your family’s support circle and because we believe the key to lasting recovery is doing it in your real life.
- Explicit skills-training for families to improve the treatment experience, build lifelong recovery skills, provide relapse prevention, and improve family function
- Tracked outcomes and proven care practices. We deliver treatment effectively—and capture and utilize data to improve patient outcomes.
Let’s dive in deeper to what each of these four pillars of Equip’s Enhanced FBT look like.
1.) A multidisciplinary team of highly-trained professionals
Traditional FBT is delivered by one provider. At Equip, you get five. In the community, only 6-25% of eating disorder “specialists” utilize evidence based techniques (4). At Equip, all providers are Equip employees, trained in the latest evidence based treatments, and supervised by Equip. Most importantly, teams are all on the same page, meeting weekly to discuss progress and changes to the treatment plan.
Order and interpret labs, monitor vital signs, prescribe medications, and collaborate with outside specialists on medically complicated cases.
- Registered Dietitian (RD)
Interpret growth charts and provide target weights, provide nutrition prescriptions and movement protocols, work with athletes, and educate families and patients on nutrition to separate fact from popular culture beliefs.
Work fluidly with families as individual therapists, couples therapists, or family therapists. The therapist delivers evidence-based treatments and is the Care Team Manager, making sure the treatment team is aligned on messages and education for families.
- Family mentor
A source of emotional and logistical support, normalizing common issues, providing context for treatment plan components, and brainstorming and coaching to develop and implement authentic solutions to create progress. Importantly, family and peer mentors both provide hope and confirmation that recovery is achievable.
- Peer mentor
A confidante who will understand, commiserate, teach skills, and support patients through challenges. Peer mentors are a living, breathing testament that full recovery is possible and worth it.
Our care teams truly operate as a cohesive team and receive the time, space, and tools they need to enable coordination. No more mixed messages from providers, or quarterbacking your own care team.
2. Care at home on your schedule
Equip’s virtual treatment delivery allows you to access your providers whenever works best for your family. Because multiple people can participate in care sessions regardless of location—you can define who is in your family support circle. No time is wasted driving to clinic appointments, and families don’t need to leave work or school for care. Your entire family has access to support, including siblings and your family’s needs are addressed holistically.
Your loved one with an eating disorder will need to face their greatest challenge multiple times a day, and we know that for most people, that requires more support than a once a week therapy session. Families have unlimited access to their care team, can adjust the number of sessions with their providers, and message them between sessions. If you just need a quick check-in, we offer short appointments—as well as regular hour-long sessions.
Finally, Equip believes that you can’t build a life worth living if you’re not living life. Our goal is to help you address challenges in real life, and rebuild your life worth living so that there are real consequences to relapsing.
3. Explicit skills-training for families to build lifelong recovery skills
While FBT is the gold standard in getting adolescents to recovery, skills based training ensures that they remain in recovery long after treatment ends.
Equip providers teach skills and deliver behavioral therapies drawing from Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBTP), Exposure and Response Prevention (ERP), and Emotion Focused Family Therapy (EFFT) from day one.
Patients and families learn distress tolerance skills, communication skills, and tangible skills like how to deal with dieting peers. We expose patients to challenges (food and otherwise) from day one to build a well of resilience and coping skills.
Finally, we know that eating disorders rarely occur in isolation. Equip providers are trained to treat comorbid anxiety, depression, trauma, substance use, and autism spectrum disorder concurrently with the eating disorder. As adolescents complete nutritional rehabilitation and gain back independence, we work with them to harness their unique temperament traits for good.
4. Tracked outcomes and proven care practices.
We can’t know if treatment is working, nor how to improve upon it, unless we measure it. Equip was built on established research and is pioneering data-driven treatment. We collect and transparently share data with patients and families because they are our partners, and we use this information to drive our treatment plan and make adjustments to ensure consistent progress. Data collection, monitoring and evaluation include:
-Scores on eating disorders evaluation instruments
-Other measures, including hope for recovery and parental self efficacy
Equip Treatment: The New Gold Standard
Equip is built by professionals, peers, and families to create treatment that works for you—because that’s critical to what makes treatment successful. We supercharge FBT and utilize behavioral therapy models and lived experience because it provides the best chance for success. We built Equip to be the last treatment program families need—providing recovery that’s real, full, and sustained for life.
- Accurso EC, Le Grange D, Graham AK. Attitudes Toward Family-Based Treatment Impact Therapists' Intent to Change Their Therapeutic Practice for Adolescent Anorexia Nervosa. Front Psychiatry. 2020;11:305. Published 2020 Apr 23. doi:10.3389/fpsyt.2020.00305
- Lock, James, et al. "Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa." Archives of general psychiatry 67.10 (2010): 1025-1032.
- Accurso, Erin C., Anna C. Ciao, Ellen E. Fitzsimmons-Craft, James D. Lock, and Daniel Le Grange. "Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa." Behaviour research and therapy 56 (2014): 1-6.
- Gregertsen EC, Mandy W, Serpell L. The Egosyntonic Nature of Anorexia: An Impediment to Recovery in Anorexia Nervosa Treatment. Front Psychol. 2017;8:2273. Published 2017 Dec 22. doi:10.3389/fpsyg.2017.02273
- von Ranson KM, Wallace LM, Stevenson A. Psychotherapies provided for eating disorders by community clinicians: infrequent use of evidence-based treatment. Psychother Res. 2013;23(3):333-343. doi:10.1080/10503307.2012.735377
About JD Ouellette
JD Ouellette is an educator turned Family Mentor whose youngest child developed anorexia in 2012; they received cutting edge, evidence-based treatment at UC San Diego, igniting JD’s passion to ensure all families have access to evidence-based care. She became active in online family support communities, writing, and began attending and speaking at conferences. She is a past board member for FEAST.
Equip is a virtual eating disorder treatment program helping families recover from eating disorders at home. Equip’s holistic, data-driven, gold-standard care program is delivered by a team of five care professionals, giving families confidence they’re providing the best opportunity for progress and lasting recovery.