When Christina Tortolani, Ph.D., isn’t busy developing Bryant’s Doctor of Clinical Psychology (Psy.D.) program, she’s supervising Rhode Island-based clinicians who are bringing family-based treatment (FBT) to homes to help patients experiencing eating disorders. Part of an ongoing collaboration with the University of Pittsburgh’s Andrea Goldschmidt, Ph.D., Tortolani and her fellow researcher have spent the past 10 years looking to improve the scope of eating disorder treatment services available to adolescents and young adults in Rhode Island.
“FBT is an outpatient behavioral approach focused on weight restoration and normalization of eating — it’s the treatment of choice for pediatric eating disorders,” says Tortolani, noting that, according to studies, more than 50 percent of patients who used FBT achieved full weight restoration by the end of treatment and had maintained their weight five years later.
While FBT research is extensive, few studies explore bringing treatment into a home-based setting. Working with Gateway Healthcare, The Providence Center, and Thrive Behavioral Health (three Rhode Island community behavioral health agencies), Tortolani — who is FBT certified — trained therapists in the FBT model and had them meet with patients in the home setting for three to six hours per week for 12 to 16 weeks.
“We saw that FBT home-based care was feasible — meaning it could be done, families liked it, and patient outcomes were positive,” Tortolani says, adding that eating disorders are devastating psychiatric illnesses that impede quality of life and can lead to self-harm or suicide.
FBT also offers a paradigm shift in how eating disorders were previously treated. Historically, if a child had an eating disorder, they may have received treatment away from the home and parents were rarely involved in the process.
“If you don't involve, educate, and partner with parents, they don't know how to help. They often feel blindsided by the illness, and at a loss of what to do,” says Tortolani, adding that funding for this research came from the Rhode Island Medicaid Interagency Service Agreement, Kohl’s Cares Foundation, and the National Institute of Mental Health.
Tortolani notes that bringing treatment into the home is valuable for multiple reasons: first, parents learn to apply treatment strategies within their own setting; second, clinicians can canvass the household pantry to support appropriate food selection and meal preparation; third, clinicians can observe familial communication patterns that may not be evident in traditional treatment settings. Additionally, implementing FBT at home can benefit underserved families who may have transportation difficulties and competing demands.
With clinicians coaching parents on how to re-nourish their child, Tortolani emphasizes that caregivers are the most important tool in their child’s recovery.
“I say to my parents, ‘I want you to know as much about an eating disorder as the nurse on an inpatient floor would,’” Tortolani says.
FBT has been around for approximately 20 years, yet the treatment has been underutilized in communities of lower income and racial and ethnic minority backgrounds. As of 2021, there were only 64 FBT-certified clinicians in the United States with several states lacking a single certified provider.
According to Tortolani, the certification process is costly and most of those who are certified work out of a private practice or research setting. Despite personnel limitations, bringing FBT into the home is a promising approach to increasing access and enhancing engagement and treatment outcomes regarding restrictive eating disorders.
“My research is community-based and really focuses on paying attention to gaps in the community and addressing them. It’s always amazing to hear clinicians’ and families’ stories of healing and recovery,” Tortolani says.
