Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model

BACKGROUND: The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model is associated with significant reductions in wait times and improved clinical outcomes for emerging adults with recent-onset eating disorders. An understanding of how FREED is implemented is a necessary precondition to enable an attribution of these findings to key components of the model, namely the wait-time targets and care package. AIMS: This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study. METHOD: Participants were 259 emerging adults (aged 16-25 years) with an eating disorder of <3 years duration, offered treatment through the FREED care pathway. Patient journey records documented patient care from screening to end of treatment. Adherence to wait-time targets (engagement call within 48 h, assessment within 2 weeks, treatment within 4 weeks) and care package, and differences in adherence across diagnosis and treatment group were examined. RESULTS: There were significant increases (16-40%) in adherence to the wait-time targets following the introduction of FREED, irrespective of diagnosis. Receiving FREED under optimal conditions also increased adherence to the targets. Care package use differed by component and diagnosis. The most used care package activities were psychoeducation and dietary change. Attention to transitions was less well used. CONCLUSIONS: This study provides an indication of adherence levels to key components of the FREED model. These adherence rates can tentatively be considered as clinically meaningful thresholds. Results highlight aspects of the model and its implementation that warrant future examination

International Dimension in Colonization of the North-West of America and California at the End of the 17-18 ^th Centuries

The article reviews the initial period of European colonization of the North Pacific Ocean and California within the context of diplomatic relations between Russia and Spain during the late 17th and early 18th centuries. It tries to understand the policies of European powers in the American Northwest and the reasons for pursuing their colonial interests there. It analyses the history of exploration of these territories, expeditions to the northern part of the Pacific Ocean, and historical maps of this region. For the first time in Russian historiography the authors touch upon the exploration of California in the 18th century.The exploration of the North Pacific Ocean, the northwestern American coast, including certain areas of California, Alaska and the Aleutian Islands has long attracted the attention of European powers. It was a process in which government authorities and private merchant companies took part. The expansion of the Spanish Empire into California was made possible in part because of the concerns of the Madrid court about the strengthening of the Russian and British empires in the North Pacific Ocean. The Spanish documents from the archives of Madrid, Seville and Simancas – the article introduces them into research communication the first time - show the validity of the fears of the Madrid court regarding the inevitable development of Russian colonization in the region. The advance of Russia to the shores of America has economic reasons: Cossacks and merchants reached the Pacific Ocean pursuing the desire to profit from the fur trade. As the economic influence expanded, the state interests of annexing territories and bringing the local population into citizenship followed behind. The territorial advance of the Russians to the Pacific Ocean was facilitated by the ambitious, but at the same time balanced diplomacy of Peter I, which managed to ensure the expansion of the borders of the Russian Empire.Spanish consolidation in certain territories in California was aimed at a possible containment of the Russian advance. Russian-Spanish relations in the Northwest Pacific at the end of the 17th – 18th centuries contributed to the nature of the subsequent development of territories in the North Pacific Ocean

Assessing the impact of First Episode Rapid Early Intervention for Eating Disorders on duration of untreated eating disorder: A multi-centre quasi-experimental study

BACKGROUND: Duration of untreated eating disorder (DUED), that is, the time between illness onset and start of first evidence-based treatment, is a key outcome for early intervention. Internationally, reported DUED ranges from 2.5 to 6 years for different eating disorders (EDs). To shorten DUED, we developed FREED (First Episode Rapid Early Intervention for EDs), a service model and care pathway for emerging adults with EDs. Here, we assess the impact of FREED on DUED in a multi-centre study using a quasi-experimental design. METHODS: Two hundred and seventy-eight patients aged 16-25, with first episode illness of less than 3 years duration, were recruited from specialist ED services and offered treatment via FREED. These were compared to 224 patients, of similar age and illness duration, seen previously in participating services (treatment as usual [TAU]) on DUED, waiting times and treatment uptake. RESULTS: FREED patients had significantly shorter DUED and waiting times than TAU patients. On average, DUED was reduced by ∼4 months when systemic delays were minimal. Furthermore, 97.8% of FREED patients took up treatment, versus 75.4% of TAU. DISCUSSION: Findings indicate that FREED significantly improves access to treatment for emerging adults with first episode ED. FREED may reduce distress, prevent deterioration and facilitate recovery

New Public Management: Promote the Public Sector Modernization Through Service Quality. Current Experiences and Future Challenges

New Public Management, Service, Quality, SERVQUAL, IPA, Inland Revenue office, Greece,