Eating disorders (EDs) are common, disabling, and costly problems that affect up to 10% of individuals in their lifetimes and have increased in prevalence and severity since the start of the COVID-19 pandemic. However, there is an extremely wide treatment gap for EDs, and over 80% of individuals with EDs do not receive treatment. Early intervention is especially important during adolescence, because untreated symptoms become more frequent, severe, and persistent over time, and shorter latency between ED onset and start of treatment is associated with better outcomes. However, there are major barriers to treatment for adolescents with EDs, and there is clearly a need for a new model of delivery that can identify and help adolescents with and at risk for EDs. The Missouri EDs Council (MO EDC), a part of the Missouri Department of Mental Health, was established in 2010 by law. The MO EDC has been addressing the lack of access to treatment for EDs in Missouri through two initiatives: 1) the Body U Program, which provides ED screening and a suite of evidence-based digital programs for EDs prevention and treatment to adults; and 2) the 360 ED Training Program, which offers free and affordable EDs training programs to health and mental health providers across the state. The overarching objective of this project is to increase access to care and improve outcomes for EDs for adolescents in Missouri by harnessing state-wide partnerships and technology, using a model that could ultimately be widely implemented. In line with this overall objective, our specific goals are to: 1) develop and implement evidence-based interventions for EDs; 2) create partnerships to address gaps in care; 3) create developmentally appropriate education and outreach; and 4) plan for a transition of a successful project to sustainability. To accomplish our goals, we will implement the Body U Program in Missouri middle and high schools. Body U is based on decades of research and is
comprised of multiple evidence-based components, including online EDs screening; a digital self-help program for adolescents at low risk of developing an ED; a digital self-help program for adolescents at high risk of developing an ED; a coached digital program for adolescents with clinical/subclinical EDs other than AN; and referrals to providers trained by the MO EDC 360 Program for those screening positive for AN. The digital programs will also address the social isolation and loneliness which has increased in the COVID-19 pandemic for many adolescent girls and contributed to ED symptoms. The adolescent version of our Body U Program will be implemented in partnership with schools and parents, with school nurses in the state serving as care navigators and supporting community-clinical linkages. We have assembled the state-wide partners needed to successfully disseminate and implement this program, as well as foster its sustainability. These partners include: the Missouri Department of Mental Health, Missouri Child Psychiatry Access Project, Missouri Behavioral Health Council, Missouri Department of Health and Senior Services, Missouri Coordinated School Health Coalition, the Missouri Association for School Nurses, and the National Center for Rural School Mental Health with additional state-wide and national partnerships to be forged over the project period. Over the course of this 3-year grant, we will implement the Body U Program in at least 10 public school districts in Missouri, reaching at least 2,000 girls. We will also determine a plan for the continued implementation of Body U, not only in Missouri, but also in other settings across the country and globally. In summary, the Body U Program is a robust, evidence-based approach for providing screening and tailored digital interventions and referrals for EDs that harnesses state-wide partnerships and technology to maximize reach to adolescents and limit barriers to access. This approach would be ripe for broad
dissemination.
