Rachel Reeves is working with Eleanor Chatburn (University of Bath) to support the evaluation of a care model introduced by Dr Agnes Ayton (Ox Health Consultant Psychiatrist, Cotswold House). The study aims to understand the impact of CBT-E (Enhanced Cognitive Behavioural Therapy for Eating Disorders) in the inpatient pathway at Cotswold House. CBT-E was first developed for the treatment of eating disorders by Prof. Chris Fairburn and colleagues at CREDO, the University of Oxford. It was adapted for use in inpatient settings in a successful randomised controlled trial conducted at the private Villa Garda Hospital in Italy.

In 2014, Agnes and a colleague visited Villa Garda to learn about the care model and, as far as is practical, the Cotswold House team have tried to replicate the Villa Garda approach within the NHS context. The changes at Cotswold House were introduced gradually, most of them starting in 2015. CBT-E is a complex system-level intervention, which includes training staff in CBT-E; individualised psychological formulation; patient and carer involvement in care planning; planned, time-limited admissions; and increased rate of weight restoration.

OHI’s involvement in the project is to try to gain a clearer understanding of how and when elements of CBT-E were introduced at Cotswold House, and to analyse the patient data.  The statistical analysis examines outcomes for patients with eating disorders admitted to Cotswold House, comparing those who were admitted before 2015 with those who were admitted after 2015. Preliminary analyses suggest that those admitted after 2015 had greater gains in BMI and shorter lengths of stay.

A qualitative evaluation of the initial implementation of CBT-E is also underway, which aims to understand the nature and impact of the intervention in terms of the patient and staff experience, and to identify the barriers and opportunities for further improvements.