<p>Classification of a community-based eating disorder service as a specialist service: Delphi survey</p><p>Findings from Delphi Round 1</p><p>Delphi round 1 Round one of the survey consisted of six questions relating to alternative criteria for a community-based eating disorder service to be classified as a specialist service (listed in Table 1). The importance of each criterion was rated by respondents on a five point Likert scale using the following categories:</p><p> 1 = Not important  2 = Slightly important  3 = Moderately important  4 = Very important  5 = Extremely important</p><p>Three of the six criteria had sub-questions which were completed by respondents who had rated the main criterion as important (‘slightly important’, ‘moderately important’, ‘very important’ or ‘extremely important’). </p><p>Consensus Consensus decision rules for the six main criteria were finalised prior to data analysis and focused on the percentage of respondents rating each criterion as either 4 (very important) or 5 (extremely important). The decision rules are as follows:</p><p>% rating criterion as 4 Decision rule or 5 80% to 100% Consensus reached and item included in checklist 50% to 79% Consensus not reached and item entered into Round 2 0% to 49% Consensus reached and item excluded from checklist</p><p>Results Responses for the six main criteria are reported in Table 1.</p><p>Consensus reached and item included in checklist The following items were rated by greater than 80% of respondents as either 4=very important or 5=extremely important when considering whether a community-based eating disorder service can be classified as a specialist service: </p><p> Offering specialist (evidence-based) outpatient treatment for eating disorders (91%)  Providing multi-disciplinary specialist outpatient clinics dedicated to eating disorders (87%)</p><p>1 Consensus was reached and these items will be included in the checklist and do not need to be re-rated in round 2 of the Delphi survey.</p><p>2 Consensus not reached The following items were rated by between 50% and 79% of respondents as either 4=very important or 5=extremely important when considering whether a community-based eating disorder service can be classified as a specialist service: </p><p> Holding weekly multi-disciplinary meetings dedicated to eating disorders (78%)  Number of cases of eating disorders a service sees per year (52%)</p><p>Consensus for these items was not achieved and so these items will be included in round 2 of the Delphi survey.</p><p>Consensus reached and item excluded The following items were rated by less than 50% of respondents as either 4=very important or 5=extremely important when considering whether a community-based eating disorder service can be classified as a specialist service: </p><p> Population size of the catchment area covered by the service (29%)  Length of time a service has existed (9%)</p><p>Consensus was reached and these items will be excluded from the checklist and do not need to be re-rated in round 2 of the Delphi survey.</p><p>References 1. Diamond, I.R., et al., Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol, 2014. 67(4): p. 401-9. 2. Boulkedid, R., et al., Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One, 2011. 6(6): p. e20476. 3. Hoffmann, T.C., et al., Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Bmj-British Medical Journal, 2014. 348. 4. Keeney, S., F. Hasson, and H. McKenna, Consulting the oracle: ten lessons from using the Delphi technique in nursing research. Journal of Advanced Nursing, 2006. 53(2): p. 205-212. 5. Jorm, A.F., Using the Delphi expert consensus method in mental health research. Australian and New Zealand Journal of Psychiatry, 2015. 49(10): p. 887-897. 6. Morrison, A.P. and S. Barratt, What Are the Components of CBT for Psychosis? A Delphi Study. Schizophrenia Bulletin, 2010. 36(1): p. 136-142. 7. Sinha, I.P., R.L. Smyth, and P.R. Williamson, Using the Delphi Technique to Determine Which Outcomes to Measure in Clinical Trials: Recommendations for the Future Based on a Systematic Review of Existing Studies. Plos Medicine, 2011. 8(1).</p><p>3 Table 1: Results for the six main criteria included in Delphi survey round 1</p><p>Criterion 1=Not 2=Slightly 3=Moderatel 4=Very 5 4 or 5 Median Mode Consensus important important y important = important E x t r e m e l y i m p o r t a n t % (n) % (n) % (n) % (n) % % (n)</p><p>( n ) 0.6 (3) 1.9 (9) 6.75 (32) 31.7 (150) 5 5=extremely 5=extremely Included 9 important important . 1 Q1. Offering specialist (evidence-based) 90.7 (430) outpatient treatment for eating disorders ( 2 8 0 ) Q2. Holding weekly multi-disciplinary 1.5 (7) 2.7 (13) 17.9 (85) 38.4 (182) 3 77.9 (369) 4=very 5=extremely Uncertain meetings dedicated to eating disorders 9 important important . 5</p><p>4</p><p>( 1 8 7 ) 1.1 (5) 1.7 (8) 10.6 (50) 37.1 (176) 4 4=very 5=extremely Included 9 important important . 6 Q3. Providing multi-disciplinary specialist outpatient clinics dedicated to eating 86.7 (411) ( disorders 2 3 5 ) 5.7 (27) 9.3 (44) 33.1 (157) 33.1 (157) 1 4=very 3- Uncertain 8 important 4=moderately . to very 8 important Q4. Number of cases of eating disorders a 51.9 (246) service sees per year ( 8 9 ) 18.5 (85) 17.4 (80) 35.4 (163) 19.1 (88) 9 3=moderately 3=moderately Excluded . important important 5 7 Q6. Population size of the catchment area 28.7 (132) covered by the service ( 4 4 ) Q8. Length of time a service has existed 40.1 (179) 26.2 (117) 24.9 (111) 6.28 (28) 2 8.7 (39) 2=slightly 1=not Excluded . important important 4 7</p><p>( 1 1 5 )</p><p>6</p>