Elsevier

Journal of Pediatric Health Care

Volume 28, Issue 4, July–August 2014, Pages 322-330
Journal of Pediatric Health Care

Article
Implementation of Family-Based Treatment for Adolescents With Anorexia Nervosa

https://doi.org/10.1016/j.pedhc.2013.07.012Get rights and content

Abstract

Although the implementation of new treatment models can be a challenging process for health care services, the outcomes can be greatly beneficial to patients and service providers. This article describes the process of change experienced within our multidisciplinary specialist eating disorder service when we implemented a new evidence-based model of care focusing on outpatient family-based treatment (FBT). Clinical outcomes were positive, including a 56% decrease in admissions, a 75% decrease in readmissions, and a 51% decrease in total bed days. Of families referred to FBT, 83% completed treatment and 97% of completers achieved >90% of their expected body weight. Despite these gains, many challenges were experienced, including misgivings about the suitability of FBT and difficulties in adhering to changes in professional roles. We describe these challenges, describe how they were overcome, and review factors perceived to be critical to the program's success, including integration of medical and mental health services, communication, and training.

Section snippets

Background

The Royal Children's Hospital is a tertiary pediatric facility in Melbourne, Australia. Inpatient and outpatient treatment is provided free of charge through the national health care system. Until 2006, case management of adolescents with eating disorders was the responsibility of pediatricians, whose management aimed to promote medical stability and involved working with the adolescent to encourage weight gain. Inpatient admissions to a general adolescent medicine ward were routinely used in

Implementing a New Model of Care

FBT is an outpatient intervention in which a mental health clinician helps parents become actively involved in supporting weight gain and normalizing eating patterns for their child (Lock & Le Grange, 2013). Treatment progresses through three phases: (a) weight restoration, in which parents are charged with the task of refeeding by taking control of meals and supporting their adolescent to eat; (b) transitioning control of eating back to the adolescent; and (c) addressing adolescent

Inpatients

As seen in Table 1, hospital admissions were considerably reduced after the introduction of FBT. When comparing 2006 (2 years prior to the introduction of FBT) and 2010 (2 years after the introduction of FBT), the total number of admissions declined by 56% and the total number of persons admitted declined by 33%. Although the average length of stay appeared to increase somewhat after 2006, it has since declined, with half the total number of bed days. Readmissions represented 31% of admissions

Discussion

Restructuring the clinical program and implementing a new treatment model was an intensive and challenging process, but the benefits have been remarkable. Inpatient admissions, readmissions, and total bed days have fallen considerably, even after accounting for changes in the provision of services to geographical regions across the state. Of note, the total number of readmissions declined by 75% between 2006 and 2010, signifying great progress toward stopping the revolving door of

Elizabeth K. Hughes, Research Fellow for Eating Disorders, The University of Melbourne Department of Paediatrics and The Royal Children's Hospital Centre for Adolescent Health; Honorary Research Fellow, Murdoch Childrens Research Institute, Melbourne, Australia.

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    Elizabeth K. Hughes, Research Fellow for Eating Disorders, The University of Melbourne Department of Paediatrics and The Royal Children's Hospital Centre for Adolescent Health; Honorary Research Fellow, Murdoch Childrens Research Institute, Melbourne, Australia.

    Daniel Le Grange, Professor of Psychiatry, The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL.

    Andrew Court, Consultant Child and Adolescent Psychiatrist, The Royal Children's Hospital Consultant and Liaison Psychiatry Mental Health Team, Melbourne, Australia.

    Michele Yeo, Paediatrician, The Royal Children's Hospital Centre for Adolescent Health, Melbourne, Australia.

    Stephanie Campbell, Clinical Nurse Consultant for Eating Disorders, The Royal Children's Hospital Centre for Adolescent Health, Melbourne, Australia.

    Melissa Whitelaw, Clinical Specialist Dietitian, The Royal Children's Hospital Centre for Adolescent Health and Department of Nutrition and Food Services, Melbourne, Australia.

    Linsey Atkins, Senior Clinical Psychologist, The Royal Children's Hospital Integrated Mental Health Program and Centre for Adolescent Health, Melbourne, Australia.

    Susan M. Sawyer, Director and Paediatrician, Royal Children's Hospital Centre for Adolescent Health; Chair of Adolescent Health, The University of Melbourne Department of Paediatrics; and Honorary Research Fellow, Murdoch Childrens Research Institute, Melbourne, Australia.

    This work was supported by The Baker Foundation, The Butterfly Foundation, and the Victorian Government's Operational Infrastructure Support Program.

    Conflicts of interest: Daniel Le Grange receives royalties from Guilford Press and Routledge and consultant fees from the Training Institute for Child and Adolescent Eating Disorders.

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