Exploring the Effects of a Family Admissions Program for Adolescents with Anorexia Nervosa

Abstract

According to existing research, Maudsley Family Based Treatment (MFBT) is the most efficacious treatment option for children and adolescents suffering from Anorexia Nervosa (AN). Despite a wealth of evidence demonstrating the superior efficacy of MFBT for these young individuals, it is being increasingly documented in recent literature that a considerable minority of patients do not respond as expected to treatment. A number of adaptations to traditional MFBT have been made to accommodate these at-risk populations, one of which is the Family Admissions Program (FAP) – a recent treatment program that has been developed by the Eating Disorders Service at the Children’s Hospital at Westmead, with the specific aim of providing high intensity and immediate support to particularly vulnerable families at the outset of treatment. The FAP involves the adolescent and his/her family living in a self-contained ward within the hospital grounds for two weeks post discharge, whereby they complete a condensed form of parts of the first phase of traditional MFBT. The overall aims of this thesis were to provide a preliminary evaluation of the FAP, looking specifically at how participants experienced the program and its effects. The research consisted of two related qualitative studies. The first was a Narrative Inquiry, in which 10 adolescents and their families were invited to recount their journey with AN and what overall role they believed the FAP played within this. Results from the Narrative Inquiry indicated that the FAP provided two important mechanistic factors in families’ process of recovery from AN – a) an opportunity to reconnect and come together in a way that was more effective in fighting against the illness; and b) an experience, for parents in particular, that allowed for an increased sense of confidence, insight and motivation to continue engaging with MFBT once back at home. The second study used Interpretative Phenomenological Analysis to gain a detailed account of the nature of four families’ experiences as they were currently undergoing the FAP. Comparison was then made between how well the patients’ reflections aligned with clinical expectations and evaluations of their treatment in the program. Analyses revealed that clinicians and families held corresponding expectations and evaluations of their participation in the FAP, particularly those to do with changes witnessed in the wider family unit and the new way in which parents approached their management of the AN. Therapeutic intensity and proximity to the hospital’s supports and services were two key factors of the FAP that both clinicians and families noted as being particularly important in leading to these observed outcomes. Overall, the findings of the thesis indicate that for families who are coming to MFBT resource-poor, under relational strain and at an acute point of crisis, treatment needs to be adapted in a way that can provide a higher level of intensity and proximity to support, so that there can be a reconnection within the family unit.