Implementation and Evaluation of Telehealth-Delivered Family-Based Treatment for Adolescent Anorexia Nervosa: Enhancing Access and Effectiveness in Rural Health Services

Abstract

Anorexia nervosa (AN) holds one of the highest mortality rates of all psychiatric conditions. AN frequently begins during the adolescent period. Research has demonstrated that AN is treatable, especially when intervention is delivered early and involves the family. Family-Based Treatment (FBT) is an intensive outpatient approach recommended for adolescent AN. However, few practitioners are trained, making access difficult for rural families. This thesis explores barriers rural families face in accessing treatment for their child with AN and how telehealth can bridge these gaps through a real-world study in the rural public health system. The thesis begins with a review of FBT outcomes, barriers to access, and the role of telehealth in dissemination. Chapter 3 presents the largest systematic review on family treatments for adolescent AN, stratifying results by specialist and non-specialist settings. It reveals a significant disparity: 87% of research in the past two decades was conducted in specialist settings. The review emphasises the need for future studies to focus on disseminating FBT in real-world health environments, where treatments often require flexible delivery due to clinical demands and complex patient needs. Study 2 involved 28 rural Australian families with children diagnosed with AN or Atypical AN receiving FBT through telehealth. Significant improvements were noted in weight and eating disorder symptoms at the end of treatment and follow up. Study 3 examined health service stakeholders' views on the influence of research processes on implementation, identifying facilitators and challenges for embedding treatments in health systems. This thesis demonstrates that FBT can be safely delivered via telehealth to rural families within a complex public health system. It illustrates how health systems can implement digital evidence-based treatments while being active research partners. The implications for clinical and health system change are discussed.