Exploring the effects of a family admissions program for adolescents with anorexia nervosa

Abstract

BackgroundThis study investigated patient experience in a Family Admissions Program (FAP) – a pilot treatment program for adolescents with Anorexia Nervosa at the Children’s Hospital, Westmead. Based on Maudsley Family Based Treatment (FBT), the FAP involves an adolescent and his/her family undergoing a two-week family-based hospital admission at the outset of treatment. The program aims to increase intensity and support to a level needed by some families struggling to engage with or access FBT.MethodNarrative Inquiry and Interpretative Phenomenological Analysis were used as a dual methodological approach to explore the prospective expectations and retrospective experiences of participants partaking in the program.ResultsResults indicated that in cases where the family unit has been particularly fractured as a result of the eating disorder, the FAP offers an opportunity for relational strengthening and reunification. Combined with the program’s intensive support and proximity to hospital services, this serves to provide struggling families with enhanced skills and a stronger foundation for outpatient FBT.ConclusionsFor families deemed at risk of unsuccessful outcomes with FBT, the FAP can be considered as an appropriate treatment adjunct to place alongside or before the commencement of FBT.

Recent advances in therapies for eating disorders

“…Empirical data indicate that the model can be formulated to fit diagnoses, with promising results 10 . FBT for adolescents has been studied across a variety of contexts 15– 22 and multiple diagnoses 14, 24, 26 with favorable results, underscoring its clinical utility in young patients. Medication trials have led to the FDA approval of lisdexamfetamine for the treatment of BED 48 , and there is promise for olanzapine as an adjunctive treatment for weight gain in AN 49– 54 .…”

“…Although FBT was originally developed to be delivered in an outpatient setting, recent evidence has supported using the model within treatment programs offered at higher levels of care 15– 20 . Matthews et al .…”

Family-based inpatient treatment for adolescent anorexia nervosa: a thematic analysis of former patients’ post-treatment reflections

“…Overall, several participants appreciated that their parents had become more effective caretakers, becoming more supportive, both emotionally and via mutual understanding, and assuming greater responsibility in more supportive ways. A recent study found that a 2-week family admissions program was beneficial in strengthening relationships and providing reunification for the participants (Fink et al, 2017). In line with this, the family-based inpatient approach provides the families with a therapeutic context that both prevents separating significant relationships and offers a new common ground by inviting the family to join forces against the illness.…”

“…Outpatient FBT is by no means a one-size fits all treatment (Conti et al, 2017;Fink et al, 2017; Le Grange & Lock, 2014;Murray, Anderson, & Cohn, 2017;Strober, 2014). Augmentations and adaptations are needed to enable a better fit to non-responders and different levels of care (Richards, Subar, Touyz, & Rhodes, 2018).…”

“…Augmentations and adaptations are needed to enable a better fit to non-responders and different levels of care (Richards, Subar, Touyz, & Rhodes, 2018). Based on promising outcome from outpatient FBT, clinicians and program developers have started to incorporate FBT-principles into higher levels of care, including day hospital programs (Henderson et al, 2014), partial hospitalization programs (Hoste, 2015;Rienecke & Richmond, 2018), and short-term family-based inpatient treatment (Fink et al, 2017;Rockwell, Boutelle, Trunko, Jacobs, & Kaye, 2011;Wallis et al, 2013).…”