Identifying and responding to child maltreatment when delivering family‐based treatment—A qualitative study

Abstract

Introduction This study describes practitioner strategies, perceptions, experiences with identifying and responding to child emotional abuse (CEA) and child exposure to intimate partner violence (CEIPV) when providing Family‐Based Treatment (FBT) to children and adolescents with eating disorders. Method Using qualitative interpretive description, this study recruited a purposeful sample of practitioners (N = 30, 90% female) implementing FBT for adolescent eating disorders. Semi‐structured interviews focused on eliciting their perspectives regarding identifying and responding to CEA and CEIPV in practice. Interviews were conducted over the phone, were audio recorded, transcribed verbatim, and coded using conventional content analysis. Interim member checking, the thoughtful clinician test, and coding memos were used to ensure the integrity of the analysis. Results Participants were 31–57 years old and practicing FBT in five countries. Three data patterns emerged: (a) perceptions of child maltreatment prevalence and identification; (b) complicating factors; and finally (c) strategies to support family‐based work. Practitioners described important considerations for CEA and CEIPV identification, as well as possible FBT adaptations that can support the safety of children and adolescents while simultaneously ensuring the treatment of the eating disorder. Conclusions Practitioners describe a need for additional training to identify and respond to CEA and CEIPV within FBT and within practice more broadly. There is a need for trials that detail the appropriateness and efficacy of FBT for patients experiencing CEA and/or CEIPV.

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

“…A qualitative study with nurses identified that power battles over 'punitive' feeding causes patients great anguish and can rupture the therapeutic alliance [64]. These interactions may be overlooked as a complicating feature within family-based treatment [65]. Interestingly, in adolescence, reduced extinction of fears appears to be more pronounced with co-morbid depression [66].…”

“As long as they eat”? Therapist experiences, dilemmas and identity negotiations of Maudsley and family-based therapy for anorexia nervosa

“…These clinician narratives highlight some key areas to bridge this research-practice gap that include:The establishment of more comprehensive guidelines and ongoing assessment of “the appropriateness and efficacy of FBT(-AN)” ([46], p., 298) in therapeutic contexts including for example, when:The adolescent’s emotional distress (including in their eating and weight restoration) is too great and the intervention risks being traumatising;The burden on a family is too great and what might be the next steps in the care of the adolescent and their family; andThere exists a risk of child emotional abuse and family violence, thus highlighting the need for therapists who practice FBT-AN to have comprehensive training in responding to child emotional abuse and family violence [46]. Drawing on therapist expertise to both inform clinical practice guidelines [25] and future research into how to effectively tailor manualised treatments to the adolescent and family needs and preferences through reflective practice in supervision [43].…”

“…The establishment of more comprehensive guidelines and ongoing assessment of “the appropriateness and efficacy of FBT(-AN)” ([46], p., 298) in therapeutic contexts including for example, when:The adolescent’s emotional distress (including in their eating and weight restoration) is too great and the intervention risks being traumatising;The burden on a family is too great and what might be the next steps in the care of the adolescent and their family; andThere exists a risk of child emotional abuse and family violence, thus highlighting the need for therapists who practice FBT-AN to have comprehensive training in responding to child emotional abuse and family violence [46]. …”

Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders

“…A recent qualitative meta-synthesis highlighted that healthcare and social service providers experience challenges related to recognizing and responding to child maltreatment in their practice (27). Emerging work suggests that this is also the case among ED specialists (28). There are several potential implications of this practice challenge.…”

“…These include a non-determinant view of the illness, a non-authoritarian therapeutic stance, empowerment of caregivers to facilitate the recovery process, as well as an initial prioritization on nourishment and symptom interruption ( 34 – 36 ). In the context of FBT, an unequivocal belief that caregivers are a positive resource to their child’s recovery has the potential to negate the identification of adverse caregiver behavior in the context of a child’s physical and psychological vulnerability, as well as magnify the impacts of any ongoing child maltreatment ( 28 ). Second, a non-determinant view of the illness may implicitly suggest to practitioners that attending to the relational patterns in the family system is secondary to the emphasis on symptom interruption.…”