Parent-focused treatment for adolescent anorexia nervosa: a study protocol of a randomised controlled trial.

BACKGROUND: Family-based treatment is an efficacious outpatient intervention for medically stable adolescents with anorexia nervosa. Previous research suggests family-based treatment may be more effective for some families when parents and adolescents attend separate therapy sessions compared to conjoint sessions. Our service developed a novel separated model of family-based treatment, parent-focused treatment, and is undertaking a randomised controlled trial to compare parent-focused treatment to conjoint family-based treatment. METHODS/DESIGN: This randomised controlled trial will recruit 100 adolescents aged 12-18 years with DSM-IV anorexia nervosa or eating disorder not otherwise specified (anorexia nervosa type). The trial commenced in 2010 and is expected to be completed in 2015. Participants are recruited from the Royal Children's Hospital Eating Disorders Program, Melbourne, Australia. Following a multidisciplinary intake assessment, eligible families who provide written informed consent are randomly allocated to either parent-focused treatment or conjoint family-based treatment. In parent-focused treatment, the adolescent sees a clinical nurse consultant and the parents see a trained mental health clinician. In conjoint family-based treatment, the whole family attends sessions with the mental health clinician. Both groups receive 18 treatment sessions over 6 months and regular medical monitoring by a paediatrician. The primary outcome is remission at end of treatment and 6 and 12 month follow up, with remission defined as being ≥ 95% expected body weight and having an eating disorder symptom score within one standard deviation of community norms. The secondary outcomes include partial remission and changes in eating pathology, depressive symptoms and self-esteem. Moderating and mediating factors will also be explored. DISCUSSION: This will be first randomised controlled trial of a parent-focused model of family-based treatment of adolescent anorexia nervosa. If found to be efficacious, parent-focused treatment will offer an alternative approach for clinicians who treat adolescents with anorexia nervosa. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12610000216011.

Health risk screening in adolescents: room for improvement in a tertiary inpatient setting.

OBJECTIVE: To determine the extent to which comprehensive health screening of adolescents was undertaken in a tertiary inpatient setting. DESIGN AND SETTING: Retrospective review of 100 consecutive medical records of 13-18-year-old adolescents admitted to The Royal Children's Hospital, Melbourne (first 20 consecutive admissions in 2001 to each of five units--general medicine, adolescent medicine, specialty medicine, general surgery, and specialty surgery). MAIN OUTCOME MEASURES: Documentation of screening for biomedical (height, weight, pubertal staging, and hepatitis B vaccination) and psychosocial concerns (HEADSS framework categorised into four screening levels--none, incomplete, adequate, thorough). Risks identified and actions taken. RESULTS: Weight was recorded for 98 patients, height for 17, pubertal staging for 12, and hepatitis B vaccination status for nine. Documentation of psychosocial screening was absent from 62 charts, inadequate in 29, thorough in three, and complete in seven charts. Adolescent medicine inpatients were more likely than patients in other units to have any screening of psychosocial risk recorded and more likely to be thoroughly screened (P < 0.005). Screening was more often documented for less sensitive issues (eg, home, tobacco) than higher risk behaviours (eg, illicit drug use) (P = 0.013). When screening identified risks, appropriate action was undertaken in most cases. CONCLUSIONS: This study highlights deficiencies in comprehensive health screening in adolescents admitted to a tertiary children's hospital. These results support the development of more consistent approaches to screening adolescent inpatients.