Implementing and evaluating the uptake of family inclusive practice in adult eating disorders: A stepped care approach to working with families of adults affected by eating disorders.

Interventions will be allocated via participant choice as appropriate for the consenting, adult patient sample, and will include outpatient treatment as usual comprising either: - eating disorder day program in group format, or - individualised cognitive behaviour therapy or - specialist support clinical management for eating disorders Where patients choose to family involvement and to participate in the family intervention in addition to any of the treatment programs above, study-specific written family orientation material and treatment information as well as general carer eating disorder support and education resources to assist in identifying and assessing current psychosocial needs of patients and carers will be provided. Carers who participate will be given study-specific written reading materials and details of online resources providing disorder specific psychoeducation including mental health first aid guidelines for eating disorders (https://mhfa.com.au/sites/default/files/MHFA_eatdis_guidelines_A4_2013.pdf), an eating disorders carers help kit (https://eatingdisorderscarerhelpkit.com.au/), and information about an understanding eating disorder recovery online program (https://butterfly.org.au/get-support/online-programs-education/) as well as links for collaborative carer skills training materials (https://thenewmaudsleyapproach.co.uk/). Patients and carers will be offered a face-to-face individualised family consultation delivered by a specialist family worker and cofacilitated by an individual outpatient therapist from the Queensland Eating Disorder Service. Family consultations can be held at any point in the individual's treatment program, for as long as they are current outpatient's of the service, and at timepoints as directed by the patient and as developmentally appropriate for the adult patient sample of the study. The family consultation meetings will involve discrete tasks across four stages within an overall framework of a 90 minute individualised meeting between the patient, the family members or other supports, the individual clinician and the family worker. The stages include welcoming participants, making introductions, and orienting participants to the session; distinguishing the main issues for work in the session including clarifying the priority of different needs and participant concerns; responding to the agreed areas via an appropriate approach depending on the identified need, for example, by providing psychoeducation or further information, facilitating communication about experiences, utilising a problem solving process, and or providing direction for next steps, resources or referral as appropriate; and finally closing the session by summarising the session and arranging a follow up contact with participants. See https://www.bouverie.org.au/support-for-services/single_session_family_consultation_practice_manual for more information. If indicated by continuing needs or further issues identified, information on other specialist interventions for families affected by eating disorders offered by a community service will be provided. Examples of further issues identified which would lead to a recommendation being provided for further services include relationship issues that extend beyond the effects of the eating disorder to multiple other domains and would benefit from generic couples counselling or ongoing family therapy, problems with life transitions, individual participant needs around personal growth and development, identity exploration, or mental health issues.