The Quality of Pastoral Care and Eating Disorder Incidence in Schools

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1 The Quality of Pastoral Care and Eating Disorder Incidence in Schools Stephanie Watterson (MSc) and Dr Amy Harrison (PhD, DClinPsy) Regent s University London harrisona@regents.ac.uk

2 Talk Map The importance of pastoral care Rationale for this study Aims and hypotheses Methods Results Discussion

3 Role of Pastoral Care Eating disorders (EDs) difficult to treat (Halmi et al., 2005) Peak age of onset during secondary school years (Wentz et al., 2009); significant portion of time spent in school Early intervention associated with better prognosis (Lock et al., 2001) HOWEVER, significant increases in UK hospital admissions over last decade (NHS Health and Social Care Information Centre, 2012) Could pastoral care help to reduce incidence of symptoms?

4 What is Pastoral Care? General student support School based social emotional support Pastoral Care Tutor, Teacher, counsellor, school nurse Staff training around mental health

Children, Schools and Families, 2007) Schools may be wellpositioned to

5 EDs on the Agenda Government initiatives promoting emotional wellbeing recognise presence of EDs in secondary school students (Department for Children, Schools and Families, 2007) Schools may be wellpositioned to promote prevention, detect cases and provide support during recovery

6 Previous Research Relatively little known about possible impact of quality of pastoral care on incidence rates We do know that 63 staff members recruited from 29 UK schools reported awareness of EDs, alongside a lack of knowledge and confidence around how to help (Knightsmith et al., 2013) School policies, training and pastoral support documents available (Knightsmith, 2015)

7 Aims and Hypotheses Does incidence of ED pathology differ depending on the quality of secondary school-based pastoral care? Prediction: Incidence rates would differ depending on quality of pastoral care

8 Method Sample & data collection: o UK schools approached through adverts and personal contacts. o Male and female fulltime students aged Measures o Demographics (gender and age) o Symptom incidence EDE-Q (Fairburn & Beglin, 1994); weight and height o General psychological wellbeing HoNOSCA (Gowers et al., 1999)

9 Operationalising Pastoral Care Points based rating system developed :- Support available type/nature/frequency General psychological wellbeing and ED specific school policies Specialist services (e.g. onsite school nurse or counsellor) ED focused staff-training External reports (i.e. Ofsted) Schools given pseudonyms (1-5)

10 Results: Final Sample Contact made with 35 schools Five (14.3%) contributed data Reasons given for not participating included The head [teacher] is very protective [of the students] and is bothered by the anorexia questions [to take part would be] going against the school s policy to protect the students, 1611 possible participants met inclusion criteria: 26% (n=425) volunteered to participate

11 Pastoral Care Quality Ratings School 4: rated high; schools 3 and 5 rated medium; schools 1 and 2 rated low Overall mean age = (SD=2.1) 221 female (52%) 192 male (45%) 12 (3%)did not disclose Mean male weight: 69.06kg (SD=13.01) Mean female weight: (SD=11.05) % of participants in schools with high, medium, low level pastoral care High (n = 79) Medium (n = 173) Low (n = 201)

12 14 12 Results: ED symptom incidence and general psychological wellbeing EDE-Q HoNOSCA School 1 School 2 School 3 School 5 School 4 LOW MEDIUM HIGH

13 Anorexia: Probable Cases Significantly fewer in high quality pastoral care setting than in lower quality pastoral care settings (F(4, 384)=3.14, p=0.015, ηp²=0.03; small effect size) High quality setting: no cases Medium quality settings: 9 probable cases (5.2%) Low quality settings: 2 probable cases (1%)

14 Bulimia Nervosa: Probable Cases No main effect of school ((F(4, 400)=1.18, p=0.319, ηp²=0.01, small effect size) However, trend towards higher rates in lower (19 cases; 9.45%) and medium quality settings (26 cases; 15.02%) than high quality setting (6 cases; 8.70%) Higher than published data (Micali et al., 2013)

15 Results: Summary Medium sized effect of pastoral care quality on ED symptom incidence (ηp²=.06): with higher pastoral quality care = lower ED symptomatology. Small sized effect of pastoral care quality on general psychological wellbeing in same direction (ηp² =0.02).

Discussion High quality pastoral care may be a vital tool in fighting disordered eating in adolescents Surprisingly difficult to recruit schools to take part tackle culture?

16 Discussion High quality pastoral care may be a vital tool in fighting disordered eating in adolescents Surprisingly difficult to recruit schools to take part tackle culture? Some excellent examples across country of schools and services linking up more of this needed? Future work could explore mechanisms behind observed difference is it prevention, detection and referral, better support during treatment or all of the above?

17 Limitations and Future Work Use of self-report Limited age group Psychiatric assessment confirmation

18 Thank you! Paper under review in BJPsych Open

19 References 1. Halmi KA, Agras WS, Crow S, Mitchell J, Wilson GT, Bryson SW, Kraemer HC. Predictors of treatment acceptance and completion in anorexia nervosa: Arch Gen Psychiatry 2005; 62: Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Råstam M. Adolescent-onset anorexia nervosa: 18-year outcome. Brit J Psychiatry 2009; 194: Lock J, Le Grange D, Agras WS, Dare C. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. Guildford Press, Health and Social Care Information Centre Provisional Monthly Hospital Episode Statistics for Admitted Patient Care, Outpatient and Accident & Emergency Data. April June. England. NHS Health and Social Care Information Centre, Department for Children, Schools and Families (DCSF). Social and Emotional Aspects of Learning (SEAL) Programme: Guidance for Secondary Schools. DCSF, Knightsmith P, Treasure J, Schmidt U. Spotting and supporting eating disorders in school: recommendations from school staff. Health Edu Res 2013; 28.6: Knightsmith P. Self-Harm and Eating Disorders in Schools: A Guide to Whole-School Strategies and Practical Support. Jessica Kingsley Publishers, Fairburn CG, Beglin SJ. Assessment of eating disorders: Interview or self report questionnaire? Int J Eat Disord 1994; 16: Gowers SG, Harrington RC, Whitton A, Lelliott P, Beevor A, Wing J, Jezzard R. Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA). Brit J Psychiatry 1999; 174: Micali N, Hagberg KW, Petersen I, Treasure J. The incidence of eating disorders in the UK in : findings from the General Practice Research Database. BMJ Open 2013; 3: e

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