Child and Adolescent Eating Disorder Service
Family Based Approach
(FBA)
Child and Adolescent Eating Disorder Service
What is FBA about?
The family-based approach (FBA) is a therapeutic intervention
for the entire family of children and young people with eating
disorders. FBA believes that as parents you already have the
resources to support your child with getting better.
FBA consists of a number of phases to help you develop your
resources and skills in order to:
• Restore the weight of your child
• Normalise their eating
• Promote healthy adolescent development
An important aspect of FBA is for parents to be united in
fighting the eating disorder. It is not about allocating blame
but rather about developing the resources as parents to
overcome the eating disorders . This requires motivation and
stamina to continue treatment when it feels difficult, especially
during the initial weight restoration phase of treatment.
We understand it is important for the team to support the
family during this time by calling on various expertise within
the team such as nurses, psychologists, family therapists,
dietitians and psychiatrists, as well as other services such as the
crisis team if required.
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Family Based Approach (FBA)
How long does FBA treatment take?
Typically, FBA takes between 10-20 sessions over 6-12 months.
Sessions last up to an hour; initial sessions might last a little
longer. In the early stages of treatment appointments are
usually weekly or more often if needed. Although this may
seem time-consuming, research has shown early engagement
and change in the young person’s eating behaviour and
weight is likely to improve the rate and maintenance of
recovery.
What does FBA involve?
FBA consists of a number of phases. In phase 1, the focus is on
getting to know you as a family, reducing physical risk as a
result of malnutrition and on assisting you in re-feeding your
child. Typically, you will have a supported family meal so that
you have an opportunity to learn more about the eating
patterns of your family and so that your therapist can support
you to re-feed your child.
Phase 2 will start once your child is approaching a more
healthy weight and any physical risks have been reduced. In
phase 2 you will be supported to hand appropriate
responsibility for eating back to your child.
Other general family relationship issues or difficulties in terms
of day-to-day adolescent or parenting concerns that you
might have had to postpone can now be brought forward for
review.
In phase 3, treatment will then focus on getting the young
person back on track, and addressing any other difficulties that
may not have been resolved in earlier phases of therapy. This
might include issues around adolescent identity and
supporting increased autonomy as well as catching up with
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Child and Adolescent Eating Disorder Service
things that might have been missed while your child was
preoccupied with their eating difficulties.
Other key aspects of FBA which are designed to maximise
change and restore health include:
• Weighing: Your child will be weighed at every
appointment. Although this can be distressing, it is
essential to ensure your child is making progress and it
can provide opportunities to problem-solve together.
A graph is used to record weight and is shared with
you.
• Attendance: All members of your family will be asked
to attend key appointments.
• Family Meal: The family meal is an important part of
your treatment program. You will be asked to prepare
a meal or snack and eat this during the session.
Although we recognise this will be a strange and
unfamiliar experience, this allows us to get a better
idea what the challenges around eating are for your
child as well as learn about your strengths as a family.
Throughout the treatment there will also be opportunities for
parents/carers to be seen separately to help you support each
other.
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Family Based Approach (FBA)
Multi-Family therapy
If your child is receiving FBA for Anorexia Nervosa, you will be
invited to attend Multi-Family Therapy (MFT). This will involve
the whole family attending a 4 day workshop with other
families, and 3 follow up days.
You will be able to take part in activities to increase
understanding of your child’s eating disorder, promote
working together as a family and facilitate change and
recovery. This is an evidence-based intervention and is
recommend in the NICE guidelines for the treatment of eating
disorders in children and young people.
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Child and Adolescent Eating Disorder Service
Why are we using FBA?
FBA is recognised as the first line of treatment for children and
young people with an eating disorder, as recommended in the
NICE guidelines. FBA has been shown to:
• Help increase weight in underweight children
• Improve psychological symptoms of Anorexia Nervosa
• Reduce binge eating and purging in Bulimia Nervosa
• Maintain changes made in treatment including weight
restoration and eating disorder symptoms after
therapy has ended
• Be more successful than individual therapies for
children with more severe eating disorders.
Alternative Treatments
Although we recommend FBA as an initial therapeutic
approach, we recognise that there are alternative approaches
that may suit some families better. Please note the evidence
base for these treatments is not as comprehensive as FBA.
These include:
• Cognitive-behavioural therapy for eating disorders
(CBT-E)
• Adolescent Focused Therapy for Eating Disorders
If you wish to know more about the evidence that supports our
treatment approaches please let us know and we can give you
more information.
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Family Based Approach (FBA)
Resources
Here are some books that give you more information about
FBA. You might want to read them before or during your
treatment.
Help your Teenager beat an Eating Disorder (2nd Edition)
by James Lock
Anorexia and other Eating Disorders: how to help your
child eat well and be well by Eva Musby
Survive FBA: Skills Manual for Parents Undertaking Family
Based Treatment (FBA) for Child and Adolescent Anorexia
Nervosa by Maria Ganci
Questions?
If you have any questions about FBA or any other services that
we provide please contact us.
CAMHS Eating Disorder Pathway
Oxfordshire Buckinghamshire
Raglan House The Sue Nichol Centre
23 Between Towns Road Bierton Road
Oxford Aylesbury
OX4 3LX HP20 1EG
Tel: 01865 902720 Tel: 01865 901325
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Child and Adolescent Eating Disorder Service
If you would like to have information translated into a differ-
ent language, please contact the Equality and Diversity Team
at:
[email protected] Oxford Health NHS Foundation Trust
Trust Headquarters
Warneford Hospital
Warneford Lane
Headington
Oxford
OX3 7JX
Switchboard 01865 901 000
Email
[email protected] Website www.oxfordhealth.nhs.uk
Become a member of our Foundation Trust
www.ohftnhs.uk/membership
OH 140.20
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