Brief parental interventions for eating disorders

Eating disorders in children and adolescents place a significant burden on families and health systems, with high levels of psychological distress, medical risk, and functional impairment. Public child and youth mental health services face increasing demand, long waitlists, and the challenge of delivering effective, evidence informed care within resource constrained environments. Parents can be central in supporting nutritional rehabilitation, interrupting disordered behaviours, and maintaining treatment gains in this cohort, yet many parents present with low confidence, high anxiety, and uncertainty about how to help their child.

To address this gap, the Child and Youth Mental Health Service (CYMHS) Eating Disorder Program (EDP) developed a focussed, program led intervention for parents (Strong Foundations), delivered before the young person begins more traditional outpatient treatment. The intervention provides targeted psychoeducation, practical guidance on meal support, and strategies for managing eating disorder behaviours. Its purpose is to mobilise parents early, strengthen their self efficacy, and create a more enabling environment for recovery.

The two studies underpinning this project examined different aspects of the same intervention pathway. The first evaluated whether the Strong Foundations program improved parent self efficacy and child symptoms. The second examined predictors and mediators of outcome across the intervention. Together, they address a central question: How can a public, program led service optimise recovery by empowering and enabling parents early, and understand the mechanisms that drive change?

Parents increased in self-efficacy, showed modest improvements in depression, and no significant change in anxiety. Young people showed significant improvements in global eating disorder symptomology, BMI and depression. Increased parental self-efficacy mediated the effect of Strong Foundations on reductions to dietary restraint, but not for BMI centile.

Perceived criticism predicted the effect of the treatment on BMI centile, such that higher levels of perceived criticism were associated with less weight gain. ED-related obsessions and rituals predicted the effect of the treatment on dietary restraint, although the high correlation between these measures may limit the meaningfulness of this result. The Strong Foundations intervention was feasible to deliver within a public CYMHS setting, with parents engaging consistently in both the online psychoeducation sessions and the face-to-face medical management component. The rolling-entry structure allowed families to access support immediately after assessment, reducing the risk of deterioration during wait periods.

The Strong Foundations intervention was feasible to deliver within routine practice and aligned with the service's philosophy that parents are central agents of change in eating disorders treatment. Embedding outcome monitoring allowed the team to evaluate real-world effectiveness without disrupting clinical flow.

A key lesson was the value of intervening early with parents. Increases in parent self-efficacy were associated with early improvements in child symptoms, suggesting that empowering caregivers can shift the trajectory of recovery even before formal treatment begins. This early momentum may reduce drop-out, improve engagement, and enhance the effectiveness of subsequent outpatient care.

The identification of predictors of poorer outcome highlights the need for flexible pathways. Young people with more severe symptomatology or family environment characterised by high expressed criticism may require additional intensity or adjunctive supports. Understanding mediators such as parent self-efficacy provides actionable targets for service refinement.

Limitations include the naturalistic design, single-site context, and absence of a control group. Full understanding of the engagement with the parent intervention was unknown due to the online format and lack of assessment (e.g., assessment of parental learnings), and missing data may have influenced findings. Nonetheless, the model is highly transferable to other public child and youth mental health services, regional centres, or stepped-care systems.

Next steps could include formalising the parent intervention into a brief manual, testing its impact in controlled designs, and exploring asynchronous digital or group-based delivery to increase reach and reduce demands on clinicians' time. Further work is needed to integrate prediction models into triage processes and examine additional mediators such as family functioning and therapeutic alliance.

Sidari, M., Wilson, D., Catania , S., Brown, V., Nkwenty, E., Davis, A., Knight, P., White, J., Maguire, S., Withington, T. (2025). Pre-treatment specialist interventions improve parents' self-efficacy and their children's eating disorder symptomology before commencing outpatient treatment. European Eating Disorders Review. https://doi.org/10.1002/erv.3211

Wilson, D., Sidari, M., Mendes., R., Loxton, N. (2025). Predictors and mediators of outcome of a focussed, programme led intervention for young people with eating disorders. International Journal of Eating Disorders. https://doi.org/10.1002/eat.24516.