Food for thought: Enabling and constraining factors for effective rural eating disorder service delivery

Abstract

This study examined the effectiveness of an assessment and referral model of eating disorder service delivery in the Northern Rivers of New South Wales and its potential as a model for rural service delivery. A qualitative evaluative research design used brief and extended semistructured interviews with clients, and surveys and semistructured extended interviews with service providers who either referred clients to the service or to whom clients were referred. A sole practitioner service based in a small non-government women's health service in rural New South Wales. Clients of the service, all but one of whom was woman; service providers including general practitioners, private practice psychologists and social workers, dietitians, mental health service workers. Participant identified enabling and constraining factors which contributed to the effectiveness of the service model. Whilst all service providers and most clients found the assessment process to be beneficial, they identified a number of constraining factors in the referral part of the service which undermined the effectiveness of the model of service delivery, especially for those with more complex or severe presentations. For a rural ED service to be effective, a number of enabling factors must be present including the capacity to provide: treatment services as well as assessment; a multidisciplinary team approach to assessment and treatment; and expert consultation and training to generalist practitioners, counsellors, hospital wards and other service providers.