Weber, MS 2010, 'A catalyst for change or just an extra practitioner to see?: an evaluation of an assessment and referral model of eating 'disorders' service in delivery in New South Wales', PhD thesis, Southern Cross University, Lismore, NSW.
Copyright 2010 MS Weber
This qualitative research is an evaluative exploration of the effectiveness of an assessment and referral service for people troubled by eating „disorders‟, and their parents. The study was undertaken as a practitioner-researcher inquiry. The service, the Northern Rivers Eating Disorders Service (NREDS), is located in a feminist non-government women‟s health centre in the Northern Rivers region of New South Wales (NSW). It did not have the capacity to provide ongoing services to clients and their families. Therefore one of the goals of this research is to explore whether the assessment process1 itself offers something of value to clients other than a referral pathway. Furthermore, the research examines whether the model of assessment and referral is effective in the context of the geographical region of the Northern Rivers, and whether it could be recommended as a model for rural NSW. The assessments and consultations with clients and parents are influenced by the principles of narrative therapy. Another intention of the research is to understand what effects the narrative therapy ideas had on clients through the assessment, and on clients and parents through the consultations.
The research was conducted in what I refer to as two layers. These reflect the philosophical frameworks guiding the research, each providing a different lens through which to make sense of the data. The first layer is critical realist. It explores client, parent and service provider experiences of their encounters with the service, identifying what was valued in those encounters as well as pinpointing the barriers to accessing or delivering effective services. These are interpreted as enabling and constraining factors. The second layer is informed by poststructural critical feminism and inquires into the assessment process and consultations – the interchange between myself as practitioner and the client/parent.
Clients, parents and service providers named a range of valued effects from the assessment, and from the other services offered by the NREDS. However, they also named a range of features of the service and its service provider network which reduced its potential effectiveness, particularly for those over the age of 18, and those with more severe presentations of eating „disorders‟, rendering the suitability of the model of assessment and referral questionable in the Northern Rivers, and for rural NSW.
The research identifies that the assessment itself can have a profound impact when shaped by narrative therapy ideas and grounded in poststructural feminist ideology. The interconnection between ideas about identity, agency, power, subjectivity and the „truth‟, and how these are constructed through therapeutic interactions was found to be highly relevant in understanding what clients and parents found to be helpful.