The Quality of Pastoral Care and
Eating Disorder Incidence in
Schools
Stephanie Watterson (MSc)
and Dr Amy Harrison (PhD, DClinPsy)
Regent’s University London
[email protected]
Talk Map
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The importance of pastoral care
Rationale for this study
Aims and hypotheses
Methods
Results
Discussion
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?
What is Pastoral Care?
General
student
support
School based
social
emotional
support
Tutor,
Pastoral
Care
Teacher,
counsellor,
school nurse
Staff
training
around
mental
health
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
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)
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
Method
Sample & data collection:
o UK schools approached through adverts and
personal contacts.
o Male and female fulltime students aged 16-19.
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)
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)
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
Pastoral Care Quality Ratings
• School 4: rated “high;” schools 3 and 5 rated
“medium;” schools 1 and 2 rated “low”
• Overall mean age = 17.14 (SD=2.1)
• 221 female (52%)
% of participants in schools with high,
192 male (45%)
medium, low level pastoral care
12 (3%)did not disclose
• Mean male weight:
69.06kg (SD=13.01)
• Mean female weight:
58.09 (SD=11.05)
18.59
High (n = 79)
47.29
Medium (n = 173)
Low (n = 201)
40.71
Results: ED symptom incidence and
general psychological wellbeing
14
EDE-Q
12
10
11.73
10.31
10.19
HoNOSCA
10.19
8
6
6.04
4
2
1.64
1.51
2
1.64
0.8
0
School 1
School 2
LOW
School 3
School 5
MEDIUM
School 4
HIGH
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%)
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)
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?
• 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?
Limitations and Future
Work
• Use of self-report
• Limited age group
• Psychiatric assessment confirmation
Thank you!
[email protected]
www.regents.ac.uk/psychology
Paper under review in BJPsych Open
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