A sequential mixed method study to investigate, understand and find co-produced solutions to the use of restrictive practices in health settings when caring for children and young people with eating disorders.

Research Questions What is the prevalence and impact of restrictive practices across services for children and young people (CYP) with eating disorders? What are the experiences of people with lived experience and staff of restrictive practices across services for CYP with eating disorders? What are the co-produced solutions to addressing restrictive practices across services for CYP with eating disorders? Background Eating disorders (ED) are among the most complex mental health conditions, with the second highest mortality rate of any mental health illness. The prevalence of ED presentations in children and young people (CYP) has risen significantly recently. ED units report the highest rates of restrictive practices (RP) in CYP mental health services including involuntary nasogastric tubes (NGT), physical restraint, seclusion and blanket restrictions. While some interventions may be intended to preserve life, growing evidence highlights their psychological impact often described by CYP and their families as traumatic. There is a critical need to understand how restrictive practices are used, reported and experienced in ED care, and how they can be minimised safely in line with NHSE’s ambition to reduce the use of RP and promote trauma-informed, person-centred care. Aim To investigate, understand and find co-produced solutions to the use of restrictive practices in health settings when caring for children and young people with eating disorders. Objectives 1. To determine the prevalence and nature of restrictive practices/blanket restrictions for children and young people admitted with an eating disorder in health settings across the UK. 2. To explore and understand the perceptions and lived experience of children and young people with eating disorders, their family members and professionals caring for them regarding restrictive practices. 3. To collaboratively develop and reach consensus on recommendations for further research and priority areas for policy and practice. 4. To explore the extent and impact of and co-produced solutions to restrictive practices across NHS sites for children and young people with eating disorders. 5. To inform iterative opportunities for learning and impact to promote positive change for those with ED and their families through an inclusive dissemination, pathways to impact and communications strategy. Methods Using a sequential mixed method design the study is divided into 5 iterative work packages including a systematic review; data extraction and analysis; critical ethnography including non participant observation of practice across 6 NHS sites, interviews of young people, families and staff about their experiences; and co-produced workshops to inform the project and explore solutions. WP5 will involve translation of our work using existing networks, communities of practice, training, resources, meaningful data and opportunities for sharing and benchmarking. The project is planned for 3 years. Anticipated Impact and Dissemination A ‘pathway to impact’ WP will drive the iterative nature of our project to create outputs and impact as described above. Real life examples from people with lived experience will be paramount. Young people will receive training and support to take part in the research process including analysis, writing papers and presenting. We will hold events to understand and inform our findings. Young people will be supported to create summaries in accessible formats.