More than just awareness: Longitudinal evaluation of an eating disorders training program for school counselors

Abstract

Background: Eating disorders (EDs) are complex psychiatric conditions that often remain undetected in school settings. School counselors (SCs), as frontline observers, may play an important role in early recognition and referral. This study evaluated the effectiveness of a training program designed to support SCs' knowledge, attitudes, and practices regarding EDs in Türkiye.

Methods: Data were obtained from forty-nine SCs from Erzincan, Türkiye, who had previously provided baseline data (T0) and participated in a longitudinal study with two additional assessment time points: post-training (T1) and three-month follow-up (T2). The training consisted of a full-day, primarily didactic seminar incorporating clinical vignettes. Participants' recognition knowledge, referral preferences, attitudes, and stigma levels were assessed using a structured, study-specific questionnaire.

Results: The training led to a short-term increase in preference for hospital-based referral (T0: 61%, T1: 83%, p = .005), but this effect diminished at follow-up (T2: 67%). Knowledge about anorexia nervosa also improved post-training but declined significantly by T2. No significant changes were observed in correct diagnostic recognition, referral to a psychiatrist, or most attitudinal measures. Total stigma scores increased immediately after training (T0: 30.7, T1: 34.1, p < .001), partially decreasing at follow-up.

Conclusion: A didactic, vignette-based training program was associated with temporary changes in selected knowledge domains and referral preferences, but these effects were not sustained. The absence of improvement in diagnostic recognition and the short-term increase in stigma highlight the limitations of brief, information-focused approaches. Future studies may explore whether more interactive, empathy-focused, and repeated training formats are associated with more durable and balanced outcomes.

Keywords: Eating disorders; Longitudinal study; Professional knowledge; School counselors; Stigma.