What the Eating Disorders Team offers

The EDT offers:

• Assessment and recommendations (second opinions)
• Time limited interventions, on an outpatient, intensive outpatient, day patient or inpatient basis
• Consultation to local teams or clinicians

Many of the young people we see come for an assessment and recommendations only. Reasons where this may be appropriate include:

• Where the diagnosis and treatment plan are not clear
• When treatment seems stuck or the child or young person is not making progress
• Where difficult decisions need to be made, or there are differences of view about the child or young person’s welfare
• Where the family has requested a second opinion
• Where there are other medical problems which need considering as part of the bigger picture

Planned (non-urgent) full multidisciplinary assessments take place over two visits for the family, with the two appointments being a week apart. During the assessment, we include time for the family to be seen altogether, for the child or young person to be seen alone and for the parents to be seen alone. The gap between visits allows time for the team to liaise with other professionals if needed, and for the multidisciplinary team to meet and discuss the child or young person. On the family’s second visit, they will receive feedback and the multidisciplinary team’s recommendations. A decision will also be made collaboratively with the parents (and child or young person, if appropriate) about the next steps. The family will receive a brief report within 48 hours of this second appointment, describing the recommendations discussed. A full, detailed report is sent to the family, referrer and other involved professionals within ten days of this second appointment.

The EDT also offers urgent assessments, subject to availability, if needed. If the clinical picture is unclear but the risk is high, an admission for assessment may be recommended. If you are unsure about whether an urgent assessment is required, please contact us (see box at end of page).

Of those assessed, some patients will be offered treatment with the EDT in negotiation with local providers. Some will continue treatment with their local services based on recommendations from the assessment, some may require hospitalisation and others may not require further treatment at this time.

Treatment is determined by the needs of the child or young person and their family, with each component of treatment intended to address one or more of the areas that are affected by or associated with the eating difficulty. All clinicians in the EDT regularly communicate with each other about the issues a child or young person and their family are facing.

First line interventions offered for children and adolescents with eating disorders will depend on the intervention the young person has already received and their response to that treatment so far. Typically, they will involve the whole family (known as family based treatment or systemic therapy for anorexia nervosa) and enhanced variants thereof. Family based treatment is the first line evidence based treatment for children and adolescents with eating disorders.

Children and young people who have not responded to these first line interventions may be offered an intensive outpatient treatment programme. This would involve a combination of therapies and medical management; the team, young person and their family would decide together what would be most suitable.

A typical treatment programme for a young person with anorexia nervosa would include a combination of:

• Family therapy
• Individual therapy
• Young people's group
• Parents' group
• Medical and dietetic input as needed

If the risks are too high for outpatient treatment, inpatient or daypatient treatment may be considered, with the aim of stepping down to daypatient or intensive outpatient care as soon as the young person and their parents are able to manage the symptoms safely. Admission may be to the children’s inpatient unit at GOSH (Mildred Creak Unit

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if appropriate, meaning if referral criteria is met and local providers are in agreement. If a child or young person is admitted to the Mildred Creak Unit for eating disorder treatment, they may be under the care of Dr Elaine Chung, Inpatient Consultant Child and Adolescent Psychiatrist.

For older adolescents, those with more entrenched illness, or where comorbidities such as depression, anxiety, self-harm, or social communication difficulties are prominent, we offer a range of tailored interventions including cognitive behaviour therapy, cognitive remediation therapy, mentalization based therapy, psychodynamic psychotherapy, and group therapies, using a recovery model where appropriate, and working alongside other specialist teams in the department.

We try to arrange appointment times that suit family life, but some aspects of treatment, such as the groups, only happen at certain times of the week.

A review of treatment, usually with the responsible consultant, is held every few months and will include the young person, their family, and team members who are directly involved in treatment. Local CAMHS, social care and school professionals are invited as needed. We can also offer reviews to families who are receiving treatment from their local CAMHS team, to ensure that progress is being made in line with recommendations, where this shared care has been agreed between the family, the local team and us.

The individual needs of the child are considered when determining the appropriate treatment package. Children and young people seen by the EDT are typically where inpatient or day patient treatment is being considered or where there has already been involvement of a specialist eating disorders team. We offer specialist interventions for overcoming avoidant eating behaviours and expanding children's repertoire and energy intake, including those in a medically and nutritionally compromised state, tube weaning of older children, nutritional advice and monitoring of growth and development, as well as addressing parent factors, such as anxiety and parenting strategies. We do this using a range of evidence based interventions, including cognitive behavioural, parenting, systemic and group interventions.

We see families at varying intervals; some will come weekly or fortnightly and others less frequently, depending on the level of need.

A consultant paediatrician with expertise in the short and long term complications of feeding and eating disorders works with our team, with access to a regular clinic for assessment and advice on treatment. This most commonly includes considering bone mineral density, growth problems and pubertal delay. Our service has access to Great Ormond Street’s paediatric bone mineral density measurement service with measurement techniques especially recommended for younger children. Being based within a leading paediatric hospital means that our team is well placed to provide care for children who have other medical conditions (for example diabetes) so that psychological and physical health needs are addressed together and joined up.