Children and young people’s eating disorder service

The best way to make a referral to our service is to visit your GP in the first instance. They will be able to access our referral form via the referral management service. The form prompts for specific information that we need in order to accept and process your referral, including:

• weight and height
• temperature
• blood pressure lying and standing (after 1 minute and after 3 minutes)
• pulse lying and standing (after 1 minute and after 3 minutes)
• blood results
• a brief description of your current difficulties and how these have developed

If you are having trouble with getting referred to our service, contact us directly using the details above. We know that it is really important when managing an eating disorder that treatment is started as soon as possible, so we want to avoid delays as much as we can. However, please be advised that we cannot accept the referral without the information outlined above.

Once we have received your completed referral, we will make contact with you to let you know that you have been placed on our waiting list for assessment. We will also arrange physical monitoring appointments in the interim.

This will be with a physical health nurse or health care assistant, and they usually take place at the following locations:

• Liskeard Community Hospital
• Wadebridge integrated health hub
• Truro Health Park

The clinics run on set days of the week and you will usually be offered a slot nearest to where you live.

During these appointments, the clinician will take the following observations and review your physical health:

• weight and height
• temperature
• blood pressure lying and standing (after 1 minute and after 3 minutes)
• pulse lying and standing (after 1 minute and after 3 minutes)

They may also take some bloods depending on the results of the set taken at referral, or if physical health concerns are raised. Generally when people are making themselves sick, using laxatives or diet pills (behaviours known as purging), we will recommend blood tests to monitor any changes in electrolytes which can affect the heart as a consequence of purging.

Our assessment clinic usually runs on a Monday from Truro Health Park. Present from our team will be a systemic practitioner, a specialist dietitian and a paediatric specialist nurse. This can seem like a lot of people, but it helps us to make a more complete assessment of your current difficulties. The assessments generally last somewhere between 1.5 to 2 hours.

We strongly encourage parents and carers to attend the assessments with their child, as we find it really helpful to get the perspectives of everyone involved. We generally offer time to speak with us without parents and the child or young person present where families want this option.

Research in young people with eating disorders indicates that an intervention that includes the family generally has the best outcomes.

Maudsley model

We offer family-based treatment using the Maudsley model, which is a well-researched model of treatment that was developed at the Maudsley Hospital in London. This intervention is offered by qualified mental health professionals who are trained in the Maudsley model. We come from a variety of professional backgrounds including: family therapy, systemic family practice, clinical psychology, mental health nursing, occupational therapy. Young people will also be offered physical monitoring appointments to monitor physical health.

NICE recommendations

The National Institute for Health and Care Excellence (NICE) recommends that young people with eating disorders are offered a family-based treatment as a first-line intervention. NICE suggests that 18 to 20 sessions are offered. Not all families will need this and some young people and families may need a different type of intervention.

Therefore, we offer regular reviews during the course of your treatment to see whether ongoing input is still needed or if something needs to change. The reviews provide an important opportunity for you to give your views on the treatment you are receiving. We can also access reviews from our paediatric medical staff (consultant paediatrician and specialist paediatric nurse), consultant psychiatrist or dietitians if needed.

Where will treatment be offered?

Due to the demand on the service, we operate a clinic model which can mean a lack of flexibility over where and when your appointments are. We recognise this can have a significant impact on your family’s life but we hope that you will be able to commit to the treatment offered to help support your loved one’s timely recovery. Due to the clinic model we operate, any sessions cancelled or not attended will not be able to be re-arranged.

The team can work with young people until they are 18. If input from adult services is required following this, we can support with referrals to adult services.

As treatment progresses, the team may discuss the potential of undertaking physical monitoring at home, with equipment being supplied by Kernow Health.

All results will be automatically uploaded and followed up with contact from the physical monitoring team. As the monitoring will be at home, we can be more flexible about when the monitoring is undertaken, but we generally recommend it is completed before any therapy appointments.

Full instructions will be given whilst still being seen face to face. If after discussion face to face appointments are the preferred way of monitoring, then this will continue. We can only offer home monitoring in instances where frequent bloods are not required.

Intensive treatment and review

6 appointments once a week for family-based treatment. This is usually offered by 2 or 3 clinicians working together. One of the specialist dietitians will also join some of these sessions. The sixth session is a review which is an opportunity to review the progress in your treatment.

• Location: Wadebridge Integrated Health Centre, Wadebridge School.
• Day: Wednesdays, timings fixed.

Follow-up treatment

If further intervention is required, we then offer up to 6 family-based treatment sessions on a fortnightly basis. These may be offered by 1 or 2 clinicians; where possible. This will include one of the clinicians involved in your initial treatment.

• Location: Truro Health Park (Tuesdays); 6A Heathlands, Liskeard (Fridays); Wadebridge Integrated Health Centre (Thursdays)

Where possible, we will try and offer you sessions in the location closest to your home.

1. Multi-disciplinary review: This will be another opportunity to review your treatment with your care team.
2. Follow-up sessions: If further intervention is required, we can offer up to 6 further 60 minute family-based treatment sessions on a monthly basis, generally with a single clinician.
3. Multi-disciplinary review: This is a final opportunity to review your treatment with the team and plan for the future.

If further input is required, either for difficulties related to the eating disorder or for other mental health difficulties (such as depression, anxiety), we will discuss with you where this can best be accessed. This may include the CAMHS service, support from education providers or other services provided by other NHS, council or voluntary agencies.

There are several paediatricians within the service who liaise closely with the therapy teams and physical monitoring teams. If we are worried about the physical health of a young person then they may either be seen in a paediatric clinic or sometimes are admitted to either Derriford or Treliske for medical stabilisation. Admissions for medical stabilisation can be up to 3 weeks long and we will provide you with further information around these if needed.

The vast majority of people that we see are offered the family based treatment model initially. Once family therapy is completed, if there is an indication for individual work then we will assess this and offer you the most appropriate intervention. This may or may not be delivered within our service, depending on what is required.

Resources for young people

If you are a young person struggling with an eating disorder, you might find the resources below to be useful.

• Beat Eating Disorders
• Centre for Clinical Interventions: Provides self help modules which you can work through on your own or with a parent or carer.

Resources for parents or carers

If you are a parent or carer supporting a loved one with an eating disorder, you might find the resources below to be useful:

• Help your child eat with trust, not logic support video: The bungee jump (anorexia and other eating disorders)
• Kelty Meal support videos.
• Eva Musby Bitesize: Learn to help your child, in short audio bites.

Useful books

• Anorexia and other eating disorders, Eva Musby: how to help your child eat well and be well.
• Caring for a loved one with an eating disorder, Jenny Langley and Janet Treasure: the new Maudsley skills-based training manual.

Other eating disorders (binge eating and avoidant restrictive food intake)

As a service, we are commissioned to treat anorexia nervosa, bulimia nervosa and OSFED. Other recognised eating disorders include binge eating disorder and avoidant restrictive food intake disorder. Unfortunately, we do not offer treatment for these conditions, but have included some resources and signposting below.

Binge eating

Binge eating involves regularly eating a lot of food over a short period of time until you are uncomfortably full. Binges are often planned in advance, usually done alone, and may include special binge foods. You may feel guilty or ashamed after binge eating. Men and women of any age can get binge eating disorder, but it usually starts in the late teens or early 20s.

If you feel that you or your child is suffering from binge eating disorder, you may find the resources below to be useful.

• BEAT binge eating disorder advice: Support and groups for people suffering from binge eating disorder.
• Overcoming binge eating, Christopher Fairburn: the proven program to learn why you binge and how you can stop.
• Centre for Clinical Interventions binge eating disorder advice: Provides self help modules which you can work through on your own or with a parent or carer.

Avoidant restrictive food intake disorder

Avoidant restrictive food intake disorder, commonly known as ARFID, is a condition characterised by the person avoiding certain foods or types of food, having restricted intake in terms of overall amount eaten, or both. For more information, visit the BEAT website ARFID page.

If you feel that you or your child is suffering from avoidant restrictive food intake disorder, we would recommend that you have a look at the following resources:

• ARFID Awareness UK
• Avoidant restrictive food Intake disorder, Rachel Bryant-Waugh: A guide for parents