Children and Young People’s Eating Disorder Service

Once we have received your completed referral, we will contact you via an acceptance letter. The letter will explain that you have been placed on our waiting list for assessment.

We aim to offer you an assessment with 28 days of the referral being received by our service. During times of high demand this is likely to take longer. In the case it takes longer, we encourage the individual, their parent, carer or professionals, to contact the service to share any worsening changes in mental health need or risk.

We will also arrange physical monitoring appointments in the interim. These appointments are booked by an administrator before the assessment.

Dependent on the assessment outcome, the physical health monitoring frequency and location will be decided and set up by the team.

An assessment is a meeting with multiple professionals to help understand the young person's mental health needs. The meeting will help to determine current care provision and treatment options.

An assessment will consist of questions around current difficulties, build a therapeutic relationship with the young person and family and developed a personalised plan.

It will usually involve 3 clinicians that will help the team to make a complete assessment of your current difficulties.

An assessment team includes:

• family therapists
• systemic practitioners
• psychiatrist and psychologists
• occupational therapists
• specialist practitioners
• dietitians

The team encourage parents and carers and the young person to attend the assessment. This helps us to ensure the team can obtain the perspective of all involved. The clinical team generally offer time to speak with us without parents and the child or young person present where families want this option.

Assessments generally last 90 minutes. This time (approximately) involves:

• 50 minutes to obtain qualitative information about ongoing difficulties
• 10 minutes for clinical multidisciplinary team meeting, where the parent or carer and young person will be asked to leave the room whilst clinicians share their formulation and create a treatment plan
• 30 minutes to share treatment plan with young person and family

This assessment develops a formulation for the individual and determines whether the service is the right service for them. If it is felt that is not the most appropriate service, the assessment provides alternative recommendations for that individual. A copy of this outcome letter is sent to the individual, parent or carer, GP, and referrer.

As part of our support, we provide physical health monitoring. This is delivered by our own clinical team to ensure integrated and accessible care for young people and their families.

The appointments usually take place at the following locations:

• Helston Community Hospital
• Falmouth Community Hospital
• Launceston Community Hospital
• Liskeard Community Hospital
• Newquay Treviglas Health Hub
• Stithians Wellness Hut
• Torpoint GP (Penntorr Health)
• Veor Surgery

The clinics run on set days of the week, and young people and families will usually be offered a slot nearest to where they live.

During these appointments, the clinician will take the following observations and review your physical health (in line with Medical Emergencies in Eating Disorders (MEED) observations):

• 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. We will recommend blood tests to monitor any changes in electrolytes which can affect the heart because of purging.

Dependent on the outcome of assessment, the physical health monitoring frequency and location will be decided and set up by the team.

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

Maudsley model

We aspire to offer family-based treatment using the Maudsley model. This is a well-researched model of treatment that was developed at the Maudsley Hospital in London. We may need to adapt the recommendation model to accommodate service demand.

This intervention is offered by qualified mental health professionals who are trained in the Maudsley model. They 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.

Family based treatment sessions

Once the 12-week parent group is completed, you will be offered family based treatment sessions as a family. It is up to you who you choose to bring to these sessions. We recommend parents and carers who live in the home with the young person join as a minimum, along with the young person.

We routinely offer 12 fortnightly appointments for family-based treatment, followed by 3 monthly sessions and a 2-month review. This is usually offered by 2 or 3 clinicians working together. One of the specialist dietitians will also join some of these sessions. Sessions 1, 6, 12, 15 and 16 are reviews. The reviews gives us the opportunity to discuss whether this treatment pathway feels right for your young person and whether there are any additional needs that should be considered.

We run these clinics in Falmouth, Truro, Newquay, Liskeard, Troon and Bude. They run on varying days of the week from Tuesday to Friday. Where possible, you will be offered sessions nearest to your home. If the waiting list for the clinic nearest your home is especially long, you may be offered an alternative location.

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

Most people that we see are offered the family-based treatment model initially. Once this 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 clinically and based on your goals.

If our service provides the individual intervention, this will be reviewed every 6 sessions alongside what we call outcome measures'to review treatment effectiveness. We typically offer a 6-week extended assessment and formulation approach to individual work. This may lead on to cognitive behavioural therapy for eating disorders or adolescent-focused psychotherapy for anorexia nervosa. The individual pathway within the service is less resourced which may result in a waiting time following a family-based treatment.

We provide groups to our children and young people which currently include:

• body image (8 sessions)
• compassion focused therapy (8 sessions)
• contemplation group (8 sessions)

You can access these groups regardless of whether you are in individual therapy or family-based treatment.

We also provide a group for parent group (8 sessions, over an 8-week period). This is a rolling programme, meaning that families can join sessions at any point following their assessment.

If you are working with a child or young person and wish to seek advice or share information, contact the team to share information with our administrative colleagues. This can be done via email or telephone.

You can also request to speak to the duty clinician if you wish to discuss worsening clinical or risk concerns.

Should your child or young person’s mental health, physical health or risk worsen whilst waiting for a new patient assessment, contact the team to share this information.

If following assessment your child or young person is accepted for treatment, they will be placed on a further waiting list for allocation of treatment. Waiting times for this can vary depending on the clinical demand for the service.

Our team provide a team approach to care, this means we do not allocate 1 single person as a lead healthcare professional. More information about this is can be found in the ‘What should I expect from family-based treatment’ section above.

Due to demand for our services, we encourage you to inform of us of any appointments you may need to cancel or rearrange. We follow a was not brought policy. This policy means we have a limit of missed appointments we can accept before considering discharge from the service. This is to ensure all children and young people waiting are safeguarded and allows other people waiting for support to access help in a timely way.

We are not a crisis service. Professionals can provide a maximum number of appointments at any given time due to supporting many children and young people. This means that if your child or young person is open to the team and requires more intensive support due to an increased risk to themselves or others, a support request can be made to our Multi-agency Rapid Response Service for enhanced risk support if deemed clinically appropriate.

We understand that coming to meet unfamiliar people and sharing personal information with us can feel an overwhelming or worrying experience. Your first experience of meeting our team will be at your new patient assessment. This assessment hopes to explore a range of topics so that we can better understand you.

We will ask you questions about:

• family life
• hobbies
• education
• your physical health
• what you are struggling with at present
• how things could be better for you
• any goals you might have
• your safety within yourself, at home and in the community

We offer you time to be seen alone in the assessment if that would be helpful for you. We encourage you to think about some of these topics, your strengths, and challenges ahead of the appointment and you are welcome to write notes down and bring this with you. This might be helpful in making sure you share as much information with us as you can to help your assessment outcome.

We are here to learn what your needs are. This might mean that other services might be more helpful for you based on your what you would like support with.

Attending appointments is not something you have to do. It is your choice to work with us as your care will be led by you. If you do not feel ready to work with us, or if you decide you would like to stop attending once you have started, we will respect your decision and will provide safety planning for you. If we feel that you are at high risk of harm and not feeling able to work with us, we may discuss alternative options with you and your parent or carers.

All information you share with us in your appointments will be kept confidential between yourself and the team. If you share any information with a professional that suggests you may have been or are currently at risk of harm from others or to others, we have a duty of care to share this with the relevant services. If we need to do this, we will be open with you as to why we are doing this and who we are sharing this information with.

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.
• Children and Young People’s Eating Disorder Service learning podcasts.

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.

• 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.

Avoidant restrictive food intake

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

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.

If you would like to help us celebrate good practice in our service, you can submit a WOW! Award nomination for a member of staff or team. We would value any positive feedback you would be happy to share.

In the unfortunate circumstance that you feel dissatisfied with the service, we encourage you to submit a complaint so that we can review practice and embed any relevant learning.