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, we cannot accept the referral without the information outlined above.

Once we have received your completed referral, we will contact you via an acceptance letter to let you know 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 through the provider Kernow Health, this is separate to the service. These appointments are usually started around 2 weeks following the referral to us.

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

• Cudmore House, Treliske
• Liskeard Community Hospital
• Newquay Treviglas health hub
• Wadebridge integrated health hub

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 because of purging.

Our assessment clinic usually runs on a Monday. Present from our team will usually be 3 clinicians, including a combination of therapists and dietitians. 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. It is 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.

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.

Following the assessment, we provide a 12-week parent and carer programme as the initial intervention within the family-based treatment pathway. Occasionally, a family-based approach is not considered appropriate, in which case a young person would be referred to our individual pathway.

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.

Physical monitoring is provided from the Kernow Health service. This service is separate, although we work closely together to meet the needs of children and young people.

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

All results will be automatically uploaded and followed up with contact from Kernow Health. As the monitoring will be at home, we can be more flexible about when the monitoring is undertaken. 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. Kernow Health only offer home monitoring in instances where frequent bloods are not required.

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, and Liskeard. 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 also provide groups to our children and young people which currently include:

• food choices (3 sessions)
• body image (8 sessions)
• compassion focused therapy (8 sessions)
• contemplation group (8 sessions)
• 16 to 25 groups which are developmentally informed groups combined with adult eating disorders

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

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.

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