Eating Disorder Service for Children and Young People - referrals

We have collaborated with BEAT (eating disorder charity) to provide education and training to schools to increase awareness and promote early identification of eating disorders. BEAT have been undertaking training for teachers, school nurses, and allied professionals in schools and colleges in our catchment area.

BEAT also offer a free training programme directed for all GPs to enhance their understanding and help with early referrals as part of our early identification and intervention strategy.

When a referral comes through, a member of our admin team will upload it to our system, where it will be screened by one of our nurses to assess the appropriateness for our service. If they are deemed appropriate, a triage is conducted by phoning the patient/carer on the number they have provided, where they will be booked into a physical health clinic or asked to contact their GP for full physical health information (weight/height, BMI, WFH, bloods, and ECG). They will then be invited to attend the education group for 4 weeks followed by CPA, if assessment completed at physical health clinic is suitable for a routine case.  

If the case is identified as urgent, they are booked into urgent clinics and discussed in MDT. Patient may be admitted to paediatric ward if urgent. Every case has a CPA review after four weeks of intervention.  

Below documents are for clinicians to refer to:

• MEED tool
• Referral form to paediatrics
• New Case Assessment Proforma
• Safety plan
• Paediatric ward plan

Patient and parent/carer complete the below (you will be sent a user ID and password):

• Patient HoNOSCA
• Clinician HoNOSCA
• Parent HoNOSCA
• CYBOCS
• EDE-Q
• RCADS Parent
• RCADS Child 
• AQ-10 for child and adolescents
• CGAS

Physical Health Clinics

Physical health clinics are a vital part of our service, to monitor risk and understand progress with our interventions. Physical health checks are conducted with a nurse or support worker to assess height, weight, blood pressure, and a SUSS test. This enables clinicians to track progress to reflect on improvements with the patient and identify any concerns.

Psychoeducation Group

Our innovative psychoeducation group has been a revolutionary and effective intervention, to meet the needs of young people and their parents in a fast and efficient manner. These groups started in May 2020 at the start of the COVID-19 pandemic and are conducted via Zoom to expand our reach to patients. Evidence of patient and family improvement from these groups was presented at the Faculty of Eating Disorders of the Royal College of Psychiatrists conference in May 2021.

There are five sessions in total: Session one is delivered by our family therapists, session two is delivered by the dietitians, session three is a question and answer with the team, session four involves body image work, and session five explores the risks of eating disorders and is delivered by our consultant psychiatrist.

Self help Information

We provide self-help information and education resources for our patients and their families. This information is readily available as soon as they contact our service. These resources include books on anorexia nervosa and bulimia, logbooks, carers guides, and various workbooks. We had very good feed-back from patients and carers on these resources.

Consultant psychiatrist provision 

The children’s eating disorder service is led by the Child and Consultant Psychiatrist in the team. The consultant psychiatrist offers timely psychiatric assessments, reviews, risk assessment diagnostic formulations, second opinions, and robust management plans for the severely unwell and complex eating disorder patients. The consultant psychiatrist also offers support to nursing and other members of the clinical team in reaching robust clinical formulations and prepare high quality and safe risk management and treatment plans to patients in the community and on the paediatric ward.

The consultant psychiatrist also leads on delivering the three full day training through the year with the help of members of clinical team and external speakers. The consultant psychiatrist leads on teaching and training programme for GPs, paediatric doctors, A&E doctors, nurses, psychiatric trainees, and other allied professionals in the catchment area of the service across the four boroughs with CCG and ICS colleagues.

The Consultant Psychiatrist offers mental health act assessment and reviews of patients under CTO and liaison with children services, tier 4, social services, safeguarding, and other agencies in collaboration with team members.

Paediatric Ward Intervention and Clinic

For children and young people who present with complex eating disorders and physical health complications, a paediatric admission may be necessary to start refeeding and weight restoration programme. The paediatric consultant may review patients in their clinic and offer suitable medical advice and a plan. This helps our clinicians to offer suitable risk planning and advice.

Family Therapy

Family Therapy helps people in close relationships help each other. Enabling family members, couples and others who care about each other to express and explore difficult thoughts and emotions safely, to understand each other’s experiences and views, appreciate each other’s needs, build on strengths, and make useful changes in their relationships and their lives. Individuals can find Family Therapy helpful, as an opportunity to reflect on important relationships and find ways forward. Family therapy considers the problem the issue, and not the person. The family is seen as a resource for the person who has been joined by the eating disorder. Family Therapy works to support and nurture the family as together we try and make sense of your experiences and hopefully begin to recover. 

Conversations in family therapy can be wide ranging and often consider peoples lived experience and understanding of things outside of eating and explore their potential influence. This means there can be lots of times where food isn’t central to our conversations, but the meaning and feelings associated with it may be, however there may be other times when the process of eating or someone’s physical health are central to our conversation. 

Family members or other important people may be invited by the referred person to come to Family Therapy, and this may mean that sometimes different people attend sessions on different occasions. There may be other times when the therapy team will have more input into who is invited to attend. People often have a natural anxiety to meeting and talking as a family and if you would like to talk more about family therapy then please contact our team and ask for someone from the Family Therapy team and we will be happy to have a pre meeting conversation with you. 

Dietetic information

The role of the dietitians in our service is to ensure you are meeting your nutritional needs. Individual sessions will involve supporting you to establish a balanced relationship with all types of food, including any fear foods, via behavioural experiments, and hierarchical exposure. There will be discussions around motivation to change, metabolism, effects of starvation on the body, recognising hunger and fullness, the binge-purge cycle, portion sizes, dietary rules, and the risks of calorie counting.  

A nutrition group is soon to be launched in September to provide support surrounding mealtime planning and support, food and mood, starvation, metabolism, and myth busting. Our dietitians work closely with young people to address any issues they may be dealing with, such as fad diets and social media. More resources can be found online through CCI Information Sheets and Workbooks for Mental Health Problems website. 

Cognitive Behavioural Therapy 

CBT (cognitive behavioural therapy) is an evidence-based treatment for young people with eating disorders and NICE guidelines recommend CBT for the treatment of all types of eating disorders.

CBT-E is a treatment that helps a young person with an eating disorder, to re-establish a regular healthy eating pattern, weight restore (if underweight), and address thoughts, emotions and behaviours that are keeping the eating disorder in place. We look at what is maintaining and feeding the eating disorder to make it grow and become more powerful.

In CBT we like to promote autonomy and independence for you to regain control of the illness that is in fact controlling young people at the time of joining our service. But…this is done in a compassionate, empathetic way, where we work together to learn and progress, as you are the expert of your own disorder.

In CBT there are many techniques used to promote understanding and progression, as there are many aspects of the eating disorder and its behaviours that are looked at and worked on in a collaborative way.

CBT are weekly sessions of 50-60 minutes and is adapted and individualised to each person and their needs. These sessions are one to one session with occasional sessions with the help and support of parents/guardians.

Triangle

TRIANGLE is a guided self-help online intervention for young people, parents, and carers. Patients who are accepted into our service will be invited to take part in this unique intervention. TRIANGLE involves reading modules, workbooks, and videos. If you are invited to take part, you will be encouraged to ask a chosen carer to support you using their own workbooks and DVDs.

You will receive emails or chat support from the TRIANGLE mentor to explore and reflect on these materials. If this service is ideal for you, then you will be provided with a username and password.

If the whole team decide discharge is appropriate, our patients will be discharged with self-monitoring tools, along with recommending a GP follow-up. Transition between services can be difficult for our young patients, which is why it is essential that we signpost and transfer care effectively between services. Referrals can be made to tier-4 wards/CAMHS, safeguarding, or children’s services. Furthermore, for our patients who are turning 18, a referral to adult eating disorder services or FREED can be made.  

Tier 4 admission  

There are specialist inpatient eating disorder services for children and young people (above 14 years of age) in Chester, Liverpool, and Manchester. We can access them for children and young people who need further help after they have been given comprehensive care on the paediatric ward and in the community. The Dewi Jones unit in Liverpool offers specialist inpatient related care to children and young people who are under 14 years old.

The Cheshire and Merseyside CEDS offers inpatient and community eating disorder service to children who are 14 or over. Galaxy house offers help to children and young people inpatient who are 0-18, priory Altringham offers for 14+, along with family visits.

Download our Tier 4 referral form.

We organise teaching and training events for our own staff, psychiatry trainees, GPs, school nurses, teachers, etc. We organise full day training programmes three times every year, with the next one scheduled for the 25th of November 2022. We have organised training sessions for our commissioners.

We offer clinical training to junior doctors, GP trainees, medical students, psychology students, nursing students, family therapy students, dietetic students, and others from UK and abroad. If you are interested to gain experience in the field of eating disorders, please contact us and we will offer supported and supervised training placement. 

Our children’s specialist eating disorder service is a selected site for taking part in NHS England and Royal College of Psychiatrist led pilot for training consultant psychiatrist and higher psychiatrist trainees in eating disorders. We will have two credential trainees attached to our service, who are supervised by our consultant psychiatrist.

We are a national centre for research in eating disorders and allied field. We are currently undertaking high level research in collaboration with Kings College London and South London and Maudsley NHS Foundation Trust. 

We are undertaking 3 research projects in partnership with our GP colleagues, CAMHS services, commissioners, ICS and ICB partners, and North West Coast SCN.

Our Young People's Community Eating Disorder Service works in partnership with leading national eating disorder charity Beat, Paediatric ward, and clinic at Whiston hospital and Kings College London.

CYPMHS Crisis Response Team 5pm to 9pm on weekdays and 9am to 9pm on weekends (for urgent phone advice) Telephone: 01744 627618 

BEAT – Eating Disorder Support Online 9am to midnight during the week, 4pm to midnight on weekends and bank holidays. Telephone: 0808 801 0677 Email: help@beateatingdisorders.org.uk 

Children and Young People’s 24/7 Mental Health Crisis Line: 0800 151 0023

PAPYRUS (prevention of young suicide): 0800 068 4141

CHILDLINE: 0800 1111

CALM Helpline (males only): 0800 585 858

Non-emergency police support: 101 Knowsley Social Care: 0151 443 2600 

Switchboard (LGBT support): 0300 330 0630

National Domestic Violence Helpline: 0808 2000247