Collaborative Meetings with Young People with Eating Disorders and their FamiliesAlfred CYMHS Eating Disorders Program

Rachel Barbara-May, EDP CoordinatorHelen Searle, Family Peer WorkerPaul Denborough, Clinical Director

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Bayside

Glen Eira

Kingston

Port Phillip Stonnington

Monash

Port Melbourne

Albert Park

St Kilda

Elwood

Brighton

South Yarra

Prahran

Toorak

Sandringham

Malvern

Bentleigh

Beaumaris

Cheltenham

Moorabbin

Caulfield

Carnegie

Mentone

Chadstone

Oakleigh

Mordialloc

Chelsea

Clayton

Carrum

Dingley

Child & Adolescent Mental Health Service Area - Inner SouthernOriginal: MHSA CHILD metro individual .WOR :: Inner SouthProduced by Paula Morrissey, Metro Health & Aged Care, 10/02/04Areas derived from: Local Government and Statistical Local Areas Australian Standard Geographical Classification (ASGC) 2003

Local Government Areas

SuburbsMain Roads

LEGEND

Program Structure• A ‘specialist’ team fully integrated within, and supporting the

clinicians of the ‘generalist’ CYMHS teams• Treating case managers are of all different professional

backgrounds and levels of experience• Treating case managers are working with children, young

people and their families from 3yo – 25yo, who are struggling with all different types of behavioural and psychological distress

• Case managers are working within 3 clinical teams from within the service, approximately 30 different clinicians

• The ‘specialist’ team ‘wraps around’ these clinicians and the families they are supporting

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Our Hopes• Soft entry – easy to get in and get what you need• Early intervention, first step in treatment for young people with

eating problems in our catchment area• Get started quickly and responsively (within two weeks of the first

contact)• Utilise the energy of the crisis as an opportunity to invite the young

person and their important people to come together• Have first meetings that are impactful, healing and hopeful • Avoid lengthy problem focused assessment• Psychological continuity• Coordinated and integrated ‘one stop shop’ treatment• Tailored to each person, modified and adapted to achieve sought

results

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Alfred Health CYMHS – headspace Eating Disorders Program

First Family Meeting

Single Session Collaborative Family/Network MeetingFamily Brief Intervention

(FBI)Multi-disciplinary consulting

teamTargeted solution focused

intervention

•Step up/step down between programs, alongside treatment•4 daysMulti-family therapy•Evidence-based, skills base training for carers, co-facilitated by a carer and clinician•7 weeks, twice yearlyCollaborative care skills workshop•Family and clinician education, co-delivered by YP, families and clinicians•1 day workshop, quarterly to assist families getting started in treatmentFamilies fighting eating disorders•4 week education program for parents just commenced re-feeding stage of treatment. Peer support

and mentoringNourishing Parents

headspace PractitionerContinuing care as needed with

primary headspace clinician Supported by medicare

Collaborative Needs Adapted Treatment

Clinic based outpatient treatmentIntegrated care

Case ManagementStrengthening role of family in

treatmentStrengthening YP networks and

routinesHospitalisation only for medical safety

Brief IntensiveIn-Home Treatment

Intensive outreach supportGoal based

Family coachingHome-based interventions

2 week integrated step-up/step-down treatment

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Helen & Paul

First Family Meeting

A Collaborative-Dialogic Process that focuses on:

• The importance of being listened to

• Exploring some new ideas about the social and relational implications of the situation

• The biological aspects of being under-nourished

• Utilising the special knowledge and expertise of the team in combination with what the person and their network bring

• Building and establishing therapeutic relationships and connections

Pre-Meeting

The Worries Questionnaire (all family members)Who is most worried about the eating issues? what is that person most worried about? Can you describe these worries? How worried are you? Can you describe your worries? Who decided that we should have this meeting? What are that person’s hopes for this meeting? If our meeting was successful, what would be different?

Eating Concerns Questionnaire for parentsWhat are mealtimes like? What is a typical day of eating like for your son/daughter? How long has it been this way? What was it like before? What are you specific nutritional

concerns? Do you have any theories as to why this is happening

Eating Concerns Questionnaire for young personHow would you describe your relationship with food? Does this worry you? Is it getting in the way of your life? Where did these worries come from? Is there anything you would like to change? Is there anything else we should know?

Pre-Meeting

• The intake clinician has frequent contact and ‘holds the family’ during the period between first contact and the day of the meeting.

• During this time, the pre-meeting process is undertaken, developing readiness, setting up process, clarifying worries and participation, all aimed at maximising the success of the first meeting

• The nurse member of the team meets with the young person, to assess and measure things like height, weight, heart rate, blood pressure, skin and hair integrity, and reproductive health

The Collaborative Process

• A live consultation with a young person and family/network including two therapists and a consulting team, lasting about 2 hours

• Approach the meeting from a curious stance• Attempt to open a dialogical space for a different kind of

meaningful, generative conversation with all members of the group, that they may not have been able to have before or again

• The consulting team (situated behind the one way screen) provide a valuable resource (including medical information) that we have alongside us in our conversation with people and that we include if it becomes relevant or important

• No fixed format, technique or intervention

Resources on Tap, Not on Top

• The therapists and families can request a consultation with the team members at any time throughout the conversation

• It is usual for there to be at least two scheduled ‘swap overs’ through the meeting

• It is common for the two therapists in the conversation with the family to engage in reflecting exchanges with each other that are interwoven in the ongoing conversation

• The consulting process is a back and forth, give and take activity that creates a ‘we’re in this together’ experience, that is connecting and allows everyone to talk with each other

• Therapists take a learning position, learning of the client’s story and perspective through the client’s language

The Collaborative Process

• The ‘not knowing’ stance• No pre-determined way of working• We make sure to enquire about their expectations and hopes for their

talk with us• We try not to hold private hypotheses or offer interpretations to a

client about their stories or problems• Making sense of experiences is balanced carefully with ‘how can we

help you go on and reduce these worries in your life?’

Consulting Team• Eating Disorder Program Coordinator: brings particular expertise in working

with families and the clinical management of eating disorders• Dietitian: Eating disorder specific nutritional knowledge and intervention,

education about recovering from malnutrition, eating behaviour and patterns

• Nurse: Integrated physical health assessment and support managing malnutrition, nursing care for other physical health concerns, education to families and clinicians

• Family Peer Worker: Lived experience of caring for a young person with eating difficulties, direct experience of participating in treatment, brings hope and mutual experience

• Mental Health Clinician(s): understanding of the impact eating difficulties have on families and individuals, bring expertise in making sense of the difficulties that people are experiencing

• Psychiatrist: In addition to the expertise offered by other clinicians, the psychiatrist can also offer specific medical/psychiatric opinion when needed/indicated

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Helen & Paul

Client-led, Needs Adapted

• Each young person and family are different and have different needs, strengths and resources

• Focusing on and trusting in the treatment alliance and partnership with families to bring about solutions

• Outcome Rating Scale and Session Rating Scale• The therapeutic process and style is adapted each time, this

includes what is talked about, the conversation style and pace, and how the ‘consulting team’ are utilised throughout the meeting

What Happens Next?

• “what happens next” is also uncertain prior to all meetings and is determined with each family towards the end of the meeting, or afterwards

• All families are provided with a copy of the meeting summary document

• Young person and family are routinely invited back to meet with the consulting team for a review meeting at ~6 weeks after start

Key Outcomes • Improved access: massive and persistent increase over many

years of the number of young people accessing the service• Core business for all clinicians• Reduced stay in treatment, sometimes this meeting with some

brief follow up is enough• Improved health outcomes and recovery rates for young

people• YP and families have positive experience, feel listened and

responded to, part of decision making• Getting a good start, with increased therapeutic gains after the

first meeting

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Helen & Paul

Thank you and contact

Rachel Barbara-MayR.Barbara-May@alfred.org.au

Paul DenboroughP.Denborough@alfred.org.au

Helen SearleH.Searle@alfred.org.au

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