We produced a business case to expand the service from 4 clinicians to 17. This has meant we have gone from having only nurses in the service to having additional nurses, consultant psychiatrist, speciality doctor, family therapists, support workers and admin staff. This has had a massive impact on the service users. Prior to this development we were only able to work with the very high risk, anorexic patients. With the expansion of the service we now work with all risk levels for those suffering with anorexia, bulimia, binge eating disorder and related conditions.
We produced a business case to expand the service from 4 clinicians to 17. This has meant we have gone from having only nurses in the service to having additional nurses, consultant psychiatrist, speciality doctor, family therapists, support workers and admin staff. This has had a massive impact on the service users. Prior to this development we were only able to work with the very high risk, anorexic patients. With the expansion of the service we now work with all risk levels for those suffering with anorexia, bulimia, binge eating disorder and related conditions.
This means that all young people suffering with these conditions can now get specialist intervention at a much earlier time in their illness giving them a much better chance of full recovery. This expansion in service has also enabled us to offer a very intensive treatment package, a hospital at home type approach with clinicians visiting the family and young person on a daily basis, offering meal support, advice and guidance, as well as continuing with the treatment approach of the team using family based treatment and a motivational approach to help the young person fight for their recovery.
We can now offer young people and their families treatment from a multi-disciplinary team meaning that many of the families we work with are able to have family therapy which also receiving nurse lead interventions and being monitored and supported by doctors as needed. We have an extremely recovery focused model of treatment and this has been embedded in the team by having whole team training once all the team were in post. We are constantly developing new ways to help patients remain focused on their recovery and helping them work with us to battle their illness together – as one young person said ‘My Nurse always believed that I would get better and never judged me or was disappointed in me when things didn’t go well. She fought the illness with me and made me feel we were a team fighting an enemy. She was strong for me when I wasn’t able to fight’
We have also been able to start delivering training to schools to help teachers identify eating disorders sooner and help them understand the referral process so referrals can be made sooner, again giving the young person the best chance at recovery.
Wider Active Support
We have worked alongside Carers in Herts, a voluntary organisation which focuses on supporting Carers of those with mental health problems. They supported our business case for expansion by explaining why the feel it is crucial. We have jointly delivered Carers groups together.
As mentioned above we work closely with schools to help in the early recognition and treatment of those young people suffering with eating disorders.
We already work closely with Paediatric wards if a young person is admitted there suffering with an eating disorder, offering support and advice. Our next step is to develop a working party which will include professionals from our service, Paediatrics and Dietetics to develop clear treatment pathways for those young people needing medical stabilisation of their eating disorder on a paediatric ward.
We work very closely with the local adolescent mental health unit who hold 3 beds for eating disorders. The consultant who works for us also works there which enables smooth transition in and out of hospital and also enables us to have very short admissions for those young people admitted, meaning they can return to their home life with family, friends, school etc as soon as possible.
We also have very good links with a local specialist eating disorders unit which allows us to arrange admissions rapidly when needed and maintain good connections with our patents while they are an inpatient, allowing for smooth transitions.
We have very good links with the local CAMHS teams too which means they can contact us for advice and support for those working with the CAMHS team who might have low weight due to other mental health problems and we will often offer consultation appointments to young people and parents with the CAMHS clinician to offer psycho education about the effects of underesting and advice on how to improve this.
Co-Production
While building the business case we sent out questionnaires to service users and parents asking for their feedback on the proposed ideas for the expansion of the service and to gain their feedback as to how they would like the service to develop should the proposal be granted.
We also held an evening for parents, professionals and commissioners to again explore the expansion of the service and how parents would like the service to be shaped. It also gave parents an opportunity to interact with commissioners and explain why they felt the expansion was so crucial to their child’s recovery and the young people who would come to the service at a later date.
We constantly use young people’s and parents feedback and stories as part of our recovery model, which young people and parents writing their stories and messages of hope that are passed to future service users. We have also had graduate parents attend the parent support groups to support new parents and help to deliver a message of hope, that recovery is possible.
Looking Back/Challenges Faced
One of the main challenges has been to work out what will be the most useful balance of professionals in the service to offer the best treatment possible, for example, how many support workers are needed, how many family therapist etc. This is under constant evaluation based on feedback from patients and parents as well as professionals in the service and outside of it. As an example we did not initially recruit a Psychologist but as time has gone on we have realised a Psychologist is crucial, particularly for those with co-morbid conditions so they can be fully supported in our team without having to enlist the support of other services, helping young people to feel safe and contained.
Sustainability
We have a whole team approach and everyone working in it is invested in ensuring we continue to deliver to best care possible for young people are parents, to ensure they have the best chance of reaching health and achieving full recovery.
Evaluation (Peer or Academic)
The expansion is very new so evaluation at this point is not possible but there are plans for evaluation as things progress.
We have been reviewed by commissioners (on a quality visit) which gave very positive feedback.
We have also recently been peer reviewed by the QNCC-ED with some very positive feedback and this will be done on an annual basis.
We also consistently receive 100% positive feedback from the Friends and Family Tests.
Outcomes
We routinely ask young people and parents to complete outcome measures at the start and end of treatment which have all shown an improvement in symptoms by the end of treatment.
We have also seen a marked decrease in the number of young people needing to be admitted to specialist inpatient beds (in April 2016 the average number of young people in inpatient beds per week was 12.5 but this has reduced to 2.5 in March 2017) – this is crucial as treatment at home gives young people an increased chance of full recovery and maintaining this after treatment, as well as meaning they are not away from their family, friends and everyday life.
Sharing
As a service we are very committed to sharing our work with others. We have appeared on radio and TV recently talking about the service, what it can offer and encouraging referrals to be made early.
We are also part of specialist interest groups in eating disorders where good practice is shared amongst other professionals.
We regularly work with students and professionals who want to gain more understanding about the treatment of eating disorders.
Is there any other information you would like to add?
We receive incredible feedback from young people and parents and this is something we are exceptionally proud of. Here are some examples: ‘Without (Nurses Name) help, our daughter would not have survived. We are forever in her debt’
‘The vast experience and understanding this team has in relation to adolescent eating disorders makes treatment for each individual uniquely targeted and therefore highly effective. It is imperative that anyone suffering with an eating disorder be given access to specialist diagnosis and care quickly, if lasting recovery is to be possible’
‘Quite simply, we were given a safety net at a time when we felt completely powerless and adrift. Our daughter’s nurse walked alongside us all, with encouragement and laughter, whilst providing firm and unwavering guidance and care for our daughter’
‘Thank you for being the best person in the world and making me happy again. I can’t thank you enough for what you’ve done for me and my family’
We found our fairy godmother…thank you from the bottom of our hearts for giving us our daughter back’
