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Coelho JS, Pardiwala T, Marshall SK, Lam PY, Grewal S, Virani A, Olmos Pérez A, Geller J. Clinical care for severe and persistent eating disorders in pediatric populations: Perspectives of health professionals. J Eat Disord 2024; 12:83. [PMID: 38886837 PMCID: PMC11181587 DOI: 10.1186/s40337-024-01044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Models of treatment for adults with severe and enduring eating disorders focus on harm reduction and improving quality of life. However, there is a notable gap in the pediatric literature in this area. The current study set out to assess the perspectives of health professionals regarding clinical care for young people (e.g., ages 10-25 years) with severe and enduring eating disorders, and to explore perceptions about appropriate treatment options for these presentations. METHODS Health professionals were invited to complete a two-stage online survey about their experiences with clinical care for pediatric eating disorders through Canadian and Australian professional eating disorder networks. Survey 1 included questions about their experiences in supporting individuals with severe and enduring presentations. Participants who completed Survey 2 reviewed clinical vignettes and shared their perspectives about treatment recommendations and models of care, including for a severe and enduring presentation. RESULTS A total of 85 clinicians responded to questions on Survey 1 about severe and enduring eating disorder presentations. A portion of these respondents (n = 25) also participated in Survey 2. The majority of respondents to Survey 1 reported providing clinical care for pediatric severe and enduring eating disorder presentations. Amongst respondents to Survey 2, there was low consensus amongst respondents for the clinical care that would be most appropriate for young people with a severe and enduring eating disorder presentation. Numerous challenges in models of care for severe and enduring presentations in pediatric settings were raised in responses on Survey 2, with clinicians sharing their awareness of models focusing on quality of life, while also raising concerns about the appropriateness of these models for young people. CONCLUSIONS The preliminary results of this study demonstrate that the majority of clinicians report that they have provided care to young people with severe and enduring presentations. There is a clear need for establishing guidance for clinicians working in pediatric eating disorder settings around models of care focused on quality of life. Engagement with interested parties, including those with lived experience, can clarify the development of terminology and clinical pathways for severe and enduring presentations of pediatric eating disorders.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H3N1, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Tanya Pardiwala
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H3N1, Canada
| | - Sheila K Marshall
- School of Social Work, University of British Columbia, Vancouver, BC, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H3N1, Canada
- Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Seena Grewal
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H3N1, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alice Virani
- Provincial Health Services Authority Ethics Service, Vancouver, BC, Canada
| | | | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Provincial Adult Tertiary and Specialized Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada
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Hawkins C, Kealy D. Readiness and Personality Disorders: Considering Patients' Readiness for Change and Our System's Readiness for Patients. Harv Rev Psychiatry 2024; 32:70-75. [PMID: 38452287 DOI: 10.1097/hrp.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
ABSTRACT The culture around personality disorder treatment has changed drastically in the past generation. While once perceived as effectively untreatable, there are now numerous evidence-based treatment approaches for personality disorders (especially borderline personality disorder). The questions, however, of who should be matched to which treatment approach, and when, remain largely unanswered. In other areas of psychiatry, particularly substance use disorders and eating disorders, assessing patient treatment readiness is viewed as indispensable for treatment planning. Despite this, relatively little research has been done with respect to readiness and personality disorder treatment. In this article, we propose multiple explanations for why this may be the case, relating to both the unique features of personality disorders and the current cultural landscape around their treatment. While patients with personality disorders often face cruel stigmatization, and much more work needs to be done to expand access to care (i.e., our system's readiness for patients), even gold-standard treatment options are unlikely to work if a patient is not ready for treatment. Further study of readiness in the context of personality disorders could help more effectively match patients to the right treatment, at the right time. Such research could also aid development of strategies to enhance patient readiness.
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Affiliation(s)
- Connor Hawkins
- From Department of Psychiatry, University of British Columbia (Drs. Hawkins and Kealy); Vancouver Coastal Health, British Columbia, CA (Dr. Hawkins)
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Geller J, Fernandes A, Srikameswaran S, Pullmer R, Marshall S. The power of feeling seen: perspectives of individuals with eating disorders on receiving validation. J Eat Disord 2021; 9:149. [PMID: 34749802 PMCID: PMC8576949 DOI: 10.1186/s40337-021-00500-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A common complaint of individuals suffering from mental health conditions is feeling invalidated or misunderstood by care providers. This is notable, given that non-collaborative care has been linked to poor engagement, low motivation and treatment non-adherence. This study examined how receiving validation from care providers is experienced by individuals who have an eating disorder (ED) and the impact of receiving validation on the recovery journey. METHODS Eighteen individuals who had an eating disorder for an average duration of 19.1 years (two identifying as male, 16 identifying as female), participated in semi-structured interviews on barriers and facilitators to self-compassion. Seven were fully recovered, and 11 were currently participating in recovery-focused residential treatment. Thematic analysis focused on the meaning and impact of receiving validation to participants. RESULTS Five care provider actions were identified: (i) making time and space for me, (ii) offering a compassionate perspective, (iii) understanding and recognizing my treatment needs, (iv) showing me I can do this, and (v) walking the runway. These were associated with four key experiences (feeling trust, cared for, empowered, and inspired), that participants described as supportive of their recovery. CONCLUSIONS This research provides insight into patient perspectives of validation and strategies care providers can use, such as compassionate reframing of difficult life experiences, matching interventions to patient readiness, and modeling vulnerability.
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Affiliation(s)
- Josie Geller
- St. Paul's Hospital Eating Disorders Program, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - A Fernandes
- St. Paul's Hospital Eating Disorders Program, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - S Srikameswaran
- St. Paul's Hospital Eating Disorders Program, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - R Pullmer
- St. Paul's Hospital Eating Disorders Program, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - S Marshall
- Department of Adolescent Health and Medicine, University of British Columbia, Vancouver, Canada
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Geller J, Isserlin L, Seale E, Iyar MM, Coelho JS, Srikameswaran S, Norris M. The Short Treatment Allocation Tool for Eating Disorders: current practices in assigning patients to level of care. J Eat Disord 2018; 6:45. [PMID: 30619608 PMCID: PMC6310938 DOI: 10.1186/s40337-018-0230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/27/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The Short Treatment Allocation Tool for Eating Disorders (STATED) is a new evidence-based algorithm developed to match patients to the most clinically appropriate and cost-effective level of care (Geller et al., 2016). The objective of this research was to examine the extent to which current practices are in alignment with STATED recommendations. METHOD Participants were 179 healthcare professionals providing care for youth and/or adults with eating disorders. They completed an online survey and rated the extent to which three patient dimensions (medical stability, symptom severity, and readiness) were used in assigning patients to each of five levels of care. RESULTS The majority of analyses testing a priori hypotheses based on the STATED were statistically significant (all p's < .001), in the direction of STATED recommendations. However, a strict coding scheme evaluating the extent to which ratings were fully consistent with the STATED showed inconsistency rates ranging from 17 to 55% across the five levels of care, with the greatest inconsistencies involving the use of readiness information, and the lowest involving the use of medical stability information. DISCUSSION Although practices were generally aligned with the STATED recommendations, readiness information was used least consistently in assigning patients to level of care.
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Affiliation(s)
- Josie Geller
- 1Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada.,2Department of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Leanna Isserlin
- 3Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario Canada
| | - Emily Seale
- 3Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario Canada
| | - Megumi M Iyar
- 1Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada.,4Department of Psychology, University of British Columbia, Kelowna, British Columbia Canada
| | - Jennifer S Coelho
- 2Department of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada.,5B.C. Children's Hospital Provincial Specialized Eating Disorders Program for Children & Adolescents, Vancouver, British Columbia Canada
| | - Suja Srikameswaran
- 1Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada.,2Department of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Mark Norris
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Abstract
Higher levels of care (HLC)-including inpatient hospitalization, residential treatment, partial hospitalization, and intensive outpatient treatment-are frequently utilized within routine care for eating disorders. Despite widespread use, there is limited research evaluating the efficacy of HLC, as well as clinical issues related to care in these settings. This review describes the different levels of care for eating disorders and briefly reviews the most up-to-date guidelines and research regarding how to choose a level of care. In addition, as HLC approaches for ED continue to be developed and refined, pragmatic and conceptual challenges have emerged that provide barriers to clinical efficacy and the execution of high-quality treatment research. This review includes a discussion of various issues specific to HLC, as well as a summary of recent literature addressing them.
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