1

Transforming a Community ED service; The Dorset experience

Dr Ciarán Newell

Consultant Nurse Eating Disorders/Facilitator Research and Development

1

Access to High Quality care

It is vital that children and young people with eating disorders, and their families and carers, can access effective help quickly. Offering evidence-

based, high-quality care and support as soon as possible can improve recovery rates, lead to fewer relapses and reduce the need for inpatient

admissions.

The sooner someone with an eating disorder starts an evidence-based NICE-concordant treatment the better the outcome. The standard is for treatment

to be received within a maximum of 4 weeks from first contact with a designated healthcare professional for routine cases and within 1 week for urgent cases. In cases of emergency, the eating disorder service should be

contacted to provide support within 24 hours.

1

Support for families and carers

Services need to be able to respond to the broader needs of families and carers as well as the child or young person with an eating disorder. This might

include supporting the family with techniques to help manage eating disorders in young people, and information about additional support services

or expert advice.

Outcomes

Providers of eating disorder services will be required to demonstrate that they deliver evidence-based, high-quality care. This can be supported through

the membership of a national quality improvement and accreditation network to produce transparent and accessible data for all stakeholders,

including the general public.

1

Trained and supported staff in evidence based care

It is then the responsibility of the provider to ensure that the service meets the specification with appropriately qualified and supervised staff to deliver

high-quality, evidence-based care.

Partnerships and Transitions

NHS England, clinical commissioning groups (CCGs), local authorities, education providers and other eating disorder services (including adult

mental health) should work in partnership to improve outcomes for children and young people with eating disorders and support their transition between services. This is an effective way to increase capacity and share resources to

deliver better care.

1

Local service availability;

Community Service for Adults (1998)

Community service for Children and young people (2011)

Both commissioned by Dorset CCG and run by the Trust

6 bed inpatient and 4 place day patient unit for Adults commissioned by NHS England

1

Population of Dorset is 782,692

The community services had a total of;

303 referrals in 2010/11

463 referrals in 2015/16

1

Access; How

7day working

Self referral

Parental referral

4/1 week waits

1

Support for families and carers

Multi family groups

Carers Training

Complex family clinic

Carers support groups

1

Outcomes

CYP IAPT training

Session by session outcome scores

Quarterly reports to team on outcomes

Ongoing work

1

Trained and supported staff in evidence based care

CYP IAPT training

CBT-E on line training

Systemic therapy

“Carers training” Training

Whole team training in models of care

1

Partnerships and Transitions

Liaison with local paediatric and acute medical wards on MARSIPAN

In reach support to patients in those wards.

Liaison with Dietetics on MARSIPAN and meal plans

TRANSITIONS

1

The peak age at onset of anorexia nervosa is the mid-teens and that of bulimia nervosa is 2 or 3 years later. The average duration of anorexia nervosa is 6 years. Thus these disorders span the transition between child and adolescent and adult services.

This age range also has its own non medical related transitions.

Transitions between different services are the norm for patients with ED: primary, secondary and tertiary care; medical and mental health services; child and adolescent services and adult services; family home and student abode.

Nice 2004 warned about the risk of transitions.

The access and waiting time guidance also stresses the need to manage these times.

1

Transition Team;

Psychiatrist

Systemic Therapist

Occupational Therapist

Specialist Nurse

Dietitian

Service lead

1

What helps us in Dorset.• Commissioner energy and commitment• Single manager of the services• Freedom to direct resources to where they are needed.• A cohort of skilled and dedicated staff within the ED service• Reputation

1

Reflections on other things.

• Manage concerns about money for Children being taken by Adult services/ Build Trust

• Confidentiality issues/ statutory requirements• Negotiate bureaucratic obstacles/ Transition protocol• Training/Shadowing

• Supervision

• Clear idea of the why to transform

1

All age service.

• Provision of a team which contains expertise in both children’s and adult services providing individual, group and family psychological interventions

• Provision of a service that is organised around the needs of the local population achieving improved patient experience and effectiveness of clinical intervention

• Prevent unsystematic gaps in care as individuals and their families/carers reach key transitions by providing a designated transition team within the service to work with young adults from the age of 14yrs to 25yrs.

• Provision of more focus on prevention, early identification and intervention with patients, families, carers, the 3rd sector and other partners such as social care and acute hospitals.

• Capture outcomes of services via a range of measures, including clinical tools to measure change and actively seek patient and carer involvement experience

1

Population of Dorset is 782,692

The community services had a total of;

303 referrals in 2010/11 of which 21 were under the age of 16

463 referrals from April 15- March 16 of which 93 were under the age of 16.