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Eating Disorders Toolkit - Centre for eating & dieting ...

Eating Disorders Toolkit A Practice-Based Guide to the Inpatient Management of Adolescents with Eating Disorders , with Special Reference to Regional and Rural Areas. Acknowledgements The Toolkit development was facilitated by MH-Kids in conjunction with a variety of clinicians and academics throughout NSW, nationally and internationally. A full list of acknowledgements can be found in Appendix 1. Eating Disorder Toolkit - A Practice-Based Guide to the Inpatient Management of Adolescents with Eating Disorders , with Special Reference to Regional and Rural Areas This work is copyright. This document may be reproduced in whole for clinical use, study and training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from MH-Kids.

secondary diagnosis eating disorders. The Toolkit is aimed at medium to longer-term admissions (i.e., longer than 24-48 hours), and is not aimed at brief admissions for medical stabilisation only. The aim of the Toolkit is to provide a practice-based manual for use by clinicians working

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Transcription of Eating Disorders Toolkit - Centre for eating & dieting ...

1 Eating Disorders Toolkit A Practice-Based Guide to the Inpatient Management of Adolescents with Eating Disorders , with Special Reference to Regional and Rural Areas. Acknowledgements The Toolkit development was facilitated by MH-Kids in conjunction with a variety of clinicians and academics throughout NSW, nationally and internationally. A full list of acknowledgements can be found in Appendix 1. Eating Disorder Toolkit - A Practice-Based Guide to the Inpatient Management of Adolescents with Eating Disorders , with Special Reference to Regional and Rural Areas This work is copyright. This document may be reproduced in whole for clinical use, study and training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from MH-Kids.

2 Locked Bag1, HRMC, NSW 2310. Ph: +61 2 49855830. Fax: +61 2 49855320 First Edition printed by WHO Printing & Presentations. 9 Bryant St, Tighes Hill, NSW 2297. Ph:+61 2 4969 4044. Fax: +61 2 4962 3162 To obtain a further copy please contact the Better Health Centre Publications Warehouse on Ph: 9816 0452. Copyright 2008 MH-Kids, NSW Health. EXECUTIVE SUMMARY It is well recognised that early, timely and appropriate care will improve the likelihood of positive treatment outcomes for young people with an Eating disorder. The high morbidity and mortality associated with Eating Disorders and the need for a multidisciplinary approach are well reported in the literature. The Eating Disorders Toolkit is a practice-based manual that aims to assist health professionals in applying best-practice principles in non-specialist inpatient settings in NSW.

3 The Toolkit aims to assist with improving access to practical information, to facilitate consultation with specialist staff and to improve consistency in care for adolescents with Eating Disorders across NSW. The Toolkit has been developed to provide practical information on key components of care for adolescents admitted with an Eating disorder including: Involving the family and other health professionals, Accessing specialist assistance, Identifying those in need of admission, Admitting the patient, Assessment, Treatment planning, Implementing treatment (primarily medical, nutritional and psychological aspects), Discharge, and Accessing further information and support. The document has been developed with the busy clinician in mind, aiming to ensure easy access to relevant information.

4 A clinician who is new to the management of Eating Disorders may find the Toolkit an invaluable resource of background information essential to the management of adolescents with an Eating disorder. The Toolkit has been designed to provide user friendly pull out sections that can be easily identified and accessed separately. The information described in the Toolkit has been developed from the evidence-based literature, international Eating disorder clinical practice guidelines, consultation with national and international experts and the experiences of clinicians working with patients with Eating Disorders in non-specialist settings. Due to the limited evidence base and often, conflicting views regarding inpatient management, recommendations should be applied carefully to individual clinical and organisational circumstances and should be followed with care.

5 It is not the intention that this Toolkit acts as a stand-alone treatment manual as any management program must take into account the unique health care needs, and the context, of each individual patient and their family. Eating Disorders Toolkit - Introduction to the Toolkit i Table of Contents _____ Section 1: Introduction to the Aims and Scope of the What is an Eating Disorder?..2 How to Use the ToolkitGeneral Principles For All Section 2: Getting the Patient to Hospital_____ ..5 Preadmission Minimum Levels of InterventionInvolvement of Specialist _____ Section 3: The First 24 Hours in The First 24 Hours What To Emergency Department Eating Disorders Determining the Most Appropriate Site for Management PlanAdmission _____ Section 4: Assessment and Treatment Assessment of Suspected Eating Eating Disorder Risk Assessment and Assessing Growth and Determining Healthy Weight Eating Disorder Clinical Formulation of a TreaTment The Roles of the Multidisciplinary Team Members on the Care (Case) Discharge From HospitalInvolVEment of the General Practitioner Before and After a Hospital _____ Section 5: Treatment and Management on the Ward_____ 37 Key Considerations For All Therapeutic Alliance and Working with the Family and Team Cohesion and ConsistencyMedical and Physical Treatment_____ Refeeding Syndrome.

6 Risk Assessment and Observation and Physical Osteoporosis and Constipation_____ 59 Eating , Nutrition and Physical Refeeding Managing Meals and Example Meal Meal Plan Providing Nutrition Physical ActivityEating Disorders Toolkit - Introduction to the Toolkit ii _____ 79 Working with the Young Basic Counselling Stages of Individual and Family Therapies_____ 89 Psychological Comorbidity in Eating Psychological Issues in Eating Secondary Diagnosis Eating Body Image disturbance and Body Deliberate Self- Harm_____ 97 Social Social Health of the Young Ward School and School Work_____ 105 Absconding From the Indications and Management of Legal Issues and Eating DisordersSurvival Strategies for _____ Section 6: Special Diabetes and Eating Pregnancy and Eating Children with Eating Indigenous Eating Disorder PhilosophyCulturally and Linguistically Diverse _____ Section 7: Further Information and Statewide Services and What is an Eating Disorder?

7 135 Information for Parents and CarersSuggested _____ Section 8: Toolkit Development ProcessToolkit Development _____ Appendices:..147 Appendix 1: Appendix 2: Growth and BMI Centile Appendix 3: Physical Activity: Staged Program Example For Use by a Appendix 4: Physical Activity: Appendix 5: Psychometric Assessment Appendix 6: Stages of Appendix 7: Appendix 8: Appendix 9: Appendix 11: Evaluation Forms Eating Disorders Toolkit - Introduction to the Toolkit iiiOther Management Issues_____ 109 Development of the Appendix 10: Index ..170 Eating Disorders Toolkit - Introduction to the Toolkit iv Section 1: Introduction to the Toolkit Section 1 INTRODUCTION This Toolkit offers a resource for health professionals who find themselves caring for adolescents hospitalised with an Eating disorder. If you are a clinician who is new to the management of patients with Eating Disorders , you will find this Toolkit an invaluable resource of background information and you will benefit from reading it from cover to cover.

8 The Toolkit has been designed to provide user-friendly pull out sections that can be easily identified and accessed separately. The recommendations within this Toolkit should be adapted to meet your patient s individual needs as well as your local service needs. It is not the intention that this Toolkit acts as a stand-alone treatment manual as any management program must take into account the unique health care needs, and the context, of each individual patient. Information in the Toolkit has been considered by a large group of experts working in the field of Eating Disorders to be of significant clinical importance. The Toolkit has also been developed in line with relevant State and National health policies and documents. Reference materials are not cited in the main text but relevant references and resources are fully cited in the Appendix.

9 AIMS AND SCOPE OF THE Toolkit The Toolkit has been developed for use in public hospitals, including paediatric general and mental health wards, particularly those in regional and rural areas throughout NSW. The target audience has not included private and specialist Eating disorder units, although the Toolkit may be helpful in these settings. The Toolkit is relevant for use with adolescents (aged 12 - 18 years) with all clinically significant Eating Disorders including Anorexia Nervosa (AN), Bulimia Nervosa (BN), Eating Disorders -Not Otherwise Specified (EDNOS), and secondary diagnosis Eating Disorders . The Toolkit is aimed at medium to longer-term admissions ( , longer than 24-48 hours), and is not aimed at brief admissions for medical stabilisation only. The aim of the Toolkit is to provide a practice-based manual for use by clinicians working with adolescents with Eating Disorders in inpatient settings, particularly in regional and rural areas.

10 The Toolkit aims to: Complement current clinical practice guidelines by providing practical and useful strategies based on the current evidence To facilitate consultation with specialist staff To provide clarity regarding effective treatment approaches for clinicians To improve consistency in practice across NSW It is important to note that hospital admissions are only one part of a lengthy treatment process for young people with an Eating disorder. As such, admissions are not viewed as curative , but necessary at times to restore healthy mental, physical and social functioning to enable continued treatment in the community. Eating Disorders Toolkit - Introduction to the Toolkit1 WHAT IS AN Eating DISORDER? Eating Disorders are moderate to severe illnesses that are characterised by disturbances in thinking and behaviour around food, Eating and body weight or shape, and are diagnosed according to specific psychological, behavioural and physiological characteristics.


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