and dietitians connecting to improve the health and well-being of … · •trrh dietitian...
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Healthy Mind and Body: headspace
and Dietitians connecting to improve
the health and well-being of young
people with disordered eating in
rural NSW
Deanne Harris Dietitian HNELHD
Lisa Staples Clinical Care Coordinator,
Occupational Therapist, headspace Tamworth
Why are we presenting today?
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Eating Disorders in Australian Young People
• Eating disorders affect estimated 9% of the population.
• Eating disorders may lead to long-term social & functional
impairment
• Impact can include psychiatric, behavioural and medical
complications, social isolation and increased risk of death
• Mortality rate for eating disorders is the highest of all
psychiatric illnesses and over 12 times that of people without
an eating disorder
• 1 in 5 people with anorexia who died prematurely committed
suicide
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Eating Disorders in Australian Young People
• Adolescence is a peak period for the onset of eating disorders
• Eating disorders are the third most common chronic illness in
young females and are increasing in young males
• 2nd leading cause of mental health issues in young females
Adolescent girls who diet at a severe level are 18 times more
likely to develop an eating disorder within 6 months
• 70% of adolescent girls have body dissatisfaction
• Body dissatisfaction is one of the top issues of concern in the
2013 Mission Australia Youth Survey
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Eating Disorders in Australian Young People
• Obesity in adolescents has increased by 75%
• Co-morbid obesity and eating disorders in young people are
increasing faster than either condition alone
• One in 5 people with obesity also present with disordered
eating
“What began as a small habit slowly became an
uncontrollable addiction. While it felt like I was in fact
totally in control of my body and my life , I was in fact
totally out of control. By the time I reached 17 years of
age I was …drowning within a world I couldn’t handle”
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Why we are sharing what we do….
•Different approach to servicing young people
•Multidisciplinary team approach (dietitian, Youth Care
Coordinator, Psychologist, GP)
•Unique location and position to work with young people
in a new service and location
•Connections between the services/staff
•Outcomes
headspace
headspace
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• headspace is the National Youth Mental Health Foundation
providing early intervention mental health services to 12-25
year olds.
• Created in 2006 in response to the recognition that the
existing health system needed to be much more accessible
and effective for young people with mental and substance
use disorders
• One stop shop
headspace
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• Services are designed to make it easy as possible for a
young person and their family to get the help they need for
problems affecting their wellbeing.
• This covers four core areas: mental health, physical health,
work and study support and alcohol and other drug
services.
• By 2015 there will be a total of 90 Centres across Australia.
Our centres
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eheadspace
Other headspace National services
headspace School Support
•The service works with school communities to prepare for, respond to,
and recover from suicide
headspace Youth Early Psychosis Program
•a significant early intervention and holistic opportunity to improve the
lives of young people, and their families, who are affected by psychosis.
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ices
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headspace Tamworth
• Opened Feb 2013
• Centacare is the lead agency
• Consortium members include Local Health Network (Mental
Health Service), PCYC, Police Area Command, North West
Health, AES, A4E (Employment Providers)
• Services include Youth Care Coordinators, Allied Health
Practitioners, GP, Employment Providers, Sexual Health,
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headspace Tamworth
September 2015
37 new young people per month
392 occasions of service
56% female
42.2% male
1.7% other gender identified
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headspace Tamworth
Age range Percentage
12-14 35.1
15-17 21.6
18-20 16.2
21-23 21.6
24-25 5.4
25 0
Dietetics Department - TRRH
• Local dietitian and GP formed a partnership based on a common interest
to work with eating disorder patients in 1995
• Evolved into a local network of dietitians, psychologists and GPs who
meet monthly to provide peer support, education and case conferencing
• TRRH dietetics provides 2 days per week outpatient service for people
with eating disorders. Inpatient and outpatient Triage tool scores a
diagnosed eating disorder as category 1
• Experienced dietitian mentoring staff to increase skill mix to care for these
clients
Dietetics Department - TRRH
• Primary concern: accessing clients in very early stages of illness before
they would normally be referred to hospital outpatient service. Research
indicates best chance of full recovery if illness caught early.
• Recovery rates for adolescents in first year of illness between 74-90%
whereas 21% if history of 4 years or more
• Lead to discussions with the new local youth health service – headspace
• Needs assessment
What did we do - Needs assessment
• 2nd year dietetics students from University of Newcastle
undertook needs assessment to study expectations of clients
at headspace Tamworth regarding dietetics services
• At the time there was a general headspace dietetics service
weekly which had issues including high non – attendance and
follow up rate and required the GP to be on-site
• Examined thoughts, perspectives and knowledge of the role
of a dietitian and any barriers, concerns or misconceptions.
• Aimed to enable headspace Tamworth to tailor their dietetics
service to best suit their clients
• Surveyed clients at headspace, headspace staff and local
dietitians
Increased dietetic interventions at headspace
• TRRH dietitian participated in “Rock your mind and
body” education group with young people and Youth
Care Coordinators
• Interest in nutrition and disordered eating grew
• Staff education developed and delivered on eating
disorders in young people
• Role of the eating disorder dietitian versus general
dietitian
Implemented changes in servicing young people
• Developing education for staff on the link between mental
health and diet.
• Increasing Nutrition Awareness of Staff (Nourishing
Networks)
• Developing resources staff could distribute to their clients if
clients want to learn more but do not want see a dietitian
• Expanding the psycho-social assessment in the eating
domain
• Involving parents in education regarding food and nutrition
• Explaining the dietetic service effectively within the mental
health domain
Implemented changes in servicing young people
• Streamlining the referral process including timeliness of referrals
• Bringing the service to the young people
• Two dietetic clinics per week – one on disordered eating and the other
dealing with other nutritional concerns
• Joint appointments to maximise attendance of the young person and their
family e.g. structure of appointments, Youth Care Coordinator,
multidisciplinary approach, individualised service
• Holistic assessment and treatment
• Monthly eating care review and education session
• Developing a nutrition resource manual specific to young people
Nourishing Networks
• headspace staff all participated in Nourishing Networks
• 10 week self directed learning package and one day
workshop
• Focuses on early identification and referral/ management of
clients with all forms of disordered eating
• CPD points for professional association
• Aimed to make staff more aware to screen and be
comfortable if presented with an actual eating disorder
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Occasions of Service (2014)
Disordered Eating Service Other Dietetic Service
98 Young People over 33 weeks
2 FTA
55 Young People over 21 weeks
11 FTAs
6 Cancelled
4 groups (average of 1.5 young
people per group)
Case studies J
• J , 14 YO male referred to headspace by GP for anxiety
• When referral received, contact with the GP was made to obtain blood results
• On headspace assessment with new nutrition questions eating issues were primary concern
and major cause of anxiety
• Referral to dietitian
• On assessment dietitian contacted GP re concerns severe eating disorder
• J weight 37kg, weight had dropped 15kg in 6 months
• GP : bloods and physical examination diagnosis anorexia nervosa, referred to paediatrician
John Hunter Hospital
• Family had been trying to get help for a few months, no recognition of Eating Disorder as
young person was male
• Paediatrician worked with dietitian and psychologist at headspace for continuity
• Dietitian and psychologist joint appointments to work with J and family around all aspects of
managing the ED
• 7 months down the road J is 50kg , playing representative basketball and looking for his first
after school job
• Usually J would have seen private GP, private psychologist, hospital dietitian in 3 locations ,
across 3 medical records systems and at significant cost to the family
Case studies A
• A, 21 year old young female
• Self referred to headspace for stress and anger management, relationships
issues
• Moved out of family home at 15, period of homelessness
• 3 year old son
• Referred to dietitian for inability to gain weight
• Weight on referral 48.3kg
• A did not meet criteria for outpatient service at hospital as not physically unwell
• On assessment history of anorexia nervosa at school
• Youth Care Coordinator attended first appointment with client
• Number of joint appointments over 12 months to look at practical issues such as
budgeting, legal issues, food preparation, nutrition needs for herself and her son
• Also worked with consortium partner (AES) employment service at headspace
• After 12 months weight is 55.9kg.
• Son enrolled in preschool and A has first fulltime job as an administration trainee
Questions?
Thank you