YCSC Eating Disorder Care

Transcript

• 00:09Hello everyone. My name is Rebecca Cammady,
• 00:11I'm a clinical psychologist and assistant
• 00:13professor with the Yale Child Study Center.
• 00:16And I'll be speaking in today's
• 00:18webinar on eating disorder care
• 00:19at the Child Study Center,
• 00:21focusing quite a bit initially on kind of
• 00:25the presentations of disordered eating
• 00:26that we see across levels of care.
• 00:29And then what the center has done to address
• 00:32that and what kind of hopes for things are.
• 00:35So whenever giving a talk on this topic,
• 00:38I start with this image of the silos
• 00:40of care and especially pediatric
• 00:42eating disorder care with other
• 00:44mental health comorbidities.
• 00:46Unfortunately,
• 00:46what's happened is receiving treatment
• 00:49and the research and program
• 00:51development that's often associated
• 00:53with eating disorder care becomes
• 00:56quite siloed from other child and
• 00:58adolescent mental health services and
• 01:00kind of thinking about those other
• 01:03presentations that we often see.
• 01:05Why is this the case that
• 01:07it's become so siloed?
• 01:09Eating disorders in the mental health,
• 01:11medical,
• 01:11social work kind of across different fields
• 01:14have become a a niche area throughout
• 01:17training and program development.
• 01:19And despite we often see the significant
• 01:22comorbidities that we often see,
• 01:24we still see it kind of separated out
• 01:27that makes providing the most kind of
• 01:30holistic and cohesive care quite challenging.
• 01:34So when thinking about how we
• 01:36really have to move that forward,
• 01:38I always invite folks to think about
• 01:40what images come to mind when you hear
• 01:42the term eating disorder and they think
• 01:43that the system of what perpetuates
• 01:45this more kind of siloed mentality of it.
• 01:48When you Google search it,
• 01:50the similar kind of images come up of slim,
• 01:53white young adult females.
• 01:55And in reality,
• 01:56we know that feeding,
• 01:58eating and weight disorders are
• 02:00actually very complex heterogeneous
• 02:02presentations that don't fit one mold.
• 02:04So when we actually think about what
• 02:07constitutes a feeding or eating disorder
• 02:08based on the DSM or a manual that we
• 02:11used to diagnose psychiatric diagnosis,
• 02:13it's characterized by a persistent
• 02:15disturbance of eating or eating
• 02:17related behavior results in an
• 02:19altered consumption of food and
• 02:21that significantly impairs physical
• 02:23health or psychosocial functioning.
• 02:24So in essence,
• 02:26it's disturbance with food that's
• 02:28clinically significant impacts relationship
• 02:29with food and how much we're eating
• 02:31and then impacts are functioning.
• 02:33And as you can imagine that that's
• 02:35quite broad in the range of youth,
• 02:37young adults who are requiring care
• 02:39for these kind of presentations.
• 02:44So I highlight here some of the issues
• 02:46related to diversity in disordered
• 02:48eating presentations that are often
• 02:50kind of not conceptualized in a lot of
• 02:53our more traditional models of care.
• 02:55So we actually know that Bipoc youth and
• 02:57young adults are less likely than their
• 02:59white counterparts to be asked by doctors
• 03:02about their eating disorder symptoms.
• 03:04Even when they're self reporting
• 03:06disordered eating symptoms,
• 03:08Bipoc individuals are half as likely
• 03:10to be diagnosed or receive treatment
• 03:12than their counterparts with it,
• 03:14the white counterparts with
• 03:16an eating disorder.
• 03:17Black individuals are less likely
• 03:19to be diagnosed with anorexia,
• 03:21but may experience the OR do experience
• 03:23the condition for a longer period of time.
• 03:26In some ways related to these difficulties
• 03:29accessing the appropriate care,
• 03:32black teenagers and adolescents
• 03:34are more likely than white teeners
• 03:37to exhibit binge purge eating.
• 03:39Similarly,
• 03:39Hispanic youth are more likely
• 03:42to experience bulimia and nervosa
• 03:44than their non Hispanic peers.
• 03:46And we know that Asian Americans experience,
• 03:49based on some nationally representative data,
• 03:52higher rates of restriction
• 03:53compared to their white peers,
• 03:54as well as some higher levels
• 03:57of body dissatisfaction.
• 04:00We see diversity in presentations based
• 04:04on gender and sexual minority identity.
• 04:07So we see higher rates of binge
• 04:09purging in gay men and adolescents,
• 04:11as well as increased likelihood of
• 04:14experiencing compensatory behavior.
• 04:16So fasting, vomiting, using laxatives,
• 04:19we see transgender college students
• 04:22reporting higher experiences of
• 04:24disordered eating as well as this
• 04:27really important component among
• 04:29individuals who identify as the gender
• 04:31minority of the role that disordered
• 04:33eating can play in a way of affirming
• 04:36one's body as a gender affirming tool.
• 04:39And that is where we see then often a
• 04:42tie in with more gender dysphoria and
• 04:45body dissatisfaction overlap and and
• 04:47impact disordered eating in this population.
• 04:53Among youth with eating disorders,
• 04:55we see a particularly high
• 04:58risk population among trans
• 05:00and gender diverse adolescents,
• 05:02so we know similarly.
• 05:05Based on prevalence data and a
• 05:07nationally representative sample
• 05:09of young adult of adolescents,
• 05:11we see that in trans use with
• 05:13youth with eating disorders,
• 05:15they're more than 20 times as likely
• 05:17to have attempted suicide in the
• 05:19past year than either cisgender
• 05:21female with the history of an eating
• 05:24disorder or trans use without a
• 05:26history of an eating disorder.
• 05:28And approximately 3/4 of trans use
• 05:31with an eating disorder have endorsed
• 05:34suicidal ideation or engaging in non
• 05:36suicidal self injury in the past year.
• 05:39So very high risk population.
• 05:42We also see diversity in terms
• 05:45of disabilities in individuals
• 05:46with disordered eating.
• 05:48So among with physical disabilities
• 05:50and young girls being more likely
• 05:52to develop disordered eating,
• 05:54we see high rates of disordered
• 05:56eating among individuals with
• 05:58neurodiversity or on autism spectrum.
• 06:01We see high rates of autism and a SD
• 06:04traits among individuals with eating
• 06:06disorders and high rates of EDHD as well.
• 06:13And despite the fact that we
• 06:14often think about these as
• 06:15presentations affecting young adults,
• 06:17we see much higher rates in
• 06:19children than adolescents Now.
• 06:20So in similarly some large national
• 06:23survey data and looking at school age,
• 06:25children see 42% of 1st to 3rd grade
• 06:29girls with a desire to be thin or thinner.
• 06:33Over 80% of 10 year old children in the
• 06:36survey reporting a fear of being fat.
• 06:39close to 50% of 9 to 11 year
• 06:42olds reporting being on a diet
• 06:44some of the time for themselves.
• 06:47And we see 35 to 57% of adolescents
• 06:50engaging in unhealth unhealthy disordered
• 06:53eating behaviors to control their weight.
• 06:56And over 90% of women,
• 06:58once they reach college,
• 06:59then trying to control their weight
• 07:01through different dieting behaviors.
• 07:03A really important piece too that I
• 07:05want to highlight here as you here.
• 07:07We're talking about just some of what
• 07:08may be developing at a younger age.
• 07:10But since the start of the pandemic,
• 07:12we've seen actually much higher
• 07:14rates of hospitalizations for
• 07:16medical complications associated
• 07:17with restrictive eating,
• 07:19especially in the younger skew to
• 07:21to being younger children who are
• 07:23requiring the highest level of care.
• 07:27So you know, important to consider despite
• 07:29the fact that we have this this kind of
• 07:32stereotyped idea of what it looks like
• 07:34to have an eating disorder that less
• 07:36than 6% of people with an eating disorder
• 07:39are actually diagnosed as underweight.
• 07:41Now this is with any clinically
• 07:44significant eating disorder, so not just
• 07:46anorexia where of course we do see much,
• 07:48much higher rates of being underweight
• 07:50given that's part of the diagnostic criteria.
• 07:52We think about clinically
• 07:54significant disordered eating that
• 07:56impacts somebody's functioning.
• 07:57We have this kind of as a society
• 08:01misrepresented idea of what that looks like.
• 08:05And yet there is a SWAG stereotype that
• 08:07exists that we talked about in the field
• 08:09of if you have an eating disorder,
• 08:11you're skinny, white,
• 08:13affluent girl when.
• 08:14And it's very problematic of not
• 08:16just societal views of it,
• 08:18but that current treatment models are
• 08:20based often on samples of affluent,
• 08:22young adult, cisgender,
• 08:24neurotypical white women,
• 08:25when there's quite a range of presentations
• 08:28of individuals who and youth who
• 08:31can experience these presentations,
• 08:32as Google Images shows us.
• 08:37So as I was saying there,
• 08:38there's a wide range of
• 08:40disordered eating presentations.
• 08:42Pika and rumination disorder are ones
• 08:44that I'll talk about in a moment that
• 08:47mostly affiliated or associated with
• 08:49neurodevelopmental disabilities in
• 08:51younger children avoidant restricted
• 08:53food intake disorder and anorexia,
• 08:55both resulting in lower weight bulimia
• 08:57nervosa and binge eating disorder,
• 08:59both associated with episodes
• 09:01of binge eating and bulimia
• 09:02with associated purge episodes.
• 09:07The challenge here,
• 09:08especially for children and adolescents,
• 09:10is, as anybody who has kids of their
• 09:12own or works of kids knows that things
• 09:15don't often nicely kind of fit into one box.
• 09:17And that happens with psychiatric
• 09:19presentations as well.
• 09:19We often see symptoms or elements of
• 09:22different presentations that are what
• 09:24we'd call trans diagnostic kind of
• 09:26crossing in and out of these boxes
• 09:28and to meet diagnosis for an eating
• 09:30disorder based on our DSM criteria.
• 09:32It's mutually exclusive.
• 09:34So having experiences with of
• 09:38symptoms of multiple presentations
• 09:39results in a lump sum diagnosis
• 09:41of something that we call Osfed or
• 09:43other specified feeding and eating
• 09:45disorder which is often what we
• 09:47see with children and adolescents.
• 09:52So here's a list of the types of
• 09:54eating disorders those that will
• 09:55be talking about requiring kind of
• 09:57our our highest level of care are
• 09:59most frequently anorexia nervosa,
• 10:01which is going to be having an unrealistic
• 10:03idea about body image and overvaluation
• 10:05of how important that is, right.
• 10:08It's one of the most fundamental
• 10:10important things to to an adolescent
• 10:12sense of self and this intense fear
• 10:14of gaining weight that results
• 10:16in significantly low body weight.
• 10:18The Lumia Nervosa are episodes
• 10:20of binge eating,
• 10:22so eating significantly large amounts
• 10:24of food with an experience of loss of
• 10:26control in a short amount of time,
• 10:28following by purging episodes or some
• 10:30other type of compensatory behavior.
• 10:33Sometimes excessive exercise,
• 10:35fasting, use of laxatives,
• 10:38binge eating disorder is bulimia without
• 10:40the compensatory behaviors are perching.
• 10:42So having those significant binge episodes,
• 10:46larger amount of food than somebody
• 10:48would typically eat in a short
• 10:49amount of time and experiencing a
• 10:51sense of loss of control and then
• 10:53an associated feeling of disgust or
• 10:56guilt with oneself after the fact.
• 10:58Rumination disorder is an experience when
• 11:01somebody swallows in the regurgitates
• 11:04the food and the re swallows and and
• 11:07pica is consuming non food objects.
• 11:10These two,
• 11:11as I mentioned are are often highly
• 11:14cooccurring with a number of other
• 11:18developmental presentations.
• 11:19Avoidant and restrictive food
• 11:21intake disorder is,
• 11:22as I mentioned previously,
• 11:24one of our other restrictive presentations.
• 11:27Whereas anorexia is focused on a
• 11:30body image concern or fed or another
• 11:33name for avoidant and restrictive
• 11:35food intake disorder is when a youth
• 11:38or an adolescent or a young adult
• 11:40forever is experiencing it severely
• 11:43restricts what they're eating for
• 11:45a non body image related reasons.
• 11:47So sometimes it's a sensitivity
• 11:50to to the experience of eating,
• 11:52sometimes not being aware of hunger cues,
• 11:55sometimes of a fear of pain,
• 11:57right of if they've had some type of
• 11:59medical complication that often leads
• 12:00to then significantly low weight.
• 12:05So with these different presentations,
• 12:07we can lump them together into
• 12:09these boxes that again don't quite
• 12:11fit nicely away from one another,
• 12:13but but do have some overlap.
• 12:15We have these presentations of
• 12:17restriction or overcontrol,
• 12:18which is what we would
• 12:19think about with anorexia,
• 12:21this regulation and loss of control
• 12:23with bulimia and binge eating
• 12:24and those related to anxiety,
• 12:26pain or sensory sensitivities.
• 12:28This is where we put our food or the pika.
• 12:31The challenge is that as we
• 12:34conceptualize these things different,
• 12:36what therapeutic treatment looks
• 12:37like is going to be different,
• 12:40but they don't fit nicely in those
• 12:42boxes and and so that's really where
• 12:44kind of providing the most effective
• 12:46treatment can be a challenge.
• 12:50So with regard to eating disorder prevalence,
• 12:53unfortunately their data overall
• 12:54is quite is a little outdated.
• 12:56So this is from the nationally representative
• 12:59prevalence data from NIMH looking at
• 13:02the lifetime prevalence of eating
• 13:04disorders by the time of reaching mature
• 13:07adolescence from about 20 years ago.
• 13:09And this was where we see close to
• 13:124% of females and 1.5% of cisgender
• 13:15males meeting criteria for an eating
• 13:18disorder by the time that they turn 18.
• 13:22This is as as is clear from the
• 13:25dates of it you know very,
• 13:27very much pre pandemic.
• 13:28And so we already saw an increase
• 13:30happening over those those years of kind
• 13:32of the the early 2000s and 2000 tens
• 13:35when we see continue to see increase on
• 13:37body image pressures by society that
• 13:40have been really exacerbated by the
• 13:42pandemic and a very important piece
• 13:44to hit on as we're thinking about
• 13:46care for this patient population.
• 13:48So beginning at the at the beginning
• 13:51of the pandemic there was anticipation
• 13:53of kind of the impact on eating
• 13:56disorders that was significantly I
• 13:58think underestimated what we would
• 14:00actually see that the,
• 14:02the first publication was now two years
• 14:05ago of how medical admissions related
• 14:07to restrictive eating disorders among
• 14:09youth had increased significantly.
• 14:11Looking at pre pandemic to during
• 14:13the pandemic rates of youth requiring
• 14:15medical hospitalization to be stabilized
• 14:17and this has been replicated throughout
• 14:20the country and throughout Europe
• 14:21and at our own Children's Hospital
• 14:24seeing that significant increase.
• 14:27So what's exacerbated the prevalence
• 14:29and severity,
• 14:30There's a number of factors that
• 14:32we can contribute to it,
• 14:34a greater susceptibility to
• 14:36illness during the pandemic,
• 14:38psychological distress with a pandemic
• 14:40happening and then the uncertainty
• 14:42and social isolation that happens.
• 14:44We do know especially things like
• 14:46anorexia is a very isolating disease
• 14:47and so social connection is one
• 14:49of the most protective things.
• 14:51And so taking, you know,
• 14:52as was needed,
• 14:53but taking kids away from one another
• 14:56really increased kind of risk factor.
• 14:58There was almost nothing but virtual
• 15:00interaction staring at one another on
• 15:02the screen and then a lot more time
• 15:04spent on social media and the dangers
• 15:06that we know associated with that,
• 15:08with what youth are exposed to in terms
• 15:10of content and unrealistic body image ideals.
• 15:15So then thinking specifically at
• 15:17our Children's Hospital at Yale,
• 15:19what we saw in the couple of years before
• 15:21the pandemic to the first year and a half,
• 15:24we saw a significant increase where
• 15:26even in half of the time we saw more
• 15:29cases in that first year and a half
• 15:31of the pandemic increasing from 48
• 15:33cases the year and a half before the
• 15:35pandemic or the three years before
• 15:36the start of the pandemic to just
• 15:38the first year and a half of 60.
• 15:40So as you can imagine and and our team
• 15:42still needed to comb through that data,
• 15:45we see more than a double increase
• 15:46anticipated of what we've seen
• 15:48in the similar time frame.
• 15:52So not only did we see an increase in
• 15:54the number of patients hospitalized,
• 15:56but an increase in the length of stay
• 15:59because of the severity of cases
• 16:00and the lack of appropriate kind of
• 16:03referral options for post discharge
• 16:04because of the crunch on the system,
• 16:07a much higher number of youth
• 16:10younger than the age of 13.
• 16:11This is consistent with now some
• 16:14recently published data that has come
• 16:16out kind of more nationally as well
• 16:18where we're continuing to see the the
• 16:21average age of hospitalization for
• 16:23restrictive eating concerns skewing
• 16:25younger and younger which unfortunately
• 16:27again are treatment care models.
• 16:29Kind of historically as a nation
• 16:31and as a society are not up to date
• 16:34with see a greater number of youth
• 16:37requiring medication intervention
• 16:39for psychiatric concerns because of
• 16:41the comorbidities and more patients
• 16:43requiring A discharge to a higher
• 16:45level of care.
• 16:46And this is consistent with other
• 16:48sites in Connecticut and then
• 16:49country and world more broadly.
• 16:53And so why are we worried, right,
• 16:55We're seeing this increase and
• 16:57we know of course that eating
• 16:59disorders can be significant,
• 17:00but really in terms of the severity,
• 17:01it's worth taking note just
• 17:03how severe they can be.
• 17:04So eating disorders are among
• 17:06the deadliest mental illnesses,
• 17:08second only to opioid overdoses.
• 17:11Relapse rate for anorexia,
• 17:13once somebody has experienced
• 17:15the disease approaches 50%.
• 17:19The standardized mortality ratio of
• 17:21somebody with anorexia is approximately 6,
• 17:24which means to somebody else there,
• 17:26same age, all other factors,
• 17:28they're six times as likely
• 17:30to have mortality of that age.
• 17:33Approximately one in five
• 17:35patients with anorexia develops
• 17:36a severe and protracted illness,
• 17:39which means we don't expect to
• 17:42necessarily experience any remission.
• 17:44And there is an estimated death
• 17:46almost every hour each each year
• 17:49attributed to eating disorders.
• 17:52Among individuals with anorexia specifically,
• 17:55we see 60% of the deaths attributed
• 17:57to the medical complications
• 17:59associated with it such as cardiac
• 18:01arrest and sudden organ failure,
• 18:04but as well as suicide.
• 18:06And we know that's overall suicide
• 18:07rates among individuals with eating
• 18:09disorders are are quite high.
• 18:12So not only is there the
• 18:14individual health costs,
• 18:15but we do see a significant
• 18:17health costs in our our medical
• 18:19and healthcare systems costing
• 18:21about close to $65 billion.
• 18:26Approximately 9% of people will
• 18:28experience some type of eating
• 18:30disorder in their lifetime.
• 18:32I think it's important to note here,
• 18:34this doesn't mean 9% people experiencing
• 18:37anorexia could be a number of those
• 18:39other presentations I mentioned.
• 18:40But that does mean clinically
• 18:42significant disordered eating where
• 18:44it's impacting somebody's daily
• 18:46life despite the prevalence and
• 18:48and kind of robustness that we
• 18:50see in society that therapeutic
• 18:52interventions have modest results and
• 18:54we actually don't have FDA approved
• 18:56medications except for an adults with
• 18:59binge eating disorder or bulimia.
• 19:02We often we also see high comorbidities
• 19:05in this patient population.
• 19:06So despite you know that that we imagine
• 19:09that these are the patients that need
• 19:12the the most cohesive and and holistic
• 19:15care because eating disorder care is
• 19:17often siloed out as when we started the
• 19:21presentation that it's difficult to to
• 19:23receive treatment for both at the same
• 19:26time and and having the psychiatric
• 19:28comorbidities are associated with
• 19:30greater negative longterm outcomes.
• 19:32We see over half of adolescence with
• 19:35anorexia display some type of mood disorder.
• 19:38The challenge here is it it's
• 19:40often hard to disentangle.
• 19:41Is that a result of the severe
• 19:44malnutrition or does the mood disorder
• 19:46predate the the eating disorder?
• 19:51One in four patients with
• 19:53anorexia have an anxiety disorder.
• 19:56We see one in four patients with anorexia
• 19:58experiencing a substance use disorder.
• 20:00Particularly cocaine and amphetamines are
• 20:02quite high and a high rate of comorbidity
• 20:06with OCD in individuals with anorexia.
• 20:09An important distinction here is that
• 20:11there are obsessive kind of tendencies
• 20:14associated with severe restrictive eating,
• 20:16and the cooccurrence of OCD requires
• 20:18the obsessions to be outside just the
• 20:21restrictive eating presentation themselves.
• 20:26Hitting further on the the importance
• 20:28of kind of conceptualizing that how high
• 20:31risk this patient publishing can be.
• 20:33In another nationally representative
• 20:35study that looked at prevalence rates
• 20:38among among adults with a diagnosis of
• 20:40an eating disorder in their lifetime,
• 20:42we saw elevated rates or we do see
• 20:45elevated rates of a lifetime and a
• 20:48suicide attempt that in individuals with
• 20:50a subtype of anorexia being over 40%.
• 20:52So despite the fact that we silo
• 20:54out and and separate eating disorder
• 20:56care from other psychiatric concerns,
• 20:59it it doesn't work as a treatment
• 21:01model because these things are so
• 21:02often Co occurring and leads to to
• 21:04poor care that can be delivered.
• 21:08So I painted this picture of the
• 21:11significance and severity of eating
• 21:13disorder presentations and the
• 21:14increase that we're continuing to see,
• 21:16that we're continuing to see it
• 21:18in younger and younger patients.
• 21:20And the reality is despite all this,
• 21:23our country continues to experience
• 21:24what we consider a crisis in care,
• 21:27in eating disorder care,
• 21:28especially in anorexia.
• 21:30And this is actually a paper from
• 21:32about two years ago now that was
• 21:33in some ways a call to action and
• 21:36it's published in Gym Psychiatry,
• 21:37the journal that highlights the
• 21:40number of reasons for that.
• 21:42So the major take home points is that
• 21:44really we continue to experience a
• 21:46crisis in care for patients with
• 21:49eating disorders and and especially
• 21:51anorexia that it's critical to
• 21:53improve eating disorder care.
• 21:55We continue to be in the systems
• 21:57where we are more kids,
• 21:59young adults requiring those higher
• 22:02levels of stabilization because
• 22:03there's not enough resources in
• 22:06the community and at lower levels
• 22:08of care that there's a need for
• 22:10more funding for research because
• 22:12eating disorders are significantly
• 22:14underfunded research field and
• 22:16the need to develop more effective
• 22:19interventions because both are are
• 22:21therapeutic and psychopharmological
• 22:23or medication based interventions
• 22:25do have modest success thus far.
• 22:28But it's critical to improve training
• 22:30as again where I'd started as it's
• 22:32been such a niche area of our fields
• 22:35that that's a much smaller percentage
• 22:37of our mental health and medical
• 22:39providers are trained in eating
• 22:41disorder care than we actually need.
• 22:43There need to be more resources for
• 22:45treatment for patients and families.
• 22:46There are often long wait lists
• 22:49that allow the the disorder to to
• 22:51exacerbate or get worse before
• 22:54receiving care and we have to develop
• 22:56higher standards of care which
• 22:57just aren't available currently.
• 23:01So highlighting the severity,
• 23:03highlighting the need,
• 23:05what are we doing about it at Yale,
• 23:08what's been done to address
• 23:09the problem is you know,
• 23:11really acknowledging the reality
• 23:12of of the severity and increase
• 23:15of cases that we've seen.
• 23:16I highlighted the,
• 23:17you know what has happened with the
• 23:19numbers overall in the pandemic.
• 23:21I would say we're continuing to see that
• 23:23escalation while while it ebbs and flows,
• 23:25I know just recently we had five
• 23:27patients in the Children's Hospital with
• 23:29being hospitalized on the Pediatrics
• 23:31floor for the medical complications
• 23:33associated with restrictive eating.
• 23:35So we don't see this
• 23:37slowing down anytime soon.
• 23:39What we've done to address that need
• 23:42kind of given given the state of the
• 23:44field and and those different issues
• 23:46with resources that we have talked
• 23:48about of just kind of as a a field
• 23:50generally is trying to be creative
• 23:52and innovative in the collaboration
• 23:54with the Children's Hospital.
• 23:56So collaborations with the
• 23:58Pediatrics team for these youth
• 24:00that are medically hospitalized.
• 24:02So these patients are managed by our
• 24:04consultation liaison team who serve or
• 24:06youth that are medically hospitalized
• 24:08requiring psychiatric supports.
• 24:10There's weekly case rounds where
• 24:11the youth with eating disorders
• 24:13are rounded on by both the medical
• 24:15and psychiatric team as well as
• 24:17other members caring for them,
• 24:19including nursing child life,
• 24:23doing trainings, teaching didactics
• 24:25with the Pediatrics team as well as
• 24:27the consultation liaison team and
• 24:29educating on eating disorder care.
• 24:31And trying to revisit our clinical
• 24:32pathway that we use to care for these
• 24:34patients to try to keep it as up to date
• 24:36as possible to provide the best care.
• 24:40We've also done is the necessity
• 24:41of providing bridging plans for
• 24:43patients due to wait list there.
• 24:44As I had kind of started to allude to,
• 24:48there is a significant kind of dearth
• 24:50of resources in the community for this
• 24:52patient population that is in a lot
• 24:54of ways you know largely connected
• 24:55to that niche area that it's become.
• 24:58So often we have patients that
• 25:00once medically stabilized,
• 25:01they're still not the right next
• 25:03treatment for them immediately available.
• 25:05And so we're having to create these
• 25:07bridging plans to not unnecessarily
• 25:08keep them in the hospital people
• 25:10either without kind of access to
• 25:13necessarily an eating disorder mill you.
• 25:16We're working to create innovative
• 25:18and responsive treatment care
• 25:19models for complex patients.
• 25:21So as I had you know already said
• 25:23that the eating disorder very
• 25:25infrequently happens in the vacuum.
• 25:27And so we've more and more frequently
• 25:29see youth coming in with those concerns,
• 25:31but also having suicidality
• 25:33or other mood concerns.
• 25:34And because treatment models
• 25:36are often very separate,
• 25:37we have to think about how do we bridge
• 25:39that and provide more appropriate care,
• 25:43finding ways to provide training
• 25:45education to clinicians within the Child
• 25:48Study Center across levels of care.
• 25:50And that who are often working with
• 25:52these patients whether it be outpatient
• 25:54or in home services who are also
• 25:57coordinating with their medical teams.
• 25:59And then thinking about the goals for eating
• 26:01disorder care at the Child Study Center.
• 26:02Building on this work
• 26:04that's already been done,
• 26:05we're working to build more robust
• 26:07eating disorder care in partnership
• 26:09between the Child Study Center and
• 26:11Neil New Haven Children's Hospital.
• 26:13This is something that in in kind of
• 26:15moving those efforts forward has been
• 26:17primarily led by the Child Study Center
• 26:19and with mental health lead and with
• 26:22the interdisciplinary partnership with
• 26:24Pediatrics and nutrition with really
• 26:27that goal again not to shy away from
• 26:30those high risk complex presentations,
• 26:33really another goal addressing the
• 26:35limited community referral options.
• 26:36So that can be done in a number of
• 26:39ways through both increasing those
• 26:41outpatient services affiliated
• 26:42directly with Yale or through
• 26:44community partnerships and trainings.
• 26:46So again training of community providers
• 26:49within the Yale system and developing
• 26:51more of those bridging services,
• 26:54trying to think about and other goals
• 26:56of developing that streamline pathway
• 26:58from those youth requiring that medical
• 27:00inpatient stabilization to outpatient care.
• 27:02So once somebody is brought into the system,
• 27:05what are the steps to getting them back out
• 27:08safely knowing that it's not, you know,
• 27:10kind of one stop and then back out.
• 27:12This includes that aim of utilizing
• 27:14sites within the Yale New Haven
• 27:17Children's Hospital Network,
• 27:18including the initiative to begin to
• 27:21utilize places like Bridgeport Hospital
• 27:23for stabilization of these patients and
• 27:25ensuring the most robust supports there
• 27:27available that are needed to support
• 27:29this patient population that has been
• 27:31built up at our York Street campus.
• 27:35Really another goal of maintaining that
• 27:37mindset of the multiple systems level
• 27:39approach that is needed in partnership with
• 27:42colleagues throughout our departments.
• 27:44So given such a complex high
• 27:47risk patient population,
• 27:49not just think about who is
• 27:50directly caring for this patient,
• 27:51but where will this patient be
• 27:53going next And and really thinking
• 27:56about helping it to be as fluid a
• 27:58process for families as possible.
• 28:01And this is where we start with the
• 28:03need and the goal of prioritizing an
• 28:05ambulatory program that can provide
• 28:07that interdisciplinary support to
• 28:08a patient and their family when
• 28:11those concerns are emerging.
• 28:14And then of course one of the other,
• 28:16you know really,
• 28:17really crucial and I would say
• 28:19critical goals and priorities being
• 28:21a prioritizing training of fellows
• 28:23throughout the departments including
• 28:25the child study center in Pediatrics.
• 28:27To get away from this idea,
• 28:28from it being a niche area of training
• 28:31and really trying to focus on kind
• 28:34of broadening the exposure for
• 28:35trainees and professionals working
• 28:37with this patient population,
• 28:38this as it's critically needed for care.
• 28:41And so well the the Child City
• 28:43Center and Children's Hospital has
• 28:45done a lot to to work through some
• 28:47of these challenges and to be able to
• 28:50address this continued increasing need.
• 28:51There continues to be a lot of goals
• 28:54for those next steps and and as you
• 28:56know it's been highlighted throughout
• 28:58the field is where we're continuing to
• 29:00see the increase in need and trying
• 29:03to evolve dynamically as a center
• 29:06and a hospital system to meet that
• 29:09need for this patient population.
• 29:11And figuring out how to to to best
• 29:14serve a patient population that does
• 29:15pull on on resources quite a bit and
• 29:17to be able to deliver the the best
• 29:20care for that patient population.
• 29:25Thank you very much for
• 29:26for attending the webinar.
• 29:27I hope that you know the note that I
• 29:30really do want to end on is with the
• 29:32hope of despite us seeing the dire
• 29:34need in the field on the increase
• 29:36in severity and presentations that
• 29:37somewhere like the child study
• 29:39center you know New Haven Children's
• 29:41Hospital has the infrastructure and
• 29:42the right sports in place to meet
• 29:44that need and and the right vision
• 29:47to continue to innovate and move
• 29:49those move that process forward.
• 29:52Thank you.