NWCED Service Provision within the Mental Health Stepped Care Model

Stepped Care offers clients the least intensive treatment that is most likely to work. Treatment is offered in a sequenced approach offering simpler less restrictive interventions first and more complex interventions if the client is not benefiting.

Step One: Prevention, Recognition, Increased Knowledge, Reassurance
Step Two: Brief Interventions and Self Help for Mild Eating Disorders
Step Three: Specialist and Continuing Treatment for Moderate Eating Disorders

Step One: Prevention, Recognition, Increased Knowledge, Reassurance

Our Drop-In service provides in-person advice to self-referred individuals. The information provided includes: understanding eating disorders, self-help, and signposting to appropriate resources. The Drop-In is staffed by an experienced, qualified counsellor and is open every Monday from 5-7 p.m. at Oakwood House.

Telephone Helpline: Callers can obtain free advice and information about eating disorders and self-help over the telephone. The telephone helpline is open on Monday evenings from 7-9 p.m. (excluding Bank Holidays), and is staffed by a qualified Advice and Guidance worker.

Step Two: Brief Interventions and Self-Help for Mild Eating Disorders

Our Psycho-education group, Coping Skills for Recovery from Eating Disorders is a ten session therapy group for self-referred clients with mild eating disorders. The goals of this group include: emotional and relational skills development, greater understanding of factors influencing body image and eating behaviour, increased recovery orientation. The group is facilitated by an experienced, qualified counsellor. Interested individuals are assessed prior to registering for the group, and people for whom the group is not suitable are signposted accordingly. Pre- and post-group outcome measures used: CORE 34, CORE Goals, Client feedback form.

Our Family, Friends and Carer's Support Group, Cherish, is for self-referred individuals who are affected by a loved one's eating disorder. It offers access to mutual support and information sharing. The support group is facilitated by an experienced, qualified counsellor.

Step Three: Specialist and Continuing Treatment for Moderate Eating Disorders

Our Step Three services are accessed by medical referral only. Medical and psychiatric risk is likely for people with moderate eating disorders. We communicate regularly with referring doctors, psychiatrists and other consultants to maintain client safety, continuity of care and appropriate step allocation. Upon referral, individuals with eating disorders or significant eating or weight distress are offered a thorough initial bio-psycho-social assessment with an experienced specialist psychotherapist. Symptom presentation will determine which treatments are recommended to the client. We endeavour to offer every client a choice of treatment modality or theoretical orientation.

Help Yourself! Guided Self-Help Programme: is a 12-week intensive guided self-help Cognitive Behavior Therapy course. Two tracks are offered: Anorexia and Binge Eating. This course is best suited to self-motivated clients, and those who benefit from a structured and sociable approach to recovery. It includes full assessment, bibliotherapy with written and practical homework, 12 weekly therapy groups and 3 monthly counselling sessions. The goals of the course include: restoration of regular eating, reduction or elimination of episodes of binge eating and/or purging, improved knowledge about the process of recovery from eating disorders. Outcome measures used: CORE-34, CORE-Goals, PHQ-9, GAD-7, Work and Social Adjustment Measure, Sterling Eating Disorder Scales (SEDS, Williams and Power, 1995), Clinical Impairment Assessment Questionnaire (CIA-3.0, Bohn and Fairburn, in Fairburn, CG (ed.) Cognitive Behavior Therapy and Eating Disorders, New York: Guildford, 2008), Patient Experience Questionnaire, Help Yourself! feedback form.

Exclusions for Help Yourself! include electrolyte imbalance or other medical complication, major depression (PHQ-9 score over 15) or other psychiatric difficulty, learning disability, personality disorder, daily drug or alcohol abuse, recent history of self harm, difficulties with spoken or written English, lack of motivation to undertake a self-help programme, or a specific request for one-to-one counselling.

Exclusions for the Binge Eating track also include: recent history of anorexia nervosa, BMI below 18, episodes of overeating not objectively large or less frequent than twice a month.
Exclusions for the Anorexia track also include: BMI below 16

Clients who opt not to do Help Yourself! and those for whom it is not suitable have a choice of the following treatments:

One-to-one psychotherapy: an integrative theoretical approach is used and clients may use up to 24 sessions although a significant proportion find that less is sufficient. The goals of psychotherapy are determined by the individual client. Outcome measures used: CORE-34, CORE-Goals, PHQ-9, GAD-7, Work and Social Adjustment Measure, Clinical Impairment Assessment Questionnaire (CIA-3.0, Bohn and Fairburn, in Fairburn, CG (ed.) Cognitive Behavior Therapy and Eating Disorders, New York: Guildford, 2008), Patient Experience Questionnaire, NWCED feedback form.

Enhanced Cognitive Behaviour Therapy for Eating Disorders (CBT-E) (Fairburn 2008): a robust new development in transdiagnostic cognitive behaviour therapy for eating disorders, this model uses a highly structured yet personalised approach to tackling core dysfunctional beliefs and eating behaviour. The goals of CBT-E include: restoration of regular eating, reduction or elimination of episodes of binge eating and/or purging, weight restoration for underweight clients, improvement in self-esteem, broader focal points for self-evaluation, improved management of mood intolerance, improved interpersonal relations. Outcome measures used: CORE-34, CORE-Goals, PHQ-9, GAD-7, Work and Social Adjustment Measure, Clinical Impairment Assessment Questionnaire (CIA-3.0, Bohn and Fairburn, in Fairburn, CG (ed.) Cognitive Behaviour Therapy and Eating Disorders, New York: Guildford, 2008). Patient Experience Questionnaire, NWCED feedback form.

Family Therapy: in some cases an essential component in eating disorders therapy, particularly for younger clients who depend on their families for care and support. The goals of family therapy may include: information sharing, improved communication, problem resolution, assistance with short-term parental responsibility for re-feeding.

Dietitian consultation: precise guidance with meal planning and dietary advice with our consultant dietician, who is experienced in working with people with eating disorders and their particular concerns. The goals of dietary consultation include: improved knowledge of appropriate energy needs and nutritional balance; guidance on meal planning; improved completion of planned meals.

Intensive Outpatient Programme and Meet to Eat: IOP offers cost-effective care at the higher end of Step Three. For clients who have recently returned home from inpatient eating disorders care, IOP offers ideal transitional treatment or an alternative to hospital-based day care, providing daily supported meals and CBT-E. Additionally, clients who are not progressing with Step Three care (e.g. rapidly losing weight with BMI between 17 and 15), can benefit from "stepping up" to IOP, which in some cases may be enough to prevent referral to hospital care. Goals of IOP include: improved energy intake, decreased mealtime isolation, improved motivation to eat appropriate meals. Also includes the goals of CBT-E. Outcome measures used: CORE-34, CORE-Goals, PHQ-9, GAD-7, Work and Social Adjustment Measure, Clinical Impairment Assessment Questionnaire (CIA-3.0, Bohn and Fairburn, in Fairburn, CG (ed.) Cognitive Behavior Therapy and Eating Disorders, New York: Guildford, 2008). Patient Experience Questionnaire, NWCED feedback form.