Meal Supervision in Eating Disorders Lisa Williams –Mental Health Practitioner Date

What is Enhanced Home Treatment (1) Enhanced home treatment (EHT) provides support to young people and their family/carers around meal and/or snack times, when they’re eating minimal amounts and/or seriously ill Provided for 8-18 years old Support is given at home/school/college/in hospital Carried out alongside family member/carer EHT aims to: Improve the physical status of a young person To prevent inpatient admission Or To decrease length of stay and improve the experience of inpatient admission

Enhanced Home Treatment (2) Duration approx. 2 weeks, need reviewed at least weekly Work is family focused (even during inpatient stays) Young person and family needs are assessed, then support plan is devised Support plan commenced as soon as possible Support given by mental health practitioners and clinical support workers

What support is given? Families/Carers educated on how to manage; Mealtimes Meal preparation Appropriate portion size Meal plan troubleshooting Helping young person at mealtimes with eating Manage duration of eating Employing post meal distractions, positive-self talk, mindfulness exercises/creative tasks

Feedback/Outcome Measures Goal(s) set with young person at beginning Outcome measures captured at the start of EHT Goals and outcome measures done part-way through and again at end of treatment Helps to target specific needs

Why involve family? Involving family: Families can inform us of normal family eating practices EHT aims to model helpful strategies to eating Gives advice/guidance/reassurance to parents/carers Helps with trouble shooting at mealtimes

What do the young people and their parents think of meal support?

What I found helpful… I was encouraged with words – no being ‘forced’ to eat “Eat it to beat it” “You can do it, do it for your future” Let’s get back to …[the things you love] I took a step towards eating with friends – it made lunch more ‘normal’ It’s nourishing “This is your medicine”

More helpful tips from YPs: Be sensitive Understand that it is REALLY hard Support YP before the eating….e.g. just physically picking up the knife and fork It gets harder throughout the mealtime, so try to avoid long pauses or putting down the knife and fork Distraction – Talk about other things, not the food Remind them of motivations Have the radio/TV on

What I found unhelpful… “Stop doing…..” Constantly pointing out behaviours e.g. leg shaking “I found praise unhelpful as I didn’t want to do it in the first place” Prompting you to have everything – “even the crumbs” “Stop taking small bites – take bigger ones” “Come on it’s fine, just do it” making it seem simple

More tips on what to avoid: Raising your voice or arguing with me Telling me things that I already know Not talking about calories or weight Just being watched or stared at Them fidgeting Not eating themselves Silence Being given an overwhelming sense of shame

Parent views (1)… Mother of a 14year old girl. Supported at home. She was really poorly, the thought of admission filled me and her with absolute terror…it was the best thing we could have had, it kept her at home and stopped her from dying” I was empowered in front of my daughter It gave me confidence/affirmed what I was doing I learnt something new at each visit of what to do I had back-up from the service The constant encouragement of my daughter… “Keep on eating it” “Lets keep going” Learning mindfulness for outside of mealtimes Some people may find the dedication difficult

Parents views (2)… Mother of a 10 year old girl. Supported at hospital then home… It was good for her and us to learn how to talk about things other than food during mealtimes It was made more ‘normal’ by having someone eating at the same time Using their tactics was helpful to continue, when they were gone We learnt how to use distraction plans before mealtimes and put them into place during and after meals…e.g. “we planned to play a game straight after eating, as soon as the time had passed, we took the plate straight away and then played” She was uncomfortable with people ‘coming to watch’ even though I explained they weren’t