 Good afternoon, everybody. Welcome to this afternoon's Eating Disorders Collab Lab. It has been absolutely lovely to see everyone joining the room and I'm sure there'll be still a few people jumping online in the next few minutes. I'm Sarah Trove and I'm going to be your host this afternoon and I'll also be joined by four moderators to support us through the program. Before we get started, I would like to acknowledge the traditional owners of the lands on which we're all meeting today from all corners of this country, and I'd like to pay my respects to their elders past and present. I live and work and I'm joining you here today from the lands of the Wurundjeri people of the Kulin Nation, and I'd like to pay my respects to their elders past and present and also extend my respects to any Aboriginal and Torres Strait Islander people here today to acknowledge your deep connection to land, sea and community. So, today's session is really exciting. It's the first collab lab for the MHPN conference. Thank you for taking the time this afternoon on overruns. Clinical schedules are fairly packed, so to take this time out to really expand your knowledge and understanding of working in the area of eating disorders. It's a really big audience and we know that you are coming from all parts of the country and from many different disciplines and job roles. So, again, I've just been looking at the titles attached to your faces in the platform and it's really, really lovely to see, especially given the theme and the spirit of today's session is to learn about interdisciplinary collaborative care. So, we need to be thinking about the different professions that are involved in eating disorder care and also across services, cross organisations and given telehealth sometimes across state and territory borders. So, in terms of today's learning objectives, we are going to be really focusing on how we engage in interdisciplinary collaborative care when we're responding to people experiencing eating disorders across diagnostic presentations and understanding then how this collaborative care can really lead to better outcomes for eating disorder presentations. I'm going to be providing you some information to, I guess, help facilitate the discussions that you're going to have in some of the breakout rooms later on. And so, there'll be some general eating disorder information provided at the start. I'm going to acknowledge that there will be a range of different, I guess, levels of experience in the room today from people who've got a lot of experience in eating disorders and collaborative care is just part of your everyday job, versus people where this might be something quite new for them. And I want to take the opportunity today when there are so many people here to learn to provide pathways for further learning and professional development, especially if you are starting out new. So, to those more experienced people in the room, sorry if some of the initial content is a little bit, I guess, repetitive and not new for you, but it really does underpin and provide you the foundation to engage in the conversation later on. So, we've got a three-part activity today. So, we've got about a half an hour together in this room to start with. As I said, I'm going to give you an overview around your role in the system of care and thinking about, you know, providing a completely comprehensive assessment and developing a formulation and care and treatment plan. And then we'll be moving into section two, which extends for about an hour. And that's where the fun and engagement happens. So, you're going to be moving into one of four rooms in which you'll be focusing on a specific vignette or case study. And the moderator will guide you through a series of questions to help you think about what needs to happen for this person, you know, and the care, I guess, the care team that needs to be involved in how that care team will be working together. In the final 30 minutes, we'll rejoin here into the main room. Each of the moderators will be feeding back to the whole group on the main learnings from their vignette, and we'll be doing just a bit of a summary of the session. There will, of course, be resources that are provided, will links to resources provided to you at the end of the session, and you'll be able to access those through MHPN also. So, mindful of large numbers, and I guess we've all learned over the last few years about how to interact online. For this first section, there'll be, the chat feature is available on the right-hand side of your screen, and on the next slide I'll show you where that's situated. And while we, like, I'll be fielding the content questions, sorry, we won't be fielding the content-related questions there, but if anything pops up that I feel can be addressed in that final section, I will endeavor to do so. But you can really use that chat-chat function to engage with other delegates in the room, to share links or thoughts on what's being presented. If you need technical help, so if there's issues with your sound or video, please use the Q&A function. Once you do go into the breakout room, so the section 2, there'll be a lot more interaction with the other delegates and with the moderator, and your moderator will guide you through how that's going to happen and be asking specific questions for you to respond to. We do really ask for you to leave your camera on when you're in those breakout rooms. We can just pretend that we're in the room together, so that we can really collaborate and engage around the content. So, this is just a little image of what should be seen on your screen, so you can see the chat, so that's for your thoughts, ideas, questions, and Q&A, you'll be using that more once you're in the breakout rooms, that there will be some little polls and things that pop up there, and if you're needing any tech support. So, diving into the eating disorder content, this is going to be a little bit of a whirlwind tour and I'll get through as much as I can in the time we've got. So, the moderators that are joining me today and helping me through the program, Amy Davis, and she's an accredited practising dietitian, both in private practice and in public mental health. My colleague, Dr Emma Spele, who's the workforce development coordinator at NADC and also a clinical psychologist. Katrina Henry, accredited mental health social worker and also senior social worker at the Central Coast eating disorders outpatient service. And Rachel Knight, who is a mental health occupational therapist and lecturer at Deakin and experienced across clinical work and also service development. We will meet them on the screen a little bit later on. So, this is something we termed eating disorder step system of care and what this really provides us is a framework to understand the role of mental health professionals and many other professionals in the identification and response to eating disorders. I guess they're kind of action pillars if you can think of that there are actions and responses that we need to do around the prevention of eating disorders. We need to be able to identify early symptoms and signs. We need to be able to respond to the early symptoms and signs and doing a comprehensive assessment. We need to support that person to access the treatment for the eating disorder and engage in any other psychosocial supports that might be needed to really support a person to, I guess, get back to their full and functioning life. So, what the gold standard is and what NADC is striving for is to have a really coordinated and connected system of care. So, that means that when early signs and symptoms are identified that is easily connected to someone who can respond and do a comprehensive assessment. After the assessment is done, that is then connected into a treatment that is provided at an intensity that really meets the needs of the person. I guess it's not linear. A person's journey through the system of care may not just go through identification, response, treatment and recovery that we move up and down and I guess the services need to respond in a way that can increase or decrease in intensity depending on the person's psychological needs, physical, nutritional and of course their functional needs to look at the whole of person and their quality of life. So, I want us to keep this framework in mind as we're working through the next few sections and especially once you move into your breakout rooms and you're thinking through a vignette and developing a care plan for a person, what needs to happen in this system of care to really support a person to get what they need. I will just point out there's a little clipboard indicator on the right hand corner of the slide. This means that this is a resource. So, MHPN will be providing your list of all of the resources that myself and the moderators have put together and so if you see the clipboard, you are going to receive that resource so you don't have to worry about scribbling down notes about what you want to access a little bit later on. So, what does your role in the system of care look like? When you look at a framework like that and think about your scope of practice and your professional role and where you're working, you might be thinking, oh, what's my position? What am I supposed to be doing? So, for mental health professionals, a really key role in proactively identifying people who might be experiencing eating disorders and definitely screening at risk groups. So, with the right training and experience, we'd be doing a comprehensive assessment, providing evidence-based mental health treatment. For GPs and other medical practitioners in the room, we'd be providing the medical management to support that person through the, I guess, the physical impacts of the eating disorder. Dietitians would be providing dietetic interventions. A number of different professional groups would be providing psychosocial support. So, thinking about how we're supporting a person to get back into their occupation and their just normal activities of daily living. We'd be understanding the system of care and making referrals for a person where it's necessary and appropriate. We might be leading that care team. So, when a person is accessing services across different individuals and service settings, it's really important that there is coordination. And so, a mental health professional might have a key role in that. And everyone. And that's mental health professionals, but also us as just individuals. We all have a role in preventing eating disorders. Now, that can be through the language we use and also through early intervention and patient education. I just realised something just came to mind that I do just want to skip back up to something here that when we're talking about eating disorders, some of this content might be triggering for people. And so, we're just going to pop in the chat function, the contact details for the Butterfly Foundation. In the case that you do want to talk to anyone, we know that group members bring a range of different backgrounds and experiences. And that may include lived experience. And that might be for yourself or also caring for someone that you know. We're really mindful of language in this session. And so, please be aware of the impacts of white stigma and the importance of using affirming an inclusive language. And our moderators will also be going through some of that information when you join the breakout rooms, when there is more opportunity for you to engage. So, sorry for just remembering that now, but just be mindful of language and that there is support available if anything that we're talking about brings something up for you. I'm just going to skip back down here. So, in thinking about our role in the system of care then, I'm going to guide us through some information to support you to be able to identify I'm not going to cover assessment in detail, but then thinking about how you develop a care plan for a person. So, to really identify eating disorder symptoms and signs, we need to know what we're talking about. What is an eating disorder? What are the different diagnostic presentations that we'd be thinking about? What's the prevalence? And that's really breaking down some of the stigma about who gets eating disorders, how prevalent are they in Australia and what diagnostic presentations are more common than others. Risk factors. So, we're projectively screening, as I said, the high risk groups and presentations. So, what are eating disorders? They're serious complex mental illnesses and that's really why we're talking about it today because they are a mental illness that requires a mental health response. Just like depression or anxiety or obsessive compulsive disorder, they need a mental health response and so as mental health professionals we need to equip ourselves to be able to make the right response depending on where we're working. With eating disorders they come with physical and psychiatric complications and sometimes that can be where the anxiety arises with eating disorders that are mental health professional things. How am I going to manage that physical risk? And that was definitely something that I experienced earlier in my career. So, with eating disorders we always work in the collaborative care space. So, that's why this topic is perfect for the Colab Lab. That we always work from a multidisciplinary approach of a minimum mental health and medical team to address those core symptoms. Eating disorders across diagnostic presentations are characterised by disturbances in behaviours, so around eating behaviours and physical activity behaviours, thoughts and feelings towards their body and shape and also in food and eating. I'm going to give you just a really high level description of some of the most of the eating disorders that we're going to talk about today. The reason being is when I'm talking about the high level criteria, I want you to think about what impact would that have on somebody's life and because that will then determine what is your treatment plan going to look like. So, for binge eating disorder that's characterised by recurrent episodes of binge eating where the person feels unable to stop themselves eating, it's associated with marked distress and guilt and it's not associated with compensatory behaviours that you would see in bulimia nervosa, such as excessive exercise, vomiting, the use of diuretics. So, if we think about something, an experience for someone with binge eating disorder, I guess the triggers can be multifaceted. So, it's really exploring what might be leading to the person binge eating and in the breakout room, you'll be exploring that I think with Rachel. So, for bulimia nervosa, it is the binge eating followed by the inappropriate compensatory behaviours to prevent the weight gain. So, someone is and the body image disturbance is there. So, someone becomes afraid of the weight gain that can happen through the binge eating and so they are engaging the compensatory behaviours. For aphid, we're not going to go into this as much in detail today, it's a newer diagnosis and this one isn't driven by a body image disturbance but by a sensory aversion to the food in the mouth. It can be a phobia of food triggered by a traumatic event or it could be a lack of interest that the neural pathways that we experience and that give us joy from eating and not actually present. So, one or more of those presentations can present in aphid and obviously if you're not eating enough or having the right nutritional requirements, that is going to have significant impacts on your physical health. So, anorexia nervosa is the restriction of energy intake leading to significantly low body weight accompanied by an intense fear of weight gain and body image disturbance or behaviours that reflect that. So, we have to be thinking about a really persistent cognition around body and weight and food and when we think about how much food is a part of our daily life you can think about how much that the eating disorder can really impact on a person's life and of course the impacts then on the body. At atypical anorexia nervosa is exactly the same and comes with the same physical risk and mental health risk. The only difference is that a person experiencing atypical anorexia won't meet the significantly low body weight criterion. It does require the same response by the care team and that sits under the OSFED diagnostic category if you're wanting to understand the DSM. There are a few other diagnostic categories within the DSM but I'm not going to go into detail but this is just kind of a FYI and you can read more about that on our website. So, the prevalence of eating disorders is increasing and it has gone up considerably since COVID. So, we don't have the best data the best research was in 2012 and now we're starting to see a few more studies come out that suggest at least 1.2 million Australians are currently experiencing an eating disorder which is really shocking if you think 1.2 million Australians. Now, what we know is that only about 25% of people actively seek treatment for their eating disorder. So, there may be other people within accessing mental health treatment for another presentation but are not talking about their eating disorder but a lot actually don't seek treatment and that can come with a lot of different reasons and it might be shame around the eating disorder behaviors. It is sometimes that the eating disorder holds a really important function in person's life. So, again, speaking to our role as mental health professionals the importance of being able to have a conversation with someone about their eating and bodies as part of our normal process. Prevalence I mean in terms of how eating disorders present it can present in anyone of any age of any gender, of any sexual identity, cultural background. So, we can't judge a book by its cover. We need to be screening at all instances where possible. Prevalence I know that the media has somewhat perpetuated, I guess, a focus on anorexia nervosis which is really, really important and we need to develop a system that can really provide a wraparound response to people who are experienced anorexia. But it is also really important for us to be thinking about the many other people that are experiencing binge eating disorder which is the most common eating disorder. 38% of people would have an other specified eating disorder which also contains the atypical anorexia and about 12% have bulimia nervosa. Within gender, binge eating disorder is about 50-50 across males and females and we don't have great data on gender diverse individuals. For bulimia, 70% of people would be female, 30% male and then for anorexia, the data that we have would suggest around 80% of people with anorexia would be female and 20% male. Again, data is emerging, it's not amazing at the moment but the data that we do have suggests that eating disorders are more prevalent in Aboriginal and Torres Strait Islander people so 27% compared with 16% of non-Indigenous Australians so we need to be thinking about a better wraparound response that is really supporting a person to remain connected to their community and is really culturally safe and appropriate. So like all mental health presentations the risk factors that contribute to the development of an eating disorder are complex and I guess they involve biological, psychological, behavioural and socio-cultural factors. So if we're thinking about a person's susceptibility to developing an eating disorder, it's best understood as a complex interaction between all of these factors. So understanding the risk factors helps us to think about in the room oh I've noticed a risk factor I need to be asking questions about their eating and bodies to see if there might be an eating disorder there. So some of the examples around biological and genetic factors we need to look at a family history of eating disorders and other mental health conditions especially knowing we understand the genetic predisposition around depression and anxiety and around 90% of people with eating disorders will experience a co-occurring condition so you can see that there is a brain base to eating disorders and other mental health conditions. Transition stages with major physical and social changes such as adolescence and pregnancy are really important there is definitely a genetic predisposition that a lot of research is going into at the moment which is really exciting because understanding genetic factors really helps us to develop better treatment approaches. So these include temperament based traits such as perfectionism heightened sensitivity sensitivity to negative evaluations anxiety and harm avoidance dieting is a huge risk factor and dieting has just become this common thing that a lot of people just throw around I'm on a particular diet I've cut this food group etc it's a significant risk for an eating disorder and so people are talking about being on a diet or wanting to lose weight we need to be identifying that stress is also a risk factor and so I'm hoping as I'm explaining these we're thinking oh look what's happened with COVID that a lot of these things are actually compounding and predisposing that person to the development of the eating disorder. Peer pressure, teasing or bullying comments about weight and shape dieting in the family or also other factors that can help can perpetuate the problem. So the high risk groups and presentations we need to be screening for again we've talked about weight bias so if someone's coming to you and saying you know I'm unhappy with my body I want to lose weight I have lost weight they're cutting out food groups that we really need to be screening to better understand the reasons behind that and understand what might be leading to what is an internal body image issue is their comments coming from other people around their team is it a health professional telling them to lose weight because all of those will help us to determine who's in the care team who do we need to have conversations with who's going to be really supporting a person through recovery in terms of high risk groups we need to be privately screening anyone who is neurodivergent First Nations people LGBTQI people who identify LGBTQI people engaging in competitive occupation sports and performing arts especially when the body is a real focus of that occupation females children and adolescents trauma is a really high risk presentation and there is a high co-occurrence of eating disorders and trauma so we need to again be thinking about trauma informed care and also considering what other services might be involved in addressing the trauma we've talked about the high co-occurrence with other mental health conditions so substance misuse is another one that often occurs so we're thinking about engagement with alcohol and drug service eating disorders and people with higher weight so eating disorder diagnosis are often missed for people with higher weight because there is that I guess old traditional stereotype that has been perpetuated that eating disorders don't occur in people who are not low weight so we really need in understanding that the population comprises more than half of all people with eating disorders we really need to be better understanding that and also think about our own personal beliefs and stigmas that might sit around weight and educate ourselves and understand the better language and also developing a I guess a clinic and a room that supports people of all body weights and shapes so we do need to focus on the protective factors and this is going to help you to really develop a care plan that can help to address some of these protective factors that can help move someone towards recovery so some of the individual factors that will protect someone from a developing an eating disorder or target through the mental health treatment around the body, the body, the body acceptance a healthy relationship with food and we don't talk about healthy in terms of following the perfect food pyramid but it's around a relationship with food and being able to eat spontaneously and eat variety and eat socially so that sort of relationship with food that we are aiming for. Having a strong connection with our community, with friends with work and school are really really important. Connections with people that don't over emphasise weight and shape is also really important. So we've talked a lot about the risk factors, the protective factors, so what's happened in COVID. Now if we look at that top line or so we might have all experienced some of that before so all of these factors on the screen here really compound so someone might have a genetic predisposition to developing an eating disorder and then you add on complete isolation whether that's your own, they're not connected with their work colleagues, they're not allowed to go to school, they can't do any of their extracurricular activities they're stressing the household around work, schooling from home financial stress. Food insecurity is a big risk factor as well and obviously with the financial implications of COVID people were put out of work and the ongoing I guess economy in Australia at the moment means that food insecurity is rising. There's been disruption to our schedules and routines and particularly around young people looking at their developmental trajectory and how that's been really impacted on them, been impacted by not being able to go to school and engage in the normal activities that they would. So these are some of the factors that our moderators will be guiding you through to think about what needs to happen for people even though hopefully we're out of the dark depths of COVID we know that it's still the impacts are still there. So coming up with a care plan we need to think about the impact of eating disorders on a person. When we go back to the diagnostic criteria and we think about the impacts of restriction, binging and purging, excessive exercise and other eating disorder behaviors the impact that can have on all parts of the body so through the heart the gastrointestinal tract, our skin our teeth, all those things so of course we need to be thinking about medical and physical care. We need a mental health approach to actually be targeting the eating disorder cognitions but we need to be thinking about the impact on a person's education their occupation their engagement or re-engagement in extracurricular activities or things that they used to do before the eating disorder happened. The impact on the family and in the house that an eating disorder can impact have a significant impact on those people closest to them. The other thing is that an eating disorder can lead to a lot of withdrawal from social relationships and so how can we support a person to reconnect where they had strong friendships and work colleagues and family and of course there can be a really significant financial impact of eating disorder behaviors. So I'm not going to go into early identification too much there is free early learning for mental health professionals available on our website that you will receive the link to but to be able to do this we need to know the warning signs as mental health professionals we all have a role and so we need to be able to be kind of have that flag in our head at all times and then understanding what's next and so after we identify we do the screening and assessment so now we know what the high risk groups and presentations are we need to learn about having a conversation and eating if that's something that doesn't feel comfortable for you at the moment understanding psychometric tools that you might like to use completing that full assessment including the risk and making sure that a person is linked in with a medical practitioner if we're the only person in that care team to start with again excellent resources and things through the learning if you'd like to access that after the conference so when you're thinking about a care or treatment plan when you move into your breakout room some of the things I want you to just to be keep in mind is that the person is always at the centre of the care plan so we need to be thinking about the whole of person what is the impact that this eating disorder is having on a person's life across all of those areas that I just outlined the treatment plan needs to be culturally safe and sensitive and appropriate it needs to be recovery oriented what would recovery look like for that person is it a complete absence of eating disorder behaviours is it that they're re-engaging in work or you know friendships or outings trauma is really really important so it always comes from a trauma-informed lens and the early intervention is really really effective so when we identify and respond to an eating disorder even if you're not providing the full treatment approach such as you know an evidence based treatment model providing psycho education and engaging someone and you know using some motivational techniques is really really effective early intervention and you know the earlier we do that the better outcomes for the person and I want us to be thinking about our own professional responsibility you do work across so many different settings and so you need to think about what's my experience what's my training what do I feel that I can do within my own scope and what do I need to do to be able to do more you know around extra training and supervision so if you're in a work setting that's like well I'm not going to be providing the treatment then it's about what will my roles look like within the team and where else do I need to refer to so where would we would be referring to so we draw your attention back to that overarching framework that I introduced at the start treatment can occur in the community in an intensive community setting and also in hospital most people recover in the community hospital treatment is needed for less than 5% of people and recovery doesn't happen in hospital that's there too in response to medical risk psychiatric risk or really significant interruption of the eating disorder behaviors if community treatment isn't able to establish that so we're really thinking about community based treatment and then using the other levels of treatment where appropriate and again it's that interdisciplinary care that's really important here that you will be required to talk with other services if that's what's required for the person when you're thinking about again the treatment plan you're going through mental health what's needed physical nutritional and psychosocial family and other supports is really crucial to your care team as well who is going to really help that person at home there's a lot of time between appointments to move towards recovery and really helping a person to re-engage with their community and life I've mentioned this throughout but just to give you a visual description of what a care team should look like is that a minimum care team is a mental health professional and medical but in most instances there's other people involved so dieticians are often involved psychiatrists and pediatricians can be especially if there are Medicare items that are being used other health and medical specialists as needed and really addressing the psychosocial aspects and the lived experience workforce is a really key one that probably definitely isn't being used as well as it should be at the moment so peer support and family support are also areas that you can explore. MBS items are available so there's the eating sort of management plans for anorexia nervosa and severe presentations and also our mental health care plans and chronic disease management plans so treatment plans we can do this privately and we can also be thinking about the public system and low cost options. So I am going to stop sharing my screen for a moment because I am going to introduce our wonderful moderators to the, I think they're going to pop up so thank you so much tech team and once their cameras are on these are the faces to the name so I've been talking about the moderators I gave you a very brief bio and you can access their more comprehensive bio in the conference platform we've got Dr. Emma Steele, Rachel Knight Katrina Henry and Amy Davis and each of these will be leading one of their four breakout rooms in the next section. Welcome back everybody I can see the numbers slowly increasing as people are jumping back in the room we'll get started I think that we're up over 500 people which I'm just amazed, just incredible to have all I get is a 500 plus so I don't know how much higher it goes from there but thank you so much just amazing turnout and thank you for your commitment to upskilling in this area. I'm going to be joined here by our four moderators who are going to provide feedback on the group and I'm going to do my best in kind of synthesizing and bringing together some of those common themes. I jumped like a very busy person through that last hour I think I spent like a few minutes in each room and just went around in circles but I really picked up on common themes all popping up but also really different cases and thank you so much the moderators for doing a brilliant job. We're going to start with Rachel Knight to provide feedback on her session if that's okay so just thinking about the collaborative care how does that work for your case how does that contribute to a better outcome for the person experiencing needing disorder and any key messages if you had time to process all of that in that hour, Rachel? We will just start off by saying in our breakout group we had a very fast and furious conversation everywhere there was so much going on across the Q&A and the chat and also people contributing it was an amazing session with lots of different inputs and stuff which made it very exciting but it did make it very hard for me I did not take notes well because I was too busy responding to everyone so I'm going to do my best to represent the broad themes across our discussion so the vignette we worked with was somebody with vingeaning disorder who also had a traumatic episode in relation to a sexual assault so we were presented with a complex and somebody had outstanding or trauma experience that hadn't been discussed or disclosed at all alongside a vingeating disorder that had developed post that traumatic event and they had a recent episode where they tried to take their own life and in fact that was the first 4A sort of in 10 plus years since the years that they had the opportunity to have contact with mental health services so they had gone to the GP for some support and been sent to a dietitian and a weight loss program and started on some medication but this attempt on her life was the first opportunity she'd had to be seen by mental health professionals so that in itself was important for us in our discussion because it was the first opportunity that we had to be able to diagnose the eating disorder accurately diagnose what had been going on understand what had been going on for a particular person and think about how we could work collaboratively to support her there was a lot of opportunities there we talked a lot about sort of overlap between trauma and eating disorders and how we would respond to each of those and how they might be responded together or separately and we spoke about doing that alongside management of risk there were a number of hurdles and challenges particularly this person very socially isolated and the fact that her difficulties had gone undiagnosed and not understood for such a long period of time so and particularly in relation to her family network so there was a bit of distance between her family and the perpetrator of her sexual assault had strong connections with her family as well which caused a number of problems so we had to think really carefully around how and when we might engage the family in the treatment plan that was important but we also wanted to respect the wishes of the person themselves and their experience that they had to get actually disclosed so we did recognise that the first keeping things simple was probably really important for Jody who is our vignette which is really about how can we engage her how can we build a trusting relationship with her and to support her to be safe so they were kind of the first three things right off the bat and we also recognised that it was easy and easy to sort of specialist to do those things there's something we all do as health professionals every day and we were all able to do and if we did that we were well on the way to supporting this lady in her recovery we did talk about what so communicating so how we communicated with her how we interacted with her how we supported with her to share what was going on for her and what she wanted to do and we did sort of make a point that we could understand what she wanted to do and when and how we could address those in order to improve the quality of life but we also discussed thinking about different structured interventions that we could use as well so we talked about things like CBT E, CBT forget that the eating disorders and the different versions of that including God itself health and the CBT 10 sessions 10 session models as well as things that might have been a little bit more trans diagnostic such as EMDR in fact acceptance and commitment therapy and a dialectical behavioural therapy we did recognise the need for a multidisciplinary team and there was lots of talk around of course with me being an OT thinking about the impacts or the involvement that OT could have in eating disorders we also recognised the importance of other disciplines as well so thinking about psychology thinking about keeping involvement with the GP and potentially others as we get a bit of an understanding for what Jodie needed and wanted to do with her life and how we could engage her moving forward Beautiful Is there anything else that I could share? I think that is absolutely excellent summary Rach because it was a really complex case and I would encourage those that weren't in Rachael's room to have a read through and actually just have a think about what Rachael has said also because that case if that person was sitting in front of you what you might do but some of those really key things Rachael round all of us have a role in just engaging and listening and making someone feel safe to share their story and that might be around trauma but also their story of the eating disorder because it can be really hard to disclose that so I think absolutely key messages there Rachael just starting small that we don't have to bring in a huge care team at the start and engaging the person we're doing a comprehensive assessment understanding them and then being able to bring in other professionals as needed and depending on your scope of practice maybe you are just the central part of it and then we are bringing in other professionals perhaps do focus trauma counselling or whatever else might be needed absolutely thank you so much we'll have to jump on to Amy if that's okay quite a different case that Amy you'll be talking about Yeah thanks Sarah so our our case on EV had a pretty complex presentation as well with a lot of physical symptoms and we really kind of focused on the transition stage that EV was at so EV was an 18 year old who had already undertaken eating disorder treatment as an adolescent and then was identified to either be relapsing or potentially have not completely recovered from her previous treatment so we really talked about the transition from adolescence to adulthood and the team I was talking with were really able to identify maybe that need for more autonomy whilst continuing to be able to include support people in her recovery and that idea around moving to a more individual treatment and then we talked about the clinicians that may need to be involved in that individual treatment and really then just the importance of communication of that treating team because this was a presentation that would have been considered an atypical anorexia nervosa and so the goals of treatment kind of just ensuring all clinicians were on the same page in terms of recovery and what that looks like so then, yeah, that communication thing really came through as well Yeah, beautiful, thanks Amy I think something that came up when I was in your room too is thinking about, I think that the transitional stage is just such an important thing for clinicians to be mindful of and most services aren't set up we have this public system that's like at 18 then you cut off and you move into an adult system but they're in such a like it's just such a tricky developmental period for them because there's so much change happening that they are becoming an adult that might be moving out of home and so what's the role of the parents in this case versus how much we're doing individually and I also think for Amy when she was involved in so many different sports and gyms and that's where her sense of connection and meaning came from in life so what are the messages when we're thinking about interdisciplinary care and who might be involved in a care team what are the messages that coaches and peers are going to be giving Amy versus what the treating team are going to be providing and what that might feel like for her if she's getting competing messages so really important to be looking at that whole person because if we weren't exploring the importance of sports and gym and exercise in her life we'd be missing a whole aspect of her treatment plan I think weight stigma was also raised in your group too that Amy had lost weight and she sat within the normal BMI and so really supporting a person to understand and providing the right cycle education around our set point so what is our biological position to being a particular weight and supporting someone to feel safe and okay to move beyond the weight that their cut off had been at and that they might need to move to a higher weight and what that might bring about from their family and other people around them if her weight changed so I think that's cycle education and who's providing it the nutritional staff, the biological staff, the mental health that's how the care team really needs to be talking about who's saying what thanks Amy Katrina we're going to jump to you to another younger case Yes much the same as Rachel's group lots going on in the chat and feel like you know couldn't really respond to everybody's questions but I guess you know in terms of the Katie's situation I mean it sounded like a very you know just a very typical presentation but as we sort of were talking about it it was more like okay what are the considerations that we need to be looking at here in terms of Katie is only 12 and you know who is it that she's presenting to but who was in her care team but also who might be those other people in her support system that might then be coming to your service as those other people and how do we have those discussions what sorts of skills of knowledge do we need to have around having those conversations particularly you know there was a grandparent that had made a comment around sort of that weight stigma and you know having to be a certain weight and shape and you know there was lots of sort of comments in terms of Katie's age being you know that sort of pre-adolescence moving into that transition all with COVID and all of those changes that come along with adolescence as well as the change of COVID the you know all of those sort of stresses and anxieties that come up in normal adolescence but then adding on top of that the isolation maybe with COVID and you know the situation that's happening at home things like that so there was yes lots of discussion about who might be in that team and you know in terms of that early identification you know really important in terms of the physical aspects so lots of people commenting on you know the physical aspects for Katie really important to get her to a GP and you know sort of assess that everything is physically okay for Katie but also yes involving a dietician involving the school involving like the school council of the parents, grandparents you know in who in each of that sort of settings can play a role just like you're all saying everybody can play a role in that it's not just singled out into this is treatment for Katie and what does that look like yeah absolutely I think there is an important one there too Katrina around restriction in you know a 12 year old girl and the impact that that can have on her physical development and obviously you know you know if there's been impact on other areas of her development as well so really important to bring in the right care team to address those issues the other I guess thing that kind of was raised in your group was around aligning the care team we can hear that there are comments coming from grandparents and you know possibly other people around her possibly peers and those sort of things so we're really needing to align the care team on what are the risks here with the restriction what are our messages how are we best supporting Katie to you know continue to have the right intake for to support development you know young people shouldn't be losing any weight you know that's really committing to their physical development so absolutely agree that you know there's a few comments in there around BMI that comes from Amy's group and also Katrina's that BMI's a really damaging outdated thing to use and it's not what we should be looking at we've got to look at the whole person so really really important the other common theme that was raised across different groups and was in yours Katrina was around the cold care and conditions so when there's anxiety and low mood and it's like what are we treating first and also chicken or the egg because we know that restriction can increase anxiety and and worse and mood so really important thinking about the I guess the sequence of the treatment and I mean that was one of the discussions that we had in terms of yeah this is the presentation that they're presenting for anxiety depression it might be more of those general mental health issues but then which is the priority how do we prioritize what it is that we need to be focusing on and yeah there's some comments around sort of an individual approach for Katie because what's actually going on for Katie as opposed to she probably meets criteria for anorexia nervosa and what's the best treatment outcomes for anorexia nervosa in a 12 year old and you know trying to intervene and support the family to step in and take some yeah to be able to support Katie absolutely early intervention if anyone takes anything away today it's early intervention we need to do something quickly and starting small I'm going to jump to you for our final case again really active room I didn't want to leave great thanks Sarah I can see that my connection might be not great am I coming through okay yep yep great so I had a very similar wonderful problem that I had a very active room and I hope I can kind of feedback and do that justice so to let you know a bit about our case so we were talking about Alex who's a 32 year old trans man who lives in rural Queensland and so Alex didn't really have any sort of substantial eating disorder history but after the macadamia crop kind of went bust from the terrible weather related to climate change they had been been cheating for probably about three months so one of the kind of key themes that I think came from our group was really how do we rest back on key principles and existing skills that we already have to try and make sense of and understand what's going on for Alex so I guess similar to what I've heard from other groups there was a real kind of motivation in our group to try and understand from Alex's perspective you know what are the kind of things that have happened to him in his life that might have exposed him to this so things like you know understanding if he has kind of like in his history like some sort of family history of an eating disorder also understanding a little bit around the kind of current factors that might be impacting upon his experience of his body and some of the concerns that he has around that so really trying to understand you know the relationship that he has with his body and his gender identity and again you know it's we really kind of had this robust discussion around the complexities of what on the surface looks like a problem with food and eating but actually you really need to take into account a lot around the person's experience of their body what does their body mean to them and for Alex there was a really strong component around gender and gender expression within the body the other thing that sort of came from the group which sort of around collaborative care was trying to kind of really make sure that we're looking at the kinds of health practitioners that might be required to give Alex the care that he needs but also thinking more broadly around and similar to what other people have talked about what are the sort of social networks that Alex has and are they supportive of and affirming of his body experience you know what's it like his relationship to try and understand how he navigates you know that within his intimate relationship what how supportive are his family and can we work with him and them to try and you know I guess address some of those social factors that might be contributing to you know issues around how he experiences his body and the other really important thing that kind of came up from our group was trying to understand and it kind of came out the you know helping Alex to understand and step back from what's happening from him from to him in terms of those kind of maintaining factors and again it was really kind of resting back on the skills that that we already use kind of as professionals to formulate and understand where we might be able to get someone out of a vicious cycle so really kind of look at things like thinking styles and intervening on behaviors and really kind of looking at strengths that would help Alex to kind of you know feel motivated to continue to address these and to align with him on what his goals are and what makes meaning and purpose to him in his recovery and in work. Yeah. Beautiful. Thank you. There was so much that kind of came up in your group and I think that the experience of their body is a really important one and look the chat is really active and there's a lot of comments about bodies and weight and you know like it's some of it's hard you know the experience that people have from health professionals talking about bodies and really inappropriate advice is shocking and we've got a lot of work to do so I hope I'm preaching to the converted but there are clinical guidelines that NADC launched last year on the management of eating disorders in people with higher weight and that comes from a weight stigma lens just saying this is harmful what's happening so really encourage you to have a read through that and use the resources but I think something came up that was quite similar across the groups is that sense of control that sometimes there's a lack of control there's an attempt at controlling food or exercise and those sort of things when other things seem to be out of control again so the importance of looking at the entire person and digging deeper than just saying okay this person might have been eating disorder really like what you said and you've got to actually get down deeper and say what's the experience for him why is this happening and what's important was how do we support someone to share their experience with us but also those people that are closer to them you know how do we support them to share with their partner that they might be binge eating because that can be a really difficult conversation some of the I'm going to kind of try and summarise in a few minutes just some of the key things that came out the idea of engaging with supports and creating connection is absolutely vital no matter who is sitting in front of you that in all of the vignettes there were episodes of feeling isolated so there was comment around COVID being gone COVID hasn't gone I've just recovered myself after having 10 days in bed definitely hasn't gone but lockdowns have gone so but we can think about isolation through COVID and how much that impacted on people's lives but also now that we're not lockdown necessarily but how we can really support someone to remain connected with their community and with their culture with their interests and activities and that's a really key role that we would do across diagnostic presentations not just eating disorders so using our normal clinical skills we can really focus on that and I think that's a skill doesn't matter what profession you are under the mental health umbrella we can all do that sort of work something I think that was in your room something kind of around the cultural aspect of eating which I think was absolutely beautiful and something I hadn't thought about before like you know eating foods that are relevant to your culture can just bring about that sense of belonging and identity and we're connecting a person to their community and their background through that process of eating so eating has just so much importance in people's lives so we can be thinking about that then I guess the care team I think that I mean all of the messages were around we need a care team in this the care team is mental health and medical at the minimum but we need to be thinking about you know the broader connections with the community and if you're not the best place person because of the role that you're in some services are limited in what you can provide then really thinking about what other services might be able to support a person to just remain connected connected and having the supports included and engaged in the treatment are the most important things my brain's got so many different thoughts swirling around thank you so much moderators that was absolutely brilliant and I hope that the 500 plus people here today have learnt a lot from the sessions and as I said encourage you to go back to the vignettes and have a look at those that were presented in the other groups really really quickly I'm just sharing my screen again all of the resources they will be provided to you we've talked about encourage please read the management of eating disorders in people with high weight and spread the word I'm trying to share screen coming up there's an eating disorders networking hub tomorrow at 10am really encourage you to join that connect with other people in this space this shouldn't be a lonely slog no there are so many people joining the eating sort of sector and we realise that eating disorders are not a specialist thing it's something that we all have the skills to be able to do and I hope that the information we've provided you today provide you know has increased your confidence and willingness to do this work and that the resources we provide you and the connections will help you after that there is also a hypothetical live from 7pm isn't it standard daylight savings time and please check the schedule there so much happening in the next couple of days and hopefully we'll cross paths again thank you for joining it's one minute to five I believe we've landed on the mark here before you log off if you could please complete the feedback survey by clicking on the survey tab on the right hand side really important for us to receive feedback for MHPN to receive feedback on this style of workshop have a lovely evening lovely afternoon to everyone in WA and look forward to seeing you in the next couple of days