Overview

The Royal Children’s Hospital Eating Disorders (RCH ED) Service provides clinical management to patients with:

• anorexia nervosa
• atypical anorexia nervosa
• other restrictive eating problems

The RCH ED Service is specifically for adolescents and their families living in the North Western Metropolitan Region.

Like other mental health services in Victoria, eating disorder services are regionalised to ‘catchment areas’. The State Government mental health services website provides contact details for Victoria’s regionalised mental health services and the suburbs and regions they cover. Use this tool to find the public mental health service for your residential area:

Referrals

General medical practitioners (GPs) can make referrals to the RCH Eating Disorder Service via the RCH Specialist Clinics referral process and faxed to (03) 9345 5034.  

Referral for the RCH Eating Disorder Service should include:

• The adolescent’s vital signs; including lying and standing blood pressure and lying and standing heart rate
• Current weight, amount of weight lost and rate of weight loss
• Brief description of concerns and behaviours around eating. 

When the referral is received by the Eating Disorders Service, the Clinical Nurse Consultant for Eating Disorders will contact you (the family) to discuss the referral and the ask some preliminary assessment questions

Enquiries

Contact the Clinical Nurse Consultant for Eating Disorders on (03) 9345 6533.

The Service

The RCH ED Service is family focused, evidence- based and has three main components:

• Multidisciplinary assessment
• Outpatient treatment
• Inpatient management

Care is integrated across acute health, mental health, outpatients and inpatients. The Service is a multidisciplinary collaboration between the Department of Adolescent Medicine, Centre of Adolescent Health and RCH Mental Health, working closely with the Department of Nutrition and Food Services and the Adolescent Inpatient Unit (Kelpie).

Multidisciplinary assessment

A multidisciplinary team comprising a psychiatrist, paediatrician, mental health clinician, clinical nurse consultant and dietitian provides a comprehensive assessment of an adolescent thought referred for concerns about a possible eating disorder. All referred adolescents and their parents (or primary carers) participate in structured eating disorder focused interviews, as well as other interviews focussing on mental health as part of this assessment. This contribute to both the assessment and ongoing evaluation of the Service. If there is a diagnosis of anorexia nervosa, or restrictive disorder, a treatment plan is formulated and communicated to the adolescent and family.

Family based treatment

Outpatient management is by Family Based Treatment (FBT). Also known as Maudsley Approach, FBT has the strongest evidence base for the management of anorexia nervosa. Treatment is provided by FBT trained mental health clinicians, who consult with the other members of the multidisciplinary team. The FBT team receive regular supervision from Professor Daniel Le Grange, an internationally recognised expert in adolescent eating disorders.

FBT runs for approximately six months with parents (or primary carers) required to attend each appointment.

The treatment comprises 3 phases:

• Phase 1: Re-feeding the young person
• Phase 2: Gradual handing back of responsibility to young person
• Phase 3: Addressing adolescent developmental concerns and termination

The goals of FBT are:

• Restore physical health
• Return to independent eating
• Resume normal adolescent development

Where necessary vital signs and physical wellbeing will be monitored by the clinical nurse consultants of paediatricians. The aim is to help the whole family come together to assist the adolescent with the eating disorder to regain their health and control over their life. 

Inpatient management

Inpatient admission is not a routine part of treatment in the RCH ED Service. However inpatient admission may be required during the course of outpatient treatment for patients who become medically unstable. On occasion patients who are particularly unwell are admitted directly from the assessment clinic or via the Emergency Department. Where possible patients will be admitted the Kelpie Adolescent Inpatient Unit.

The ‘Inpatient Management Protocol’ provides for consistent quality care to inpatients with eating disorders and works through several stages of recovery. Once recovered the adolescent and their family will return to, or commence, outpatient management or care of their GP. Patients admitted via the Emergency Department from other mental health regions will be returned to the treating team in their region after discharge.

Clinicians and organisations

The Royal Children’s Hospital is committed to consistent quality care for children and adolescents Statewide. The RCH Eating Disorders Service can support this, where practicable, by providing to other eating disorders services:

• Secondary consultation
• Team visits
• Education and supervision

Treating teams from other mental health regions - either mental health or medical - can contact the RCH ED Service for advice on management of patients and families who are struggling. The RCH ED Service will sometimes take on the care of ‘out of region’ patients and families as negotiated with the treating team in the region. Contact Michel Yeo on (03) 9345 4985. Michele is paediatrician with a specific interest in anorexia nervosa, a clinical lead of the Service, and part of the adolescent medicine team.

Agencies planning to develop or improve their own service to eating disorders patients are invited to contact the RCH ED Service to arrange a visit to the RCH site and learn more about the Service. Contact Martin Pradel on (03) 9345 7912. Martin is a social worker, clinical lead for the FBT group, and has extensive experience facilitating eating disorders service development

Resources

Eating Disorders Victoria
The Butterfly Foundation  
Feast-ed
Resource List
Printable FBT Information Sheet

Research and evaluation

To provide great care to children and adolescents with anorexia nervosa and restrictive eating disorders the RCH ED Service team will be undertaking and evaluation of the service. This evaluation will involve collecting information about the health and wellbeing of patients when they are first seen at the service and then at regular follow up periods. The team will then be able to see if improvements to the Service are having the desired impact.

The RCH ED Service also collaborates with the University of Melbourne eating disorders research programme on a number of projects. The collaborative team recently completed a randomised controlled trail into two forms of family based treatment.

To find out more about the research have a look at the current research projects through the RCH Centre for Adolescent Health.