Reprinted from "Eating Disorders" issue of Visions Journal, 2002, No. 16, pp. 32-33
Since the inception of the Kelowna Eating Disorders Program (EDP) in September 1999, approximately 180 referrals have been received for adults in the Central Okanagan and for youth (under 19) in the Central and South Okanagan. The program mandate is to provide outpatient assessment and treatment to clients who have been diagnosed by their physicians with anorexia nervosa, bulimia nervosa, or eating disorders not-otherwise specified (excluding binge-eating disorders).
The Program has undergone a number of exciting changes in the last three years. Most recently, we were fortunate to have Dr. Mike Ocana join our team, two mornings per week. Dr. Ocana comes to us from Ontario and specializes in child and adolescent psychiatry. Prior to entering medical school, he had a nutritional science background, and has a special interest in eating disorders. He will see clients of all ages within our program.
In terms of service delivery, for the first two years we offered mainly individual therapy, family therapy, nutritional counselling and nutritional psychoeducational groups. Earlier this year, our waitlist for all services had escalated to unmanageable proportions. So, with the assistance of our senior management, consultations with the Provincial Eating Disorders Advisory Committee, and some creativity, we were able to re-design our program to offer more timely service.
Background to Waitlist Problems
The process of recovery for eating disorders tends to be lengthy and variable. For bulimia nervosa, recovery averages 3 to 5 years. With anorexia nervosa, recovery averages 7.5 to 10 years2,5 or as long as 10-15 years.3 Because of the protracted nature of recovery, clients who are newly diagnosed and/or seeking treatment tend to engage in our outpatient program for at least 1 to 2 years, sometimes longer. Thus, our time for individual and family therapy became scarce, with new clients having difficulties accessing those services.
The life-threatening nature of eating disorders demanded creativity in reducing our program’s waitlist while functioning within a fixed operational budget of having very part-time staff (1.7 FTE) that serves a geographical population of almost 300,000. We continue to be reminded that anorexia nervosa has the highest suicide rate,4 and mortality rate1 of any other psychiatric illnesses. Therefore, it is potentially dangerous to have clients on waitlists unless various safety measures are in place.
Increasing Accessibility via Use of Groups
Because some clients had been waiting for a year without being able to access therapy, in May 2002, we initiated group therapy for adults to replace individual therapy. Approximately 12 of the 21 women who were on our waitlist for individual therapy agreed to participate in this group. Of that group, approximately six women attend on a regular, weekly basis. Since it’s designed to be an open, ongoing group, newly-referred clients are able to access group therapy services immediately after assessment (if appropriate). Although a significant percentage of clients were reluctant to join the group, taking time to understand and help them process their fears, and using a trial approach seemed to help. As well, monthly individual check-in sessions are offered to those engaged in group therapy. Having a core group of women attending regularly for the past four months has offered strength and stability to this ever-evolving group.
The waitlist for family therapy in our program was just as dismal. Families often need education prior to starting family therapy. So, recently, the ‘Why Weight?’ parent and teen psychoeducation group was initiated as a pre-requisite to family therapy, and five families agreed to this process. This bridges the gap between the time spent waiting for family therapy while offering support in an educational forum. Family therapy has also been reduced to a biweekly format in order to accommodate more families.
Individual nutritional therapy with Linda Trepanier is also a resource with great unmet need, given the one day per week funding. Linda has been running a “Why Eat?” nutritional psychoeducation group for clients and their families. This group has played a pivotal role in our program’s ability to offer “some” service during the time when our waitlist for individual and family therapy had been so lengthy. This five week group series also reduces the amount of time Linda spends in education and frees up more time for counselling in the individual sessions. ‘Continuing Connections’ is another group for adults with eating disorders, specially designed to address quality of life issues. Motivational enhancement is the key approach within this group. Individual therapy continues to be offered to teens on a more intensive basis, i.e., once per week, while adults attending groups are seen once a month.
The waitlist for the Kelowna Eating Disorders Program has been dramatically reduced to the point where clients wishing to access services are waiting a maximum of four weeks for assessment and treatment. Although there was much resistance from our clients (and sometimes ourselves) toward the idea of ‘group,’ it has proven to be effective in offering a more timely and diverse menu of services. Although there may be approximately 20-30% of clients who refuse group services, the majority of clients are reaping the benefit. Other service challenges remain related to lack of funding for meal support, day programming, and case management workload. Thanks to all those who supported us in this process.
About the authorMary is the Program Coordinator and Nurse Specialist of the Kelowna Eating Disorders Program. She recently completed a thesis study, Recovery from Anorexia Nervosa: Becoming the Real Me
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