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Development of an evidence and values based eating disorder service:
the HSE approach
Irish National Eating Disorder Conference
February 23th 2018:
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
Dr Sara McDevitt,
National Clinical Lead for the HSE Clinical Programme for Eating Disorder
(...a new hope)
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Learning objectives
• Model of care development
• Key recommendations
• Implementation and next steps
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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HSE Clinical Strategy and
Programmes Division
• Design and planning improvement; not operations
• ~33 clinical programmes– Mental Health Programmes
• Eating disorders
• Early onset Psychosis
• DSH in emergency department
• Dual diagnosis
• Adult ADHD
Dr Sara McDevitt: HSE National Clinical
programme for Eating Disorders
Severe
Frequent >>>>
Highest
Risk
Eating disorders
√ Quality
√ Access
√ Value
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‘Here is Edward bear,
coming downstairs now, bump, bump, bump, on
the back of his head behind Christopher robin. It is,
as far as he knows, the only way of coming
downstairs, but sometimes he feels there really is
another way, if only he could stop bumping for a
moment and think of it’
Winnie the Pooh, A.A. Milne
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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What is quality?
Clinical presentation
Patient values
and actions
Expertise/ evidence
base
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
Evidence
+
Values
=
Expertise and
quality of care
Coulter et al,
Kings fund 2011
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360 degree perspective
‘Self lens’:
Clinicians on Working group and service
data
Evidence based lens
External lens
Peer
Patient lens:
Bodywhys
Our Strategy
Clinical Advisory Group
CPsychI
Integrated care consultations•acute medicine
•paediatrics
•Palliative care
•Emergency medicine
(provisional : primary care)
Evidence base•28 BPG/ SR/ META.
• Level 1 literature
review
Dr Sara McDevitt, HSE National Clinical Programme for Eating Disorders
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Patient lens and values
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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Evidence lens
Highest mortality and morbidity in
mental health (Arcelus, 2011)
Early intervention works
Evidence based approaches can double
remission rates
TAU ; more expensive, less effective and less satisfaction (Gowers,
2007)
Outpatient setting superior to inpatient
for most people
Expertise requires lots of case work
(NHS, 2015, RCPsych)
Physical risk monitoring saves
lives (RCPsych 12,15,
AACAP, 2015, NICE, 2017)
Low uptake /access to services- trust/
stigma
(Butterfly foundation, 2012, McNicholas)
Huge socioeconomic and psychosocial cost
(B-EAT, 2012 & 2015 Butterfly foundation. 2015)
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Programme themes and values
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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KEY RECOMMENDATIONS
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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1. Stepped care model
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
]New developments
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2. National Eating Disorder Network
• Coordinated through 8 regional eating disorder Hubs
• 16 additional dedicated eating disorder teams– multidisciplinary
– 8 adult; 8 child and adolescent
– Outpatient, group and day programmes
• Up skilling for existing teams
• Dedicated inpatient programmes– 4 adult
– 5 child and adolescentDr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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Access
Service optionsED teams: 11-12 clinicians per 600,000
Core team
• Psychiatrist
• Trained therapist (senior)
• GP
• Access to dietetics if
needed
• Access to medical/
paediatric if needed
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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3. Integrated care
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
Led by the ED teams
Local;
✓MARSIPAN and clinical
pathways
✓Single point of contact to
ED team
✓Keyworker
✓Outreach to MHS
✓In-reach to hospitals
✓Quarterly development
meetings
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4. Eating Disorder training
programme
• ED teams• Interprofessional training model
• Comprehensive training curriculum and programme
• CPD
• MHS• FBT/ CBT-E group supervision
• National update days
• From the ED teams to their Hubs
• The wider system• Medicine, paediatrics- MARSIPAN/ Induction
• Primary care
• Postgraduate and undergraduate training bodies
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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5. Evaluation
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
Service activity
•e.g. Admissions, Access times
Clinical recovery
and outcome
Quality
Patient experience
•Routine and continuous
evaluation
•Evaluation model will
be reviewed each year
•Model of care has a 3
year review period
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OUR NEXT STEPS
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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5 year Implementation plan
Recruitment
• Recruitment of 3-4 teams per year
• 3 teams funded in 2017- in recruitment
Training
• Specialist ED team- curriculum and training programme
• MHS- supervision networks and update days
• Broader health service- MARSIPAN, GP programme, induction
• Bodywhys
Change management
• Sharing the vision, identifying champions, and building coalitions
• Collaborative care pathways- transitions, MARSIPAN
• Joint resource development
Improving understanding
• Evaluation and audit
• Body whys
• Specific clinical areas of focus
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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Model of care collaboration...HSE
Working GroupDr Sara McDevitt
Rhona Jennings
Dr Margo Wrigley
Dr Caroline Maher
Prof Elizabeth Barrett
Cheryl Comiskey
Caroline Larmer
Dr Aileen Whyte,
Jacinta Hastings (Bodywhys)
Dr Brendan Doody,
Deirdre Dunne,
Aine Furlong,
Mary Harron
Dr Ed O Mahoney
James Lynch,
Anne Brennan,
Rachel Gibson
Eilish Smyth
Maeve Sweeney,
Clinical Advisory
Group (CPsychI)HSE CSPD
Philip Dodd (NCAGL- Mental Health)
Prof Alf Nicholson (NCAGL Paediatrics)
Grace Turner
Dr Gary Courtney (NCL Acute Medicine)
Dr Yvonne Smith (NCL Acute Medicine)
Blathnaid Connolly,
Dr Karen Ryan (NCL Palliative Care)
Breda Naddy,
Dr Gerry McCarthy (NCL Emergency Medicine)
Other advisorsDr Aoife O Sullivan (Primary Care)
Dr Caitriona O Malley
Prof Fiona McNicholas
Dr Therese Thornton
Dr Aisling Campbell
Dr Terence Larkin
Dr Aideen Moran
Dr Caroline Maher
College of Psychiatrists
of Ireland
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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Further information
Our web page (Model of care information):
https://www.hse.ie/eng/about/who/cspd/ncps/ment
al-health/eating-disorders/moc/
HSELIVE (for service queries):
https://www.hse.ie/eng/hselive/
Ph: 1850 24 1850
Dr Sara McDevitt, HSE National
Clinical Programme for Eating Disorders
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HSE National Clinical Programme
for Eating Disorders
Dr Sara McDevitt, HSE National Clinical Programme for Eating Disorders