Evaluation enlivens East Kootenay Eating Disorder Program

“The evaluation gives very specific, tangible jobs that need to be done, and an actual working roadmap for the next five years on how to make the program better. It keeps the clinic vibrant.”

After five years of apparent success with the East Kootenay Pediatric Outpatient Eating Disorder Program, family physician, Dr Cecile Andreas, and the eating disorder clinical team wondered if there might be room for improvement.

The team was proud of the local model it had created, in which pediatricians, dieticians, family physicians and Ministry Child & Youth Mental Health (CYMH) clinicians regularly meet in the same room, with the patient and their home support person, to ensure that everybody hears the same message at the same time.

Relationships developed through the work of the East Kootenay Local Action Team of the Shared Care Committee’s Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative, spurred the development of this innovative outpatient program. A key focus was to work together to build a local team of experts to support patients struggling with eating disorders, recognizing the negative impact of families having to travel to Vancouver for treatment.  

The program has been successful in this respect, with fewer patients now having to make that trek, and although some still need hospital stays, they’re now shorter and usually happen locally.

A quest for feedback

These results are positive, but a formal evaluation was seen as a need. “Because the clinic started up quickly and got busy so fast, there was no structure or hierarchy to evaluate its success and shortcomings," says Jennifer Westcott, a clinician and regional team leader for CYMH.

So in the late summer of 2020, the program hired consultant Laura Cain to conduct an evaluation with funding from Shared Care.

Research prompts revelations

Ms Cain interviewed youth, caregivers and health care providers connected to the ED program, as well as all the division’s family physicians, and compiled the results in a report called HealED Together: Evaluating the East Kootenay Pediatric Eating Disorder Program.

The report revealed, among other positive feedback, that patients and their home supports truly appreciate the quick, intense response and the high-quality, specialized service offered by the EK Eating Disorder Clinic.

“That was really encouraging for us,” says Dr Andreas. On the other hand, she says, “One of the things we heard from patients was how daunting it is to walk into a room full of people you don’t know. That, to me, was just a reminder that unless you’re on the receiving end of the service, you really don’t understand how it feels. .

Jennifer Westcott says the team also learned that it needed to work on “consistency of practice", such as using a shared template where everybody enters the same information over time. This means every member of the team is looking at the same data and watching the same trends.”

What is working well

With eating disorders requiring multiple care providers to address complex physical and mental needs, a well-functioning team is key. The report highlighted the benefits of the collaborative approach:

1. A collaborative approach cuts down on appointments - Patients and their families are relieved of the stress of making and attending numerous appointments. One appointment every two weeks covers all the bases.
2. Everyone’s on the same page - Meeting together means each team member understands the particular focus of each patient’s treatment.
3. Teamwork is lighter, brighter - Seeing patients collaboratively decreases the team members’ personal workloads and allows them to learn from one another.

Opportunities to improve

The report also revealed some gaps. It noted that:

1. Patients are apprehensive before their first appointment - They need to be told explicitly what to expect.
2. They don’t find the room friendly - The team needs to create a warmer space.
3. Every patient is different - The program’s family-based approach is not always appropriate, despite it being recognized as best practice.
4. Outside the clinic, support can be scarce - Some of the community’s most vulnerable youth who need treatment don’t have a supportive caregiver.
5. At-home help might be necessary - Some patients could use in-home assistance.
6. People crave peer support – Peer support groups for youth, caregivers and family members would be beneficial.
7. Indigenous youth are not being served - Indigenous youth seldom engage with the program, the reasons for which aren’t clear. 

Looking to the future

After the evaluation, team members met for a brainstorming session with representatives from the Primary Care Network (PCN) and Physician Quality Improvement (PQI). The group came up with Quality Improvement ideas that have been developed into a diagram listing priorities and next steps, and local pediatricians and family physicians have already produced an interactive brochure which jclearly illustrates the program and treatment available for patients and their caregivers.

Westcott summarizes the evaluation process for the program and all involved:

“The evaluation enlivens us again – we have work to do, and it looks like great work.”

Contact

Jacqui van Zyl, Program Manager
East Kootenay Division of Family Practice
jvanzyl@divisionsbc.ca