Hybrid approach enables continued care for young patients with eating disorders

For adolescents and young adults with eating disorders, life can feel like a roller coaster ride of emotions. Imagine what it would feel like if the guardrails supporting you through that bumpy ride suddenly disappeared? How would you hang on?

The coronavirus outbreak left young patients of the Comprehensive Eating Disorders Program (CEDP) — and their parents — struggling with that fear as stay-at-home orders prevented them from receiving in-person treatment and group therapy sessions.

“I was concerned my son would have to leave the eating disorders program due to COVID-19,” said the parent of a teenager diagnosed with Avoidant Restrictive Food Intake Disorder (ARFID). The CEDP staff had been working with the family to restore his dangerously low body weight and extremely limited diet.

CEDP’s treatment team of approximately 20 staff members (social workers, physicians, nurses, behavioral health technicians, administrative staff, a psychologist, a dietitian, etc.) were equally concerned. Although they could no longer offer Michigan Medicine’s unique partial hospitalization program (PHP), the treatment team “met” multiple times a week via Zoom with each patient and their families throughout the height of the outbreak.

The move to virtual treatments was an immediate relief for patients and family members.

“I have been amazed at how incredible our video appointments have been,” added the parent of the teenager diagnosed with ARFID. “It was super easy to connect with our providers right through the U-M Health app. I can honestly say I don’t think we would still be successfully in our treatment if we were not able to receive this incredible support.”

The importance of finding a solution

“There is a significant lack of eating disorder specialty providers in Michigan,” said clinical social worker Alexis Sears, LMSW. “If CEDP was unable to see patients, many with eating disorders would go without care. This would be detrimental for our patients’ physical and psychological health, especially since many are immunocompromised and medically fragile.

Sears said it was also vital to keep up with treatment in order to assist colleagues on the front-line during the pandemic.

“Our treatment helps to reduce the risk that our patients might later require emergency or inpatient care,” Sears said.

That would ensure Michigan Medicine could commit as many resources as possible to COVID-19.

Going hybrid

While patients and families were generally accepting of virtual care, the team recognized the importance of social elements of the program, especially among their patients, aged 8-22, who can be more susceptible to the difficulties of social isolation. Therefore, as Michigan’s phased restrictions began to lift, the treatment team developed a hybrid model of care including virtual care, in-person visits and socially-distanced group therapy.

Before COVID-19, patients came to the hospital in person for regularly-scheduled treatment days, which included meal support sessions, group therapy, family sessions, and appointments with an adolescent medicine provider and psychiatrist. Now, families are seen in-person for their first three weeks of treatment before switching to virtual care.

“The goal is to equip parents with the education and skills to feel confident managing their child’s eating disorder at home,” Sears said.

“Initially, we were concerned that the more intense therapy and monitored care would not be enough to allow for continued progress at home, but our team has not let this happen,” said a parent of an adolescent with anorexia nervosa, an eating disorder characterized by low body weight and a fear of gaining weight. “As the eating disorder evolves, the CEDP has been there every step of the way to discuss and develop a treatment plan for our daughter.”   

In addition to virtual care and in-person treatments, group therapy commenced once again, though in line with social distancing guidelines, group sizes had to be reduced.

“Group therapy is an important part of healing from an eating disorder,” Sears said. “It helps our patients connect with other patients so they understand that they are not alone. Group therapy sessions also help parents and caregivers feel encouraged and supported during a very difficult time.

“These groups are even more critical now as our families go through life-saving treatment while also navigating stressors related to the COVID-19 pandemic.” 

Take action: Support tips for families 

It is normal for people to experience changes in their appetite during stressful times. Read these tips to identify and help children or young adults who may be struggling with eating disorders.

Keep in mind people of all ages may be impacted as well.

• What might an eating disorder look like? Turning to food as a way to cope with stress may involve:
  • Cooking/eating too much “comfort food” 
  • Eating less than usual
  • Eating more than usual
  • Changing an exercise regime
• If you notice a change, have a conversation with your child or teenager. Approach the conversation with curiosity and without judgment. For example, you might say: “I haven’t seen you eat breakfast recently. Has your appetite changed?” or “I’ve noticed that you seem more hungry lately. Have you noticed this too?”
• Be mindful of what social media your child is consuming. What are they posting or reading? You may find information about their internal world that they may not be verbalizing to you. Additionally, social media can be a source of misinformation about diet/exercise, and can trigger body shaming.
• If you notice your child is more concerned or preoccupied with their appearance or body shape/size, check in with them. 
• To learn more, the National Eating Disorder Association (NEDA) is a great resource. Families can also contact CEDP for more information and resources.