Background: Managing acute food refusal is one of the most challenging clinical dilemmas for clinicians working with clients with eating disorders. Effective clinical management of these dilemmas requires close coordination of the medical, nutritional and psychological priorities. This workshop, led by a physician and psychologist, explores the pathophysiology of acute starvation, outlines important markers for level of care decisions, and reviews specific behavioral and interpersonal strategies for building and maintaining commitment and consensus with treatment teams, clients and their families.
Objectives: Following this presentation, participants will be able to identify the physiological markers of nutritional and medical instability that necessitate higher levels of care Following this presentation, participants will be able to utlilize a graduated sequence of behavioral, familial and interpersonal strategies for building motivation and treatment adherence Following this presentation, participants will be able to explain ways that medical and behavioral clinicians can effectively collaborate in the management of food refusal by clients at different levels of care
- Introduction 5 minutes
(Bunnell and Jahraus)
2.Pathophysiology of immediate starvation/dehydration 10 minutes
(Jahraus)
3. Clinical Crisis as Window of opportunity 10 minutes
Tolerating the Anxiety Associated with Food Refusal
Balancing Medical Risk with Clinical Opportunity
Building a Safety Net
(Bunnell)
4. Level of Care Decisions 10 minutes
Using Medical and Motivational Markers to Evaluate Level of Care Needs
Transitioning from Outpatient to PHP Level of Care
Transitioning from PHP to Residential Level of Care
Markers for Inpatient Treatment
Urgent Action Markers
Setting Timelines for Change based on medical and motivational markers
(Jahraus)
5. Developmental Considerations in Managing Food Refusal 10 minutes
Adolescent
i. Medical and physiological markers
ii. Family involvement
iii. Assessment of psychiatric co-morbidity and cognitive capability
Adult
i. Medical and Physiological Markers
ii. Support System
iii. Assessment of psychiatric co-morbidity and cognitive capability
(Jahraus and Bunnell)
6. Building Consensus and Establishing Priorities 5 minutes
Treatment Team
Family
Prioritizing Treatment
Minimizing Splitting
Peers and Others Supporters
(Jahraus)
7. Behavioral Interventions 15 minutes
Gentle and Firm
Rewards
Limits
Establishing Non-negotiables
Creating Crisis
Using the Treatment Team
Using the Family
Using Peers and Other Supporters
Phrases and Things to Say
i. Medical
ii. Psychological
(Bunnell)
8. Sustaining Optimism 5 minutes
Speaking the Truth
Maintaining Long Term Perspective
"It's Just What You Need Right Now"
Treatment Fails the Client/Family
(Jahraus and Bunnell)
9. Avoiding Team Burnout 5 minutes
(Jahraus and Bunnell)
10. Discussion and Questions 10 minutes
(Jahraus and Bunnell)
These strategies provide a framework for a clear understanding for the clinical team, the client and the family about markers for transfer to a higher level of care. They also reinforce to the client and family the need for comprehensive treatment across the full continuum of care.
This workshop, led by a physician and psychologist, explores the pathophysiology of acute starvation, outlines important markers for level of care decisions, and reviews specific behavioral and interpersonal strategies for building and maintaining commitment and consensus with treatment teams, clients and their families. The final section addresses strategies for avoiding burnout and for sustaining therapeutic optimism for clients and their families and for the clinical teams.
Professional Experience: 2016-present Chief Clinical Officer, Monte Nido & Affiliates 2013-2016 Chief Clinical Development Officer, Monte Nido & Affiliates 2012- 2013 Vice President, The Renfrew Center Foundation 2007- 2012 Vice President and Director of Outpatient Clinical Services, The Renfrew Center Books: Maine, M., McGilley, B., & Bunnell, D. (Eds.). Treatment of Eating Disorders: Bridging the Research Practice Gap. London: Elsevier, 2010 Articles: Bunnell, D.W., Shenker, I.R., Nussbaum, M.P., Jacobson, M.S., & Cooper, P.J. Subclinical versus formal eating disorders: Differentiating psychological features. International Journal of Eating Disorders, 1990, 9, 557-562. Bunnell, D.W., Cooper, P.J., Hertz, S., & Shenker, I.R. Body shape concerns among adolescents. International Journal of Eating Disorders, 1992, 11, 79-83. Awards: National Eating Disorders Don and Melissa Nielsen Lifetime Achievement Award, 2010
Dr. Joel Jahraus, CEDS, Fellow AED, joined the Oliver-Pyatt Centers team in May 2012 as Medical Director, becoming Chief Medical Officer for Monte Nido and Affiliates’ national network in June 2016. A graduate of Washington University Medical School, Dr. Jahraus practiced primary care medicine several years before becoming Associate Director, University of Minnesota Family Medicine Residency Program, then became a Pre-doctoral Director, University of Minnesota Medical School, receiving the Distinguished Teacher of the Year Award. He co-authored a chapter on eating disorders in the Textbook of Psychosomatic Medicine 2010, published by APA, and a chapter on medical complications in The Treatment of Eating Disorders (Grilo and Mitchell 2010). Named a US News and World Report Top Doctor, he has been featured in two national ED documentaries, served as the NEDA help line consultant, is on the iaedp Board of Directors, and chairs the Medical Certification Subcommittee.
