Academic journal article Journal of Multidisciplinary Research

Coordination of Care and Early Adolescent Eating Disorder Treatment Outcomes

Academic journal article Journal of Multidisciplinary Research

Coordination of Care and Early Adolescent Eating Disorder Treatment Outcomes

Article excerpt

Introduction

Eating disorders are biopsychosocial disorders that involve a collection of behavioral symptoms intended to lead to weight maintenance or weight loss and psychological symptoms that typically include guilt and shame about body shape, fear of weight gain, difficulties with emotion regulation, and perfectionism (Eating Disorders Association, 2013). Evidence suggests that the lifetime prevalence estimates of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) have risen to 0.3%, 0.9%, and 1.6%, respectively (Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011). Community studies have reported significantly greater prevalence rates of disordered eating behaviors in children and adolescents (e.g., Dorian &. Garfinkel, 1999; Jones, Bennett, Olmsted, Lawson, & Rodin, 2001; Lucas, Beard, O'Fallon, & Kurland, 1991) with a significant percentage of children presenting with AN and BN symptoms at less than 12 years old (Madden, Morris, Zurynski, Kohn, &. Elliot, 2009; Zhao &. Escinosa, 2011). This pattern is particularly alarming given the sensitive nature of this developmental period when neural advancement, physical growth, and psychological maturity change substantially and rapidly (Royal College of Psychiatrists, 2001; Roze, Doyen, Le, Armoogum, Mouren, &. Léger, 2007; Sweene & Thurf)ell, 2003).

Anorexia is the third most common chronic disorder among adolescents (Gonzalez, Kohn, & Clarke, 2007; see Herpertz-Dahlmann, 2015, for a review). Clinical practice guidelines (e.g., Hay et al., 2014; MH-Kids, 2008) and position statements (e.g., Golden, et al., 2003; Ozier &. Henry 2011; Rosen, 2010) from a variety of disciplines across the world recommend managing restrictive eating disorders with a multidisciplinary team, which has been a standard of practice for the last three decades since the goal of treatment involves improving both physical and psychological functioning (e.g., Becker, 2003; Lock, Le Grange, Agras, &. Dare, 2001). The majority of authorities on eating disorders recommend the treatment team consist of three core disciplines: medical, nutrition, and mental health (Rosen, 2010; Rome et al., 2003; Walsh, Wheat, & Freund, 2000), including other providers, such as psychiatry and social work, on an individual basis.

However, care coordination (i.e., the deliberate collaboration between two or more providers to facilitate care activities for a patient; McDonald et al., 2007), is much harder to measure and document than simply if patients' care is multidisciplinary. Dejesse and Zelmann (2013) interviewed providers to examine the nature of collaborative relationships between mental health professionals and nutritionists in the treatment of eating disorders, with several themes resulting, but did not address the impact of this relationship on patient care. A recent study suggested that a team approach for college students with eating disorders facilitates the extent to which they participate in treatment (see Mitchell, Klein, &. Maduramente, 2015), but little is known about how the level of regular communication among providers impacts patient outcomes (e.g., weight change, level of psychological distress), especially in the adolescent population.

Close care coordination is the standard of care in treating those with restrictive eating disorders (e.g., American Psychiatric Association 2000, 2012; Sylvester & Forman 2008); therefore, it is important to understand better which models of care coordination among providers are most effective. One proxy for care coordination is the proximity of providers to one another. For example, providers working within a single clinic with twice weekly meetings dedicated to care coordination face significantly fewer barriers to effective and timely communication chan do providers working in different locations who do not have regularly scheduled contact with each other. Comparing these two groups in terms of early treatment outcomes would improve our knowledge of how to best structure care in the community to maximize its effectiveness. …

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