Share & Learn! CAPP Learning Collaborative Newsletter

Share and Learn! CAPP Learning Collaborative

Newsletter for School and

School Based Health Center Partners

Welcome to our Second Edition!

What is this newsletter? The University of California San Francisco (UCSF) Benioff Children’s Hospital Child and Adolescent Psychiatry Portal (CAPP) Learning Collaborative is happy to share our second newsletter for School and School Based Health Center (SBHC) Partners! This effort is inspired by our time-limited funding opportunity with La Clínica de la Raza to support care coordination, consultation, and training in SBHCs.

Why am I receiving this newsletter? We are inviting all members the La Clínica de la Raza SBHC team to receive our newsletter series. We also are hoping to expand this newsletter audience to school and SBHC partners across California. Please feel free to forward the newsletter so potential readers can subscribe! Anyone preferring to unsubscribe may select this option at the bottom of this page.

How did you select the focus of this newsletter? In the fall of '21, we met with La Clínica SBHC staff to learn about pressing needs currently facing our school communities. Overwhelmingly, we heard a concern about Eating Disorders and appropriate resources for diverse youth throughout our communities. In response, we developed this second-edition of our newsletter with Eating Disorders resources and education. We look forward to your feedback and hope to be in touch soon!

Case Example: Eating Disorders

"Danny" is a 15 year old, cisgender boy who lives with his mother in Oakland. His family identifies as Latinx, and Danny identifies as pansexual. Danny became a vegetarian when he was 12 years old, describing his concerns about animal welfare. When he was 13 and the pandemic hit, he found himself at home with more time to do the online workouts that he had been thinking about. At his well child check later that year, his pediatrician, Dr. X, noted that he had lost 20 pounds over six months, though his BMI fell within the "normal" range. Dr. X discussed their concerns with Danny's mom, who noted that Danny had been doing a great job cutting down on many "junk" foods he had enjoyed previously, such as sweets, chips, and starches like rice and bread. He had also begun exercising more regularly, even waking up early to work out in his room before school.

Dr. X shared Danny's growth charts with his mother, explaining that weight loss carries serious health risk, including to the heart and bones. Dr. X also explained that eating disorders are one of the most deadly of the psychiatric disorders, and it is important to understand whether Danny may have one so that he can get treatment as quickly as possible (given that early intervention is predictive of later recovery). Danny's mom wasn't sure that she shared the pediatrician's concern that the weight loss was problematic, but she accepted a referral to an eating disorders specialty clinic in order to learn more. She also agreed with Dr. X's recommendation to ensure that Danny has 3 meals per day and several snacks, including all of the foods that Danny's family usually eats.

At the specialty clinic, Danny was diagnosed with Atypical Anorexia Nervosa (a disorder in which all of the criteria for Anorexia Nervosa are met, except that despite weight loss or failure to gain weight as expected as part of normal growth, the individual's weight is above the "underweight" category when compared with BMI cutoffs).

Danny was referred for Family Based Treatment, the leading treatment for adolescent eating disorders. His therapist worked with him and his mother to normalize his eating patterns, increase his nutrition, and restore his weight. At discharge from care, he had return to his previous growth trajectory and reported few worries about his weight and shape.

Clinical Pearls

Eating Disorder Prevalence, Presentation

and Service Utilization Across Diverse Groups

Eating disorders impact about 10% of the population and usually onset in the teen years
About 25-40% of those with eating disorders are male-identified
While some with eating disorders state thinness as a goal, some may state muscularity or other appearance-related goals (e.g., desire to look more or less masculine or feminine), while some may not endorse body image-related concerns
Eating disorder prevalence rates are higher in the LGBTQ community, likely related to: 1) stress associated with stigma and/or 2) appearance-related concerns
Eating disorders do not discriminate - there are very few differences in prevalence rates of eating disorders among racial/ethnic groups
However, minoritized groups and those with lower income are significantly less likely to be screened and treated for eating disorders

Eating Disorder Screening

The following have been demonstrated as effective screening questions:

Are you satisfied with your eating patterns?
Do you ever eat in secret?
Does your weight affect the way you feel about yourself?
Do you currently suffer with or have you ever suffered in the past with an eating disorder?

Additional information about Eating Disorder screening and management: https://publications.aap.org/pediatrics/article/147/1/e2020040279/33504/Identification-and-Management-of-Eating-Disorders?autologincheck=redirected

If there is concern for an eating disorder, recommend an eating disorder-specific assessment

Eating Disorder

Treatment Considerations

The recommended treatment for eating disorders involves mental health therapy, medical monitoring (ideally with a physician with specialized training in eating disorders, when available), and sometimes nutrition counseling
Where there is smoke, there is usually fire - if providers or caregivers have concerns about disordered eating, there is likely reason for referral to specialty care for assessment (including virtual specialty care)
While primary team awaits specialty referral or if specialty care is not available, recommend close medical follow up (see provider guide for additional information)
If, despite recommendations to increase nutrition at home, there is continued significant weight loss, and/or eating disorder behaviors such as purging are unable to be controlled at home, providers may consider a referral to a residential or intensive day treatment program (see referrals below)
When possible, families should be involved in treatment
The leading treatment for adolescent eating disorders is Family Based Treatment (FBT); sometimes, Cognitive-Behavioral -Therapy (CBT) or Dialectical Behavior Therapy (DBT) are used instead or in conjunction with FBT
When there has been weight loss, nutritional and weight restoration are almost always the first steps in treatment
Thoughts and emotions about eating (e.g., fear of certain foods or weight gain) typically cannot improve without nutritional and weight restoration (due to the impact of malnutrition on brain function)

For Eating Disorders Guides for Providers and Families (including medical stabilization admission criteria, resources and referrals), visit: https://capp.ucsf.edu/content/eating-disorders