Transforming Inpatient Care with CBT-E: A Success Story
Inpatient care for eating disorders faces challenges like coercive practices and poor outcomes. Dr. A. James shares their journey of implementing CBT-E, leading to improved outcomes, reduced relapses, and enhanced patient-staff relationships through a collaborative approach. Changes were gradual but impactful, emphasizing the importance of trust, teamwork, and perseverance in transforming traditional care models. The process involved setting up a dedicated team, training, communication, and navigating initial fears and uncertainties to ultimately embrace change and achieve positive results.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
CBT-E for Inpatient and Day patient Settings Dr A James
History Inpatient care often operated without a defined model. Weight restoration seen as central. Indeed, in some cases weight restoration is seen as the only option or goal. Regimes frequently paternalistic, medical and more than often coercive. Coercive practices include: not listening to the patient and having a defined, mechanistic approach. Lack of choice. Various approaches, with the same patient, some contradictory. Approaches not necessarily focused on ED pathology. cses
Why Change ? Outcomes poor. Length of stay long, often to target weight. Relapses frequent. Coercive practices with poor relationships, draining ward atmosphere, high degrees of stress. Frequent NG tube feeding. Oppositional attitudes ( both staff and patient).
How did we change ? Attended a 2 day workshop by Chris Fairburn on CBT-E. Right time, right place, right people. Trust allowed new ways/treatment methods to develop as part of the University/Trust link. Freedom to move things had to be better. Realisation that change took time as attitudes and practices were engrained
Change the process We set up a small working party. All were interested and committed to change . We specifically excluded people ( even senior people) who were not directly involved or contributing, or going to contribute to the new programme. We were allowed on line training so there was a personal and group investment. We took an active decision to involve and inform everyone at all levels We worked aa a group - it takes courage.
Change the process. We informed everyone regularly, even if they were not seemingly interested or receptive . Need senior people to push for change. Have to listen to worries and concerns of others. Anticipate resistance change is often feared. Be committed don t waiver or compromise too much. Keep track of progress as one looses track and one feels the process is being derailed. People become dispirited why is it taking so long? what are we doing? will it work?
Take the plunge! First round table we were all anxious! A step into the unknown- exciting and potentially risky, dangerous. We employed a family therapy technique: using our weakness/lack of experience as a strength: We had to follow the model closely, without deviation. We were open and told patients and parents that we were new to this therapeutic model, but that we were following the protocol closely. We highlighted the expertise of Prof C Fairburn and team, especially the research findings from Oxford, Leicester (adult) and Italy (residential and adolescent).
Taking the plunge. Things have to be better. We are talking to the patient. Revolution: More than collaboration - We put the patient at centre stage (See Round Table). We had 6 monthly consultation with Arianna Banderali from Italy You are the therapist, I am your coach .
Setting NHS Adolescent Unit. We accept medically ill patients. We accept urgent/emergency referrals. We accept detained patients.
Setting We run 3 programmes: Medical FBT CBT-E And no others!
How do we engage the patient? Take the pressure off you and the patient. Talk and discover. Pros and Cons for both remaining the same and changing.
