1. Meal Supervision in Eating Disorders
Lisa Williams –Mental Health Practitioner
Date

2. What is Enhanced Home Treatment (1)
Enhanced home treatment (EHT) provides support to young people and their family/carers around meal and/or snack times, when they’re eating minimal amounts and/or seriously ill
Provided for 8-18 years old
Support is given at home/school/college/in hospital
Carried out alongside family member/carer
EHT aims to:
Improve the physical status of a young person
To prevent inpatient admission Or
To decrease length of stay and improve the experience of inpatient admission

3. Enhanced Home Treatment (2)
Duration approx. 2 weeks, need reviewed at least weekly
Work is family focused (even during inpatient stays)
Young person and family needs are assessed, then support plan is devised
Support plan commenced as soon as possible
Support given by mental health practitioners and clinical support workers

4. What support is given? Families/Carers educated on how to manage;
Mealtimes
Meal preparation
Appropriate portion size
Meal plan troubleshooting
Helping young person at mealtimes with eating
Manage duration of eating
Employing post meal distractions, positive-self talk, mindfulness exercises/creative tasks

5. Feedback/Outcome Measures
Goal(s) set with young person at beginning
Outcome measures captured at the start of EHT
Goals and outcome measures done part-way through and again at end of treatment
Helps to target specific needs

6. Why involve family? Involving family:
Families can inform us of normal family eating practices
EHT aims to model helpful strategies to eating
Gives advice/guidance/reassurance to parents/carers
Helps with trouble shooting at mealtimes

7. What do the young people and their parents think of meal support?

8. What I found helpful…
I was encouraged with words – no being ‘forced’ to eat
“Eat it to beat it”
“You can do it, do it for your future”
Let’s get back to …[the things you love]
I took a step towards eating with friends – it made lunch more ‘normal’
It’s nourishing “This is your medicine”

9. More helpful tips from YPs:
Be sensitive
Understand that it is REALLY hard
Support YP before the eating….e.g. just physically picking up the knife and fork
It gets harder throughout the mealtime, so try to avoid long pauses or putting down the knife and fork
Distraction – Talk about other things, not the food
Remind them of motivations
Have the radio/TV on

10. What I found unhelpful…
“Stop doing…..”
Constantly pointing out behaviours
e.g. leg shaking
“I found praise unhelpful as I didn’t want to do it in the first place”
Prompting you to have everything – “even the crumbs”
“Stop taking small bites – take bigger ones”
“Come on it’s fine, just do it” making it seem simple

11. More tips on what to avoid:
Raising your voice or arguing with me
Telling me things that I already know
Not talking about calories or weight
Just being watched or stared at
Them fidgeting
Not eating themselves
Silence
Being given an overwhelming sense of shame

12. Parent views (1)… Mother of a 14year old girl. Supported at home.
She was really poorly, the thought of admission filled me and her with absolute terror…it was the best thing we could have had, it kept her at home and stopped her from dying”
I was empowered in front of my daughter
It gave me confidence/affirmed what I was doing
I learnt something new at each visit of what to do
I had back-up from the service
The constant encouragement of my daughter… “Keep on eating it” “Lets keep going”
Learning mindfulness for outside of mealtimes
Some people may find the dedication difficult

13. Parents views (2)… Mother of a 10 year old girl.
Supported at hospital then home…
It was good for her and us to learn how to talk about things other than food during mealtimes
It was made more ‘normal’ by having someone eating at the same time
Using their tactics was helpful to continue, when they were gone
We learnt how to use distraction plans before mealtimes and put them into place during and after meals…e.g. “we planned to play a game straight after eating, as soon as the time had passed, we took the plate straight away and then played”
She was uncomfortable with people ‘coming
to watch’ even though I explained they weren’t