Helping Patients, Parents and Families with a Stepped Care Approach to Treating and Supporting Those with Eating Disorders.

We work closely either as a direct commissioned service accepting self and professionals referrals into our mild-to-moderate services or as a pathway provider with Adults (A-CEDS) and CAMHS (CYP-CEDS) NHS community eating disorders service teams. Our coordinated approach is proven to help people suffering with mild to moderate eating disorders to get better and stay better through one-to-one support, focusing on reducing social isolation to regain life skills enabling them to thrive in their hobbies and passions.

We ensure that our stepped -care approach is efficient and effective for both step-up and step-down, aligned with our person-centred approach;

Step up

If our staff feel it is appropriate to step-up a service user into NHS specialist eating disorder services, our embedded pathway processes enables us to respond effectively.

Step down

Our NHS partners also effectively step-down patients into our services as part of their discharge planning process. This ensures that anyone coming to us for support receives safe and effective professional support appropriate to their eating disorders requirements.

Where an individual comes to us for support where we may not have an established NHS pathway in place, with consent we will always work with the individuals General Practitioner (GP) requesting medical monitoring is put in place locally to ensure that we can continue to provide safe care whilst they access our services which is often through our video clinic and video group consultation services. This good practice approach ensures that our staff adhered to our safe practice procedures and assures the service users GP understands their patient is receiving appropriate care.

Meet the team.

Our team understands what it takes to reach out for support and are here for you every step of the way. We have a dynamic team, all with experience in delivering support in an environment which best suits the individual and their recovery plan. Our eating disorder-informed support officers understand that there is no one-size-fits-all approach to sustainable recovery, which is why we take a person-centred approach to all of what we do, providing a service and support unique to you.

Sharon McCabe

What is Integrated Community Services (ICS)?

ICS is a unique service that provides a specialist support officer (SSO), suited to the service users (SU’s) needs, that provide weekly assistance around eating disorders covering a variety of support. The main use of ICS is to have a SSO join at mealtimes to help during the difficult moments, this can be breakfast, lunch, dinners, or snacks. The sessions can be face to face, virtual or a blended approach depending on the service users requests and availability of SSOs. These can range from one to five sessions a week with an average of two that can take place in a range of places from schools, homes, and cafes.

With the consistent and frequent sessions, the service user builds a relationship with the SSO that creates a safe and trusting space to open up around their eating disorder and other experiences, creating opportunities for development with the help of constant support. The aim of ICS is to gradually get service users to improve their eating habits and be comfortable to function without the need of support. Due to the individualist nature of eating disorders ICS can provide different benefits for people for example:

Company

Many find mealtime a daunting experience that can be isolating and intense, with someone there to join them it can relieve the pressure in the moment and take the focus away from food and instead be part of a joyful conversation as a distraction.

Assistance with Goals

Those who are approaching goals in their recovery can benefit from an SSO being part of the journey, through setting goals and completing them together. This can include eating out in public, or can be more food specific such as eating trigger foods.

A Confidant or Advisor

Often having someone to listen and talk to about their experiences with and seek advise from is something that offers instant relief and ICS gives the time to discuss their thoughts and feelings with someone they have rapport with, often making difficult conversation easier.

Motivation

Some service users benefit from motivation during a meal which may include some words of encouragement throughout, having bites in synchronicity for a feeling of togetherness or a celebration after their meal to enjoy their wins.

“I don’t know where I would be without the help of First Steps. My ED would be so loud, forcing me to push back and sometimes skip my lunch. Since having my meal support with the team I have managed to get back on track and haven’t missed any meals! I have been so grateful having the opportunity to talk to someone knowing what i’m going through and someone who knows what to say. Not only has First Steps helped me, they have also helped my family, giving tips on how they can support me. If it wasn’t for my meal support I would have never been able to go out in public to eat. The team have helped me to build my confidence and challenge myself, proving that I can do it! And there are no consequences. ”

Service User, First Steps ED

“The joint help and support pre and post discharge from the Leicester ED inpatients service, Derbyshire Community Team and First Steps ED has been absolutely crucial for us. As parents we honestly do not know how we would have coped with everything we were dealing with, if it was not for their amazing support and teamwork helping and educating us on this horrific illness. We were lucky in that respect; however, I do not know how other carers/parents can cope and survive if they are not as fortunate as we were in receiving this type of help and support.”

Parent of Service User, First Steps ED

Despite the main focus of ICS being around eating, it is important to build the service user’s identity outside of their eating disorder to help integrate back into the community and gives them a chance to focus on something other than their eating disorder which can be all consuming. This side of ICS is optional and done when the SU feels they’re ready for this stage of their recovery. In this occupational side of ICS, we create goals and look at hobbies/activities that make them SU feel like themselves. Then create step by step plans to gradually expose the SU to this new goal, followed by using ICS sessions to complete the plan with support at every stage.

An example might be; facing anxiety around public transport: First a plan is created to decipher what public transport makes them most anxious for example a train and build up steps to eventually getting a train. This can include a session researching trains, then spending time in a train station, to boarding a train etc.

Despite the unique support given to service user during an intense part of recovery, this also relieves pressure for those around the service user. For example, leaving hospital can be an overwhelming experience for families that feel responsible and support them on their return home. Having a SSO there to step in at meal times can give families an opportunity to relax and take away pressure. Also having that consistent support can reduce worries about the service user due to them having someone to talk with. Another exclusive aspect of ICS is a relationship is also developed with families from times spent in their homes and being in contact with them regularly, giving a chance for relationships and trust to develop that can equally benefit and reassure the families.

Another aspect of support given is to the NHS partners, having another member on the service user recovery team can reduce stress and workload that NHS staff may find they have. They can also gain valuable information from ICS to provide more specific support and explore issues that may have otherwise not have arisen.

This is mainly access through the NHS pathway, whereby CAMHS or the NHS ED team feel that extra support would be beneficial, often due to the severity of the ED. The relevant ED team can make a referral into our ICS team through First Steps ED. This can occur through two processes:

  1. Step Down Process: where a service user is being discharged from hospital and to help with the transition out of 24/7 care, FS provide extra support around mealtimes that would otherwise be stopped completely.
  1. Step Up Process: if an SSO feel it is appropriate to step-up a service user into NHS specialist eating disorder services, our embedded pathway processes enables us to request further help for a service user and thereby offer ICS.

People cannot self refer onto this service as it’s an internal pathway with our NHS partners. If you feel as though you may benefit from this service, please contact our team for more information.

Important: Please note that First Steps ED services are for people with mild to moderate eating disorder and comorbid mental health issues. We do not provide a crisis or emergency service. Following support from a crisis team, we require 12 weeks from your discharge date before making a referral into our services unless a professional referral is made by Integrated Community Services (ICS). If you need help for a mental health crisis or emergency, please visit the NHS website, contact your GP or for immediate assistance call 999.