ED Transitions: Ensuring good working relationships between services

    This page forms part of our "supporting age-related transitions in eating disorders" resources.

    Guidance from the Royal College of Psychology (RCPsych) emphasises that good working relationships between Childhood and Adolescent Eating Disorder Services (CAEDS) and Adult Eating Disorder Services (AEDS) need to be nurtured.

    They also say that joint working and training fosters a spirit of mutual respect and reciprocal learning between services. This can also prevent splits developing; these can occur, e.g. when clinicians from one team imply that the other provides an inferior service.

    This point is important. There is some research evidence suggesting that CAEDS and AEDS clinicians do sometimes hold biased beliefs about each other (Lockertsen et al., 2020). So, let’s look at this in some more detail.

    CAEDS and AEDS practitioners are different 'tribes' and may hold unhelpful beliefs about each other

    Do any of the thoughts shown below ever go through your mind when you are dealing with colleagues from your partner team? If so what does that say about your team relationships? How might this affect transitions of patients?

    • "...they only deal with nice, easy, straightforward cases"
    • "...you'd better get well soon, because otherwise you will be sent over to THEM!"
    • "...if we had the amount of resources they had, we'd do brilliantly"
    • "...they deal only with complex, chronic (hopeless) cases"
    • "...they exclude families, are focused on impairment or deficits and are remedial/palliative in approach"
    • "...they leave us to pick up their dirty work"

    Ideas for strengthening co-working with CAEDS or AEDS colleagues

    • Regular joint learning events or training sessions between teams
    • Shared posts
    • Regular meetings between transition champions in both teams
    • Shared projects and initiatives
      • Joint public-facing initiatives such as conferences, open days, websites, joint GP liaison, joint training of others e.g. on Medical Emergencies in Eating Disorders (MEED)
      • Joint quality improvement/research, e.g. finding out how big the referral gap is between CAEDS and AEDS in your locality
      • Joint treatment provision, e.g. multi-family groups

    There are many other ways in which teams can find creative ways to co-work. Let your imagination run riot!

    Building good relationships between other services

    RCPsych guidance states that where there has been significant involvement of paediatric or medical services or social care, these services should be involved in transition planning. It is helpful when general practitioners (GPs) can be involved in planning and facilitating the transition; when they cannot be directly involved, minutes of meetings should be copied to them.

    The practicalities of good transitions

    There are a number of practical steps which can support good transitions at a service level:

    • Transition coordinators

      A transition coordinator should be appointed for transitions between CAMHS and AMHS. This may involve the identification of a key worker from each service or a permanent joint post shared between services. The role of the transition coordinator is to guide and support patient and carers through the transition process and function as a point of contact.

    • Clear protocols and pathways

      Services should have clear protocols and pathways for patients transitioning between them. Patients and their carers, as well as clinicians and managers, should be consulted during the development and evolution of such protocols.

    • Providing good information

      From the earliest stage the provision of good-quality information to the patient and their family/carers will be important. This may include facts about the service they may be joining, as well as about the process of transition itself. Aspects of care planning and how that is communicated will be part of this.

    The transition care plan

    An agreed and well-structured, patient-centred care plan, focused on the individual rather than on organisational considerations, can be the most important single element in the whole transition experience.

    The patient must be consulted and involved in discussions about the care plan, taking into account their:

    • stage of recovery
    • level of maturity
    • personality

    Dunn found that young people and parents agreed that transition preparation should be asset-focused rather than deficit-focused, i.e. focused designing a plan that plays on the strengths of the young person rather than trying to "fix" perceived weaknesses. Building self-confidence was seen as key, along with resilience, help-seeking, coping strategies, self-esteem, organisation and social skills.

    The transition care plan is covered in more depth in Module 3.

    Multidisciplinary discharge planning meeting & joint working

    Formal handover of care should be structured by at least one specific multidisciplinary discharge planning meeting. More than one meeting may be required, if the transition process lasts over several months.

    There should be an overlap period of joint working by both services during the transition, in order to:

    • explore and explain the differences in the ways of working between the two services
    • help the patient to get to know key members of staff from the new service
    • put in place arrangements for the necessary therapeutic interventions
    "If I had known more about what adult services would have been like, that would have really helped. That would have encouraged me to consider transitioning as an option"Recent transitioner, Service X Mental Health Trust

    Attachment issues

    Respect for the importance of attachments and therapeutic alliances is crucial in the work towards recovery from an eating disorder. A sensitive and developmentally informed approach to a transition may transform it from a traumatic and disjointed experience into an opportunity for building resilience and healthy maturation.

    "It takes a lot for you to just tell a random person your problems. So, you have some appointments with [adult healthcare providers] and my therapist now, so just dipping my feet in the water with them and keep going to them more and this therapist less and then eventually full-time there and not them here"Young person, quoted in Nadarajah et al. 2021