When Katie Grady was first diagnosed with anorexia five years ago, when she was 14, the treatment for eating disorders in East Kootenays was uncoordinated and tough to navigate.
Her family doctor was in one office and pediatricians in another; the mental health counsellors were in the offices of Child and Youth Mental Health (CYMH) at the Ministry of Children and Family Development (MCFD), and the dietitian was at the hospital.
Few of the care providers had extensive experience managing the complex, high-risk, and intensive needs of youth with eating disorders. Moreover, communication between all the various care providers, who all work for different employers, was challenging and inconsistent. In fact, sometimes they barely talked to each other.
“We would see one or two patients a week in our office, focusing mainly on their medical issues,” says local pediatrician Dr. Chris Pienaar. “Then the patient would go over to the CYMH counsellor for therapy. And sometimes the message would get lost between us. If we did talk, we’d be playing endless telephone tag. It was taxing and inefficient.”
For Grady and her family, the experience of coping with this serious and complex disorder was not made easier by trying to navigate appointments among different providers. A top student and athlete, Grady was twice admitted for weeks at a time into B.C. Children’s Hospital specialized eating disorders program in Vancouver. “We felt all alone,” said Grady, 19, who is now in Environmental Studies at College of the Rockies.
Now, all that has changed.
Over the last 2.5 years local providers have come together to create a team-based model of eating disorders (ED) care. The simple but effective model — designed by local providers and implemented by them — is helping young patients from all the communities in the East Kootenays (EK) to receive top-notch, coordinated and integrated care.
Not only that, but the clinic they’ve created, which runs every second Tuesday out of the pediatricians’ office on 12th Street in Cranbrook, is being hailed by others in the province as ground-breaking. Now it is being replicated in other locations in B.C., such as Nelson.
“It’s a totally different way of providing care, in which we all meet together and work together, and learn from each others’ strengths and expertise. It is not only better for patients, it is so much better for us, too,” said pediatrician Dr. Laura Swaney.
Recently, in honor of National Eating Disorders Awareness Week (Feb1-7) eight members of the EK eating disorders team sat around the board room table at the pediatricians’ office, a.k.a the EK-ED Clinic. Patient Katie Grady, and pediatricians Pienaar and Swaney were joined by three CYMH therapists from MCFD — Jennifer Westcott, Brenda Kraushaar, and Kali Love — as well as Interior Health dietitian Ali Wilson, and family physician Dr. Cecile Andreas.
They talked about how and why they changed the way they worked together and the tangible benefits it has brought about, not only for young people experiencing eating disorders and their families, but for their own work life and professional satisfaction.
“Just the fact that we are all here, together, talking like this around one table, shows how much we have changed! In the past, we never met,” said Kraushaar, who provides mental health therapy and counselling to patients and families. “I feel so proud of this team and what we are doing. I am so grateful for all of them. And I am especially proud of the fact we are still looking for ways to make the model even better.”
It all started four years ago when a special initiative, funded by a joint committee of the Doctors of BC and the B.C. government, encouraged communities to form local action teams to examine issues of youth mental health.
Called the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative, the initiative supported 64 Local Action Teams across the province to bring the right people together, to meet regularly, discuss top issues, and collectively develop their own solutions to local mental health challenges for children and youth.
Doctors, therapists, educators, social workers, families, and, in some communities, even the RCMP, have all been involved.
The East Kootenays local action team identified care for youth with eating disorders as a top priority, which at the time amounted to about seven or eight serious cases in local youth each year.
“These kids were at a point where their health and wellbeing was seriously threatened, and it was crucial they get the help they needed to recover,” explains Westcott, who was co-chair of the local action team.
Finding a solution meant local health professionals had to acknowledge how vulnerable and isolated they felt trying to meet the complex health needs of youth with eating disorders.
The team started by organizing a day long workshop in March 2015, in which an expert team from B.C. Children’s Hospital presented to more than 90 local professionals. The presentations were videotaped and edited into ED learning modules about team-based care.
Then in September 2015, Kraushaar began walking from her MCFD office on 13th Ave, crossing the Safeway parking lot, every second Tuesday to see patients together with the pediatricians. Negotiations with Interior Health eventually enabled dietitian Wilson to leave her office setting and join them on clinic days. By fall 2016, the team had started a parent support group with a therapist on the alternate Tuesdays.
Referral to the clinic comes via local family doctors, or through the CYMH offices. Soon, so many youth were being referred — now more than 30 a year —that the team trained GPs and CYMH therapists to create six “transitional clinics” to provide support and follow up to youth doing well enough to move out of the higher-level program and allow new youth to come in. Transitional clinics have been created in Cranbrook, Creston, Golden, Kimberley, Invermere and Fernie.
“It is a fantastic model that is just so sensible and effective,” said Caryn Malabar, an Interior Health mental health therapist in Nelson who is now leading the creation of a similar, team-based ED clinic in the region, which serves all the communities in the Kootenay Boundary area.
Amazingly, all of this positive change has come about without any need for special budgets or increases in daily operating funding. What has been required was the initial vision and funding of the CYMHSU Collaborative to bring people together, and then the willingness for professionals and organizations, like Interior Health and MCFD, to change the way they work together. Now other local youth with complex mental health conditions are benefitting from the closer relationships and better team work from health professionals.
It is a win-win for all, especially young vulnerable patients.
Grady is now seeing therapist Love and family doctor Andreas once a month through the Cranbrook transitional clinic. “I am still on the road to recovery, but I am heading in the right direction,” said Grady. “And now I feel that I am surrounded by a fantastic, supportive team every step of the way.”