Vermont needs more early treatment for eating disorders, report finds
A new report evaluating the services available for Vermonters struggling with eating disorders found the state is lacking in higher levels of coordinated care.
Despite nutritionists, clinicians and physicians providing comprehensive care, the state has some gaps in its approach to treatment.
The goal of the report was to consolidate findings from a working group of services already available to Vermonters with eating disorders, and to identify which additional services might be needed.
Vermont Public’s Mitch Wertlieb spoke with Dr. Kelley Klein, medical director for the Vermont Department of Mental Health, and Dr. Haley McGowan, the medical director for the Children, Adolescent, and Family Unit (CAFU) with the Department of Mental Health about the findings from the report, and possible legislation to come out of it. Their conversation below is edited and condensed for clarity.
Mitch Wertlieb: Can you give us kind of a thumbnail sketch of the main takeaways, the overall findings of this report? What stands out the most to you?
Dr. Kelley Klein: Well, there were several different aspects that we looked at, we kind of put our recommendations into what we call buckets. And the separate buckets were programs and providers, education and prevention, data access, navigation and support. I'll turn it over to Dr. McGowan to start with talking about a large part of this, which was the programs and providers — which talks about what we have available in Vermont currently and what we're looking at as recommendations for that.
Dr. Haley McGowan: So Vermont is already doing the best it can to meet the needs of people facing eating disorders. There's a small pool of really exceptional outpatient multidisciplinary providers that specialize in this treatment. That includes registered dieticians, mental health providers — therapists and psychologists and a few physicians — but the resources really don't come close to meeting the need for those with eating disorders in Vermont.
Often primary care providers, with limited training or support, find themselves struggling to care for pretty ill individuals in the community. And so what Vermont is lacking first and foremost, the workgroup found, is a continuum of care. And the continuum of care would allow individuals and families to access early family-based treatment in their communities, including intensive, sometimes daily treatment, and prevent the need for a higher level of care out of the home, like 24/7 care.
Dr. Klein, let me ask you this, I understand that it can be difficult to track exactly how many Vermonters have eating disorders, and there are different reasons for that. I wonder if you can give us an idea, though, of the numbers when it comes to individuals who are struggling with this problem. What kind of data can you give us on the percentage of population, average age, etc. of those who struggle with eating disorders?
Dr. Kelley Klein: Yeah, so the average in general for the entire population is that one in 10 will suffer from an eating disorder at some point in their life. We know that eating disorders do often start in adolescence or early adulthood, but they can occur at any point in the lifespan.
Dr. McGowan, what does the state need to do better? You identified a continuum of care being a problem, and what does the state need to do better that it isn't doing right now to help people with that continuum of dealing with this problem?
Dr. Haley McGowan: So what the workgroup found was, we need to bolster the continuum by increasing the capacity of the workforce of primary care, of schools to identify patients early on, individuals early on, get that treatment started before it advances to the level where they need that higher level. The in-between is intensive outpatient and partial hospitalization, which allows for individuals to stay within their community and do intensive family work, have support groups, sometimes daily treatment, but they don't need to leave the home setting in order to get that treatment.
So the continuum spans from that very early intervention all the way to residential and inpatient treatment, and the whole, the middle and the higher levels of care are what we found is really lacking in Vermont.
You should both feel free to correct me if I'm wrong about this, but one of the things that I think might be really tricky about this problem is that identification to begin with. What kind of guidance do you have for family members to first identify where there might be a problem with someone that they love, and how to identify an eating disorder and what steps they should take once they do?
Dr. Kelley Klein: That's an excellent point that most people, even those working in the school system, might not understand or recognize the early signs. And of course, there's different early signs for each type of eating disorder, so it's hard to make a blanket statement about it. But one of our major recommendations is to increase that education for primary, intermediate and secondary schools, as well as after school programs, coaches, school food staff, around the awareness for eating disorders and how to recognize them earlier. And one of the main recommendations that we made in that realm was to add a continuing medical education requirement for licensure for certain specialties and subspecialties of licensed physicians in the state.
Dr. McGowan, what would you like to see, if anything, from Vermont lawmakers about this problem? What can they do to help?
Dr. McGowan: So right now this report is in the Legislature’s hands, and our primary hope at this point is for ongoing, high-level of attention within this legislative session, so that the state can begin taking some tangible next steps. We do hope that a version of this workgroup, with involvement of individuals and families with lived experience, continues.
We heard loud and clear from the workgroup, specifically from individuals and families with really painful lived experience that they were very courageous to share, that we need a centralized online, Vermont-specific clearinghouse of information that helps individuals, and families, and care teams learn about eating disorders, and navigate the complicated and currently pretty sparse system. So that's a very tangible first step is just sort of collecting what we have and helping families navigate that system as it improves over time.
And kind of a one-stop-shop it sounds like you're saying, too — a resource where people can go to if they think there was a problem here, and they can identify steps to take from there because right now it seems like it's a very haphazard approach, is that about right?
Dr. Haley McGowan: That's exactly right. And I think some things that such a site would feature would include, basic eating disorder information, including warning signs to support that early identification and intervention, like a roadmap for care that helps individuals and families know even where to begin, rather than just making random phone calls or asking friends or hearing through the grapevine. Lists of active providers, and then very importantly, connections to active community resources and support groups, so individuals don't feel so alone and isolated.
Yeah. and Dr. Kelley Klein, let me end with you here, because I think what Dr. McGowan is touching on a little bit here is the stigma that is often associated with eating disorders. Is it important to bring this out into the light and have people say, it's not just okay to talk about this, but that we must talk about it?
Dr. Kelley Klein: Absolutely. And that's, again, another big part of our recommendation is public health awareness messaging around eating disorders, how common they are, how beneficial treatment is for them, and how beneficial it is to have family and community support — all exceptionally important in the treatment of these disorders.
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