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Public Pathway for Children and Adolescents

Note: This pathway will be updated as the HSE National Clinical Programme for Eating Disorders is rolled out nationally. Some areas may not yet have eating disorder (ED) or day programmes teams in place.

Step 1 – Contact the GP

Your GP is the place to start. The GP will do a screening, and if they are not clinically concerned, they will offer reassurance and advice. If the GP is unsure as to whether the person has an eating disorder, they will  consult with the local CAMHS / ED team and monitor things. The GP may examine the person and take blood tests or an ECG.  If the GP is clinically concerned, they will refer to the local CAMHS (Child and Adolescent Mental Health Services, or CAMHS ED team, if established) for a further assessment. If they are worried about the person’s physical health, they may refer them to a hospital for medical care.

Step 2 – A) Child and Adolescent Mental Health Services (CAMHS)* Assessment or B) Child & Adolescent ED team Assessment**

Eating disorder assessment involves a multidisciplinary assessment at a clinic. This includes a clinical interview with the child and parents, a physical examination, investigations and questionnaires. It can take up to 2 hours. The aim is to make the correct diagnosis of the child’s needs and to identify other conditions or complications that may be similar or related such as depression or medical conditions.  The doctors on the team will review the young person’s blood results and liaise with their GP about their physical health. Their weight and height will be measured.

A) If the CAMHS / ED team assessment concludes that there is no diagnosis of an eating disorder, the team may discharge the person back into the care of the GP, if there is no other condition that needs treating there.

B) If the child or adolescent is diagnosed with an eating disorder, then the next referral step is dependent on the level of risk assessed by the team.

– A person diagnosed with a low / moderate risk will be treated within the outpatient service. If the person responds well to this outpatient treatment plan, they will, when ready, be referred back into the care of the GP (step down), or if the person does not improve, they will be referred into the more intensive day programme (step up).

– A person diagnosed with higher risk may be referred specifically for a more specialised treatment or day/ inpatient care. If the Child and Adolescent ED treatment team assessment diagnose an ED, the person will be treated within the eating disorder outpatient team structure.

– The person moves up or down these steps depending on their clinical needs and how they are responding to treatment.

Public pathway for children and adolescents

* CAMHS – Child and Adolescent Mental Health Services – this is the general mental health service for children and adolescents in the locality, which is not an exclusive eating disorder treatment team. There are personnel within the CAMHS team that have the expertise to make an assessment of an eating disorder, and where there is low to moderate risk, treat the person within the team.

** Child ED team – This is a specific team dedicated to the assessment and treatment of adults with eating disorders, where a moderate to high risk is diagnosed. This is an ED outpatient service for the locality. It will take some time to roll out the ED teams across the country, so for the moment there may not be a specific ED team in place in your locality, however, there will be specifically trained ED clinicians with the C/AMHS teams.