Improving Screening and Referral of Psychiatric Outpatients with Eating Disorder through Implementation of Toolkit

Eating disorders (ED) affect between 20-30 million people within the United States, and the prevalence of these disorders is increasing. Approximately 97% of individuals with ED have one or more co-occurring psychiatric conditions related to depression, anxiety, and substance abuse. Mental health providers currently treat approximately one-third of individuals with ED and concurrent psychiatric conditions, but the majority of individuals with ED and concurrent psychiatric conditions never receive treatment for their ED (Linvelle et al., 2010). One reason for lack of treatment is that providers feel unsure about how to assess, screen and treat individuals with ED. Patients often deny ED symptoms due to feelings of shame, embarrassment, stigma, and ambivalence towards treatment. Eating disorders may not be considered or even missed even though other mental health issues are addressed. In order to identify undiagnosed ED among mental health clients who were being seen for other mental health problems, this project introduced the validated SCOFF screening tool in an outpatient mental health clinic. Participants included 7 mental health providers who were given a preliminary survey to assess their confidence and knowledge in screening for ED. The participants were also asked which screening process they felt would work for introducing ED screening in their clinic. The participants received an educational session that explained the SCOFF screening tool and introduced a toolkit that included client resources and a referral list for ED treatment. After the session, participants screened patients and used the toolkit for 8 weeks. A post-implementation survey was used to analyze the differences in participant perceptions and knowledge regarding ED screening. Results showed that participant ED screening increased by nearly 60% after implementing the toolkit. Participant confidence in identifying clients with ED increased in their work setting while their confidence in referring patients with ED decreased. All of the participants reported that they will continue to screen clients for ED. Screening for ED among mental health clients can be an effective way to address the unidentified problem and increase referrals for ED. An educational session and a toolkit that provides screening and informational resources for ED and referral can be an effective method for improving screening rates in mental health clinics. Further evaluation of the referral process in this project would add to the strength of the toolkit.