The Body Esteem Program Overview
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The Body Esteem Program (BEP) is a 20 week peer-facilitated program that explores issues related to body image, self-esteem, and eating disorders. It is run by Women's Health Works and facilitated by people with lived experience of eating disorders who are in recovery. The program is for those suffering from anorexia, bulimia, binge eating, or related issues. It also offers an 8 week support program for families and partners, as well as ongoing monthly support after completion. The BEP takes an integrated approach and works with other organizations to provide a supportive recovery program.
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The Body Esteem Program Overview
- 1. The Body Esteem Program Mandy Stringer – Executive Director Tracey Hennessy – Program Development Manager
- 2. Joondalup Map courtesy of: www. Perthtourist.com
- 3. The Body Esteem Program The “BEP” Cath Ashton - BEP Coordinator Our facililators: Liz, Madeleine, Anna, Leanne Kathy, Jemma, Kathleen & Helen
- 5. Early days • 35 weeks (Netherlands) • 20 week program consisting of two x 10 week blocks (Australia)
- 6. BEP Program •Umbrella term for three group programs •20 x session, self help - peer facilitated program •Women suffering from Anorexia/Bulimia OR Binge/Overeating symptomology
- 7. BEP Program •Explores issues: body image, loneliness, self esteem, perfectionism, relationships, relapse, sexuality , the change cycle and decision making •Two facilitators – lived experience and who have embarked on recovery from and ED
- 8. BEP Program Support and information program for parents/partners family members • 8 x 1.5 hour sessions •Insight into the experiences and difficulties of sufferers •Key stakeholders provide presentations
- 9. BEP Program Step-Down Program •For participants who have completed the 20 week self help program •Ongoing monthly support to maintain recovery
- 10. BEP Program – snapshot 20 week program •(2.5 hrs per week) •Women accepting responsibility •Themes, group activities and homework tasks, work time, closing circle •Ideal = 8-10 participants •Meal at local restaurant to conclude program – significant achievement
- 11. An Integrated Approach •Safety and respect •Role modelling and visualisation of recovery •Continual improvement processes •Continual liaison with key stakeholders across the ED field
- 12. Our BEP Facilitators •Dual expertise – combining the lived experience with professional / semi- professional backgrounds •Personal and professional •Subjective but balanced with objectivity •Training, guidance, supervision and support of staff – strong duty of care
- 14. Stakeholder Agencies •Bridges Assoc Referencing group and Mgmt Committee •Butterfly Foundation – EDANN & NEDCP •Eating Disorders Foundation, Vic •Princess Margaret Hospital ED clinic •Centre for Clinical Interventions •Hollywood Clinic •GPs and Psychologists
- 15. Integrated Approach •New directive – consumer driven services √ •Carers WA – participants unique needs •Clinical supervision: MOU with PMH – Principle Clinical Psychologist •Flexible supervision/debriefing opportunities •Policies and procedures – protection of staff
- 16. The participants •Across the Perth Metro area •Employed OR studying •Isolation •Anorexia/Bulimia – 28.7 years •Binge/Overeating – 37.8 years •Depression/anxiety
- 17. Jemma’s Story
- 18. Kathy’s Story
- 19. The future?? •Funding – ongoing negotiations with the WA department of Health •Expanding the website •Preventative work •Developing a Train the Trainer manual for other ED services
Editor's Notes
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- Introduction – Mandy Stringer My name is Mandy Stringer – I am the Executive Director of WOMEN’s Healthworks (WHW). WHW is one of 12 independent women’s health centres in WA and is located approximately 26 kilometres north of Perth – as some of you would know – we are located in the middle of the ever increasing urban expansion of the ‘Northern Corridor’ suburbs of the city. WHW has been offering health, education and resource services to the women of Perth for over twenty years. About seven years ago now, WHW noticed an increasing demand for support services for women who were suffering from eating disorders and from families wanting to support their daughters/sisters. A long, turbulent, frustrating and yet incredibly rewarding journey ensued. A result of that journey is that we are now in a position today to talk with you about our experiences, and hopefully share with you the lessons we have learned and where possibilities and opportunities lie in the future. <number>
- Introduction – Tracey Hennessey My name is Tracey Hennessy; I am the Program Manager at WHW. My role since being with WHW is to manage a suite of social services, one of which is the unique and aptly named Body Esteem. I would like to acknowledge Cath Ashton the Coordinator of the BEP – unfortunately Cath couldn’t be with us here today however, we have bought her ‘image’ along with us, which is not the same but it’s important that we recognise her and the work she does with the program. Also, we will be seeing a film clip of a couple of our facilitators later in the presentation however I would also like to acknowledge the very hard work of all past and present BEP facilitators including Liz, Madeline, Anna, Leanne, Kathy, Jemma, Helen and Kathleen. We will now take you on a small journey of the BE, it’s history and some of the lessons which have been learned in delivering a consumer driven service: <number>
- Body Esteem Program History In 2003 WHW became aware of an increase in the number of enquiries from women experiencing the anguish of an eating disorder and who were seeking support to assist them in their recovery. WHW was only able to refer to extremely limited services within Perth. Extensive community consultation followed, via public forums which targeted those families with a lived experience and subsequently led to the development of a peer supported self help group which was adapted from an evidence based program originating from the Netherlands. <number>
- Initially the program was delivered over a consecutive 35 week period, and through evaluation and further analysis, a revised version of the program was piloted in 2005/06. Further delivery and evaluation led to redevelopment of the program to better suit the Australian context and was subsequently reduced to a twenty week program (consisting of two ten-week blocks). <number>
- The Body Esteem Program is an umbrella term which incorporates three programs which are offered at regular intervals throughout the calendar year. The Body Esteem Program provides: A self-help peer facilitated 20 week program for women experiencing and wanting to recover from an eating disorder (this includes specific groups for Anorexia/Bulimia sufferers as well as those experiencing Binge/Overeating symptomology). <number>
- This program provides education around eating disorders and health consequences, identification and understanding of what constitutes ‘normal’ and healthy eating, it provides strategies for making positive changes around eating behaviour and provides participants with opportunities to explore and address issues through discussion and activities (issues such as self image, body image, loneliness, perfectionism, relationships, relapse, sexuality, the change cycle and decision making). Each group is facilitated by two women who have experienced and recovered from an eating disorder. The facilitators provide support and guidance based upon their own experiences. <number>
- A support and information program for parents/partners and family members who have loved ones suffering from an eating disorder. This program provides education and insight into the experiences and difficulties experienced by sufferers, and are delivered over eight weekly sessions (of 90 minute duration). Key stakeholders and service providers across public and private mental health services in WA, who specialise in eating disorders provide presentations and allow opportunities for participants to ask questions and interact with each other in a supportive and developmental environment. <number>
- A ‘Step-Down’ program for participants who have completed the peer facilitated self help program and are needing additional support to assist in the maintenance of recovery. This program is only available to those who have completed the initial program and are wanting/needing further support to assist them in refraining from returning to destructive and harmful thinking patterns and behaviours. <number>
- The Body Esteem Program – A snapshot of the 20 week program The emphasis of the BEP is upon women accepting responsibility (and credit!) for effecting positive change in their own lives. It is also about the sharing of support and guidance between women who are, and who have experienced similar difficulties. Facilitators guide their groups through a series of themes, group activities and homework tasks. Each group session runs for 2 and a half hours and has a regular structure: opening circle, theme discussion/evaluation of homework task; work time; closing circle. Each group has a cut off of 15 participants. Experience has shown us that optimum numbers for group dynamics and retention sits at approximately 8 – 10 participants. The group celebrates the end of the program by sharing a meal together at a local restaurant. This is a significant achievement for all members of the group and this event enables the participants to gain practical experience of engaging in an event which has previously been far too terrifying to contemplate. <number>
- The BEP promotes an environment of safety, respect and one that is free from any judgement. It provides an opportunity for role modeling and the visualisation that recovery can be achieved. Choices can be made that can lead to the retention of positive emotional health and wellbeing for the women it serves. Results of the continual improvement processes gained from consumers, presenters, facilitators, key stakeholder agencies as well as administrative staff has ensured ongoing content review, policy development and program accessibility. Referral pathways are continually updated. Continual liaison and negotiation with key stakeholders has meant that WOMEN’S Healthworks has established a fundamental place within eating disorder services in Western Australia, as well as at a national level. <number>
- A unique attribute of the Body Esteem Program is the dual expertise that the facilitators of the program hold. Different to that of a peer led unstructured program, the Body Esteem Program has evolved so that the facilitators hold professional qualifications (or work and facilitation experience) as well share the experience of having an eating disorder. This distinguished difference that sets this program apart is that it bridges the gap between professional pedagogical styled treatment programs and peer led groups which are formed through promoting mutual assistance whereby the participants have come together to satisfy a common need. The adaptations and continual review processes have established a West Australian evidence base which is unique to mental health service provision and supports a model of facilitation that embraces both the lived experience and professional expertise. This model has not come about by chance. The implementation of the Netherlands program leaned towards the engagement of women who had the lived experience who could be then trained in the art of facilitation – the focus was not on professional skills and experience as being an equal and balanced factor in the recruitment and selection process. The impact therefore which was felt early on in the BEP journey was that a majority of the women who were accessing the service, were still vulnerable and not ready to take on a facilitator role, following the initial 20 week program. The Western Australian experience soon informed us that to ensure program guidelines were adhered to and that participants’ additional mental health needs could be supported and responded to in an appropriate manner, suitable staff who had a level of professional and or relevant work experience, be employed to meet this need. As a result it is now a requirement of the recruitment process to ensure that all facilitators working for the Body Esteem Program bring with them a diverse range of experience, skills and knowledge around the specific mental health issue of eating disorders which is both personal and professional, subjective yet balanced with objectivity. As alerted to earlier, the challenge here is that it is essential for the organisation to implement and activate strong policies for the training, guidance, supervision and support of staff. Every situation whereby the facilitator engages with a participant - holds within it, a possible trigger which could initiate relapse for the staff member. A strong duty of care and flexibility to meet individual needs is a quintessential requirement when supervising staff who each day, are exposing themselves to potentially very threatening situations. <number>
- Rather than to let me speak on their behalf I would now like to play a short video in which I interview two of our facilitators – Jemma and Kathy about their perceptions and experiences of facilitating the BEP 20 week program. <number>
- I must add that both Jemma and Kathy were very nervous about the prospect of being filmed – but once they got over the camera shyness, there was no stopping them!! As stated previously it has been vital to sustain communication and referral pathways with key stakeholders in the ED field. These Key stakeholders are: Bridges Assoc Referencing Group and Bridges Management Committee, The Butterfly Foundation The Eating Disorders Australian National Network and the National Eating Disorders Collaboration Project Eating Disorders Foundation Victoria Inc, Princess Margaret Hospital Eating Disorders Clinic (WA), The Centre for Clinical Interventions (Perth WA) and Hollywood Clinic – a private hospital providing treatment services for eating disorder sufferers in Perth. As well as a number of private GP’s and psychologists providing services to eating disorder sufferers and their families. Affiliations with current research initiatives ensures that all staff connected to the Body Esteem Program are informed and kept abreast of contemporary trends and research. <number>
- Whilst the current strategic direction for mental health services in WA embraces consumer driven services and supports the involvement of consumers in determining their own recovery journey, WOMEN’S Healthworks has been at the forefront of putting this discourse into practice – the BEP can lay due claim to delivering services which are innovative and which embrace best practice of including consumers and responding to their needs, at every possible level of service delivery. WOMEN’S Healthworks has responded to a need that has been identified in delivering the education and support group and has negotiated with Carers WA to work together to provide support for this client group within an environment that is conducive and supportive to the participants’ unique needs. This client group do not typically see themselves - or avail themselves of the services available for carers however, by establishing an MOU with Carers WA and by delivering the programs from the premises of this organisation, the participants are enabled to access services and resources which can greatly contribute to their own health and wellbeing. Clinical supervision arrangements are provided through a MOU overseen by the Principle Clinical Psychologist at Princess Margret Hospital. This arrangement ensures that staff of the Body Esteem Program gains the direction and guidance needed to assist them in their roles and ensures that inter-service collaboration remains active, and that support for the facilitators is provided at a multi-agency level. It has been imperative that the organisation implement strong facilitator and program guidelines, rigorous staff management strategies, contingency planning and the assurance of flexible supervision and de-briefing opportunities (for all staff involved in service delivery). The content of the program combined with the personal revelations of the participants, staff are continually exposed to ongoing threats to their own wellbeing which can lead to the possible ignition of triggers that can then incite relapse. WOMEN’S Healthworks has responded to these additional staff needs by putting intensive human resource management strategies into place and has actively embraced the development of policies and procedures which protects consumers, staff as well as the integrity of the organisation. <number>
- Let us now conclude by looking at the profiles and experiences of the participants themselves. With over eight 20 week programs now having been delivered, we can develop a profile of common characteristics and behaviours for those women entering the program. Participants come from across the Perth metropolitan area to attend the weekly program. The majority of participants tend to be employed, approximately half are studying and only a small minority is unemployed. All participants report that only the occasional family member is aware of the severity of their eating disorder and despite many hospitalisations – prior to attending the program - there are frequent reports by the participants about the isolating nature of eating disorders and how sufferers quickly develop the ability to hide and mask the intensity and malignity of the ailment. The average age of participants entering the Anorexia/Bulimia program is 28.7 years. Differing from the Anorexia group, the average age of participants in the Binge/overeating program is 37.8 years. Pre-selection interviews note that where participants have accessed professional services previously, the majority found that little help was forthcoming and that overwhelmingly, psychologists and counsellors did not take their condition seriously. Many participants entering this program take prescription medications for depression and/or anxiety related problems. <number>
- I would now like to conclude by sharing with you Jemma and Kathy telling us a little bit about their own experiences and that they are living proof that recovery is attainable. <number>
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- As you can appreciate it was a big ask for both these women to share their story for the purposes of this conference so we sincerely acknowledge and pay respect to them for being brave enough to share. It is their stories and ones we hear like theirs every day, that makes us continue to strive for developing our service and to secure more funding in this area – so where does this take us to - Funding – as always, funding is the never ending thorn in the side for NGO’s however we are on the verge of signing a three year agreement with the Department of Health (WA) which will provide stability and an opportunity to expand the service we provide – additionally it is exciting to report that we have engaged recently in negotiations with Butterfly Foundation who are keen to also implement our BEP 20 session program, which is very exciting. Developing the website – a large proportion of referrals are self referrals and come through electronically – interstate and OS enquires are regularly received –so to have an interactive web page that is jam packed with information, research and links to other sites is something we are very keen to expand We know that onset or presentation ‘ages’ of Anoriexia (Bulimia) are puberty/early adolescence and again on the brink of adulthood so being able to do more preventative work including is a very interesting area which we’d like to pursue. <number>
- Thankyou for taking the time to attend and listen to our presentation. For more information about the BEP or about WHW please note our contact details and website details. Are there any questions? <number>