Free neuroaffirming tool for clinicians working with eating disorders

Is traditional eating disorder treatment not working for your clients?

Research shows that standard eating disorder treatment is not effective for individuals who are:
- Neurodivergent
- Ambivalent
- Have co-occuring presentations
- Present with 'Atypical' Anorexia
and can even cause iatrogenic harm
(Cobbaert & Rose 2023‍, Lock 2015, Wilson & Shafran 2005)
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SAFETY is an adaptation to the RAVES model (Shane Jeffrey, 2021) that is specifically targeted to neurodivergent individuals. It was developed in collaboration with the neurodivergent community, and aims to support clinicians working with neurodivergent individuals, or individuals with a strong sensory profile, that experience eating challenges to support them to meet their nutritional needs while minimising distress. 

Download SAFETY.pdf

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To learn more about implementing SAFETY or using a neuroaffirming approach to working with eating disorders, check out our training page.

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Explanatory Notes for Using SAFETY

SELF-DIRECTED

• The individual’s nutritional plan should be self-directed. The individual is encouraged to play an active role in determining what foods are consumed, when, and how
• Sensory needs are accommodated as a core component of supporting individuals, not a ‘nice to have’. There are times where this may be difficult (eg. inpatient setting) but every effort should be made to make accommodations
• If adequacy needs are not met, the individual determines the ways in which increased adequacy would be most tolerable
• Supplements are an acceptable way to meet nutritional needs and should not be viewed as nutritionally inferior to food
• Food sameness (strong preference for familiar foods) is accommodated 
• Regular eating/eating based on the clock is only preferred if self-directed and supportive to the individual
• Challenging foods are only implemented if supportive to the individual
• Tackling aversive foods is not a nutritional goal unless specifically requested by the individual

ALL FOODS FIT

• Acknowledges that all foods are made up of nutrients and can be utilised by the body in the same way from a physiological perspective. For example, adequate protein needs can be met from chicken nuggets or from steak
• Emphasis on there being no good or bad foods (or inherently healthy/unhealthy foods)
• Extension of the ‘fed is best’ concept whereby a fed child/adolescent/adult no matter how they are fed is more important than the preoccupation with the content of their diet. In other words, adequacy trumps regularity and variety
• Individuals are supported to unlearn neuronormative, ableist, diet culture rules about food and nutrition. For example, views around what a meal should look like. A meal can be made up of snacks, not be visually colourful, not occur at a typical meal time, etc. 
• Acknowledges that variety is not essential in order to meet nutritional adequacy (from either macro or micronutrient perspective) and that the ‘healthiness’ of food plays a minimal role in health outcomes. If eating particular foods is aversive and stressful this is not without harm and potential health impacts

FLEXIBLE AND ADAPTIVE 

• It is the community (health professionals, hospitals, institutions) that need to be flexible and adapt to the needs of marginalised groups such as neurodivergent individuals with eating and feeding challenges as per the social model of disability, rather than the individuals seeking support having to adapt to the expectations of others
• Clinicians working in this area are expected to be mindful of intersectionality and to incorporate basic neurodiversity affirming principles into their practice, including but not limited to, deference to the neurodivergent community for neuroaffirming practice, use of identity-first language (IFL), valuing all forms of communication styles, valuing lived experience, using the neurotype model over the pathologising model of neurodivergence, etc.
• Clinicians should be mindful of their own privilege, biases including gender expression and heteronormative biases, internalised weight stigma/fatphobia, internalised ableism, and neuronormative expectations

ENVIRONMENT

• Environmental accommodations for the individual is encouraged such as providing a quiet eating environment, dimmable lighting, and access to preferred music or distractions (such as sensory toys, use of phones or iPad) 
• Mindful eating is not necessary and can make it harder for individuals to nourish themselves
• Preference to eat with others or alone accommodated. Acknowledges that some individuals are better equipped to meet their nutritional needs through body doubling (engaging in an activity with another present) and others by eating alone

THERAPEUTIC RELATIONSHIP

• Collaborative therapeutic relationship emphasised (not expert/patient dynamic)
• Relationship needs to be built on trust for the individual to feel nutritionally supported  
• In the context of Anorexia Nervosa and similar eating disorders, a strong therapeutic relationship is needed to work with the individual to untangle sensory needs from anorexia based behaviours (eg. whether avoidance of specific food is fear based, sensory based or both, or whether pacing is exercising, stimming, or both)
• Clinician works to empower individuals that have the capacity and willingness to do so to be self advocates

YIELD ONLY WHEN CLEARLY MEDICALLY NECESSARY

• Only divert from the above principles when there is a case of clear medical necessity i.e. the individual is facing serious medical consequences if adequacy, regularity, and/or variety are not implemented soon 
• Every effort should be made for medically necessary changes to incorporate the above principles and the individual should determine which method of change would be the most tolerable

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SAFETY was developed by Lucy Smith and Andrea Parker.