Free neuroaffirming tool for clinicians working with eating disorders
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.
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
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
Exhale Psychology Centre has developed training for clinicians around delivering neurodiversity affirming treatment for adolescents and adults with eating disorders (ARFID and AN, BN, BED, etc.) and is now available here. In the spirit of being neuroaffirming, it will be self-paced online training filled with case examples, and will cover:
Using SAFETY - a neurodiversity affirming approach to develping neutral food relationships
Untangling ARFID and Anorexia Nervosa
Supporting Clients to untangle their neurotype from their ED
Working with Autistic Clients (and AuDHDers) with eating disorders and eating differences
Working with ADHDers with eating disorders and eating differences
Working with clients with complex mental health difficulties and utilising a harm reduction approach
SAFETY was developed by psychologist Lucy Smith in collaboration with dietitian Andrea Parker.
Lucy Smith is a credentialled eating disorder psychologist with over 10 years experience in the eating disorder space. She is passionate about neuroaffirming care and is the mother of an AuDHDer with ARFID.
Andrea Parker is a credentialed eating disorder dietitian with over 10 years of experience in the field. She is an anti-diet dietitian and identifies as an ADHDer.
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We are a psychology centre focused on empathetic treatment of complex mental health issues and eating disorders for adults and adolescents (ages 14+).
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A tailored approach
We do not offer a one size fits all but instead see each client as a whole person requiring an individualised approach.
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