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Ontario Health’s Eating Disorders quality standard addresses care for people of all ages with anorexia nervosa, bulimia nervosa, or binge-eating disorder. It applies to all care settings.

Although many statements may apply to avoidant/restrictive food intake disorder (ARFID), as well as other specified and unspecified eating disorders, this quality standard does not directly address the management of these conditions. This quality standard also does not address pica or rumination disorder.

With the growing incidence of eating disorders in Ontario, this is an urgent issue with many opportunities for improvement. This quality standard includes nine quality statements that address areas identified by the Eating Disorders Quality Standard Advisory Committee as having high potential to improve care for people with an eating disorder in Ontario.

Below is a sample of tools that may help you implement the quality statements in practice, organized by purpose. Many of these tools will help support multiple quality statements.

This list is not exhaustive, and these may resources have recognized shortcomings—some of which are noted here. Are there other tools or resources you use? Do you have experience implementing these or other tools? If so, please share your thoughts in the comments section below.

Tools and Resources to Support Clinical Practice

Screening:

• SCOFF questionnaire: A 5-question screening tool for anorexia nervosa and bulimia nervosa
• Comprehensive Assessment Checklist for Eating Disorders: A checklist of physical, mental health and comorbid conditions to assess as part of a comprehensive assessment for eating disorders, adapted from the Eating Disorders quality standard.

Eating disorder self-report assessment tools: Please note that the evidence base for these assessment tools comes from a limited population that may not represent all people who might be assessed for eating disorders. Self-report measures should not be used in isolation to make a diagnosis of an eating disorder.

• Eating Disorder Examination Questionnaire (EDE-Q 6.0): A 28-item self-reported questionnaire designed to assess the range and severity of features associated with an eating disorder. Commonly used in assessing outcomes for eating disorder treatment
• Clinical Impairment Assessment (CIA 3.0): A brief, 16-item self-report measure of the severity of psychosocial impairment related to eating disorder symptoms
• Eating Pathology Symptoms Inventory (EPSI): A 45-item self-reported questionnaire designed to assess the psychopathology of eating disorders
• Eating Disorder-15 Questionnaire (ED-15): A 10-item tool to measure session-by-session change in eating disorder cognitions and behaviors over the course of treatment

Clinician-administered interview assessment tools:

• Eating Disorder Examination (EDE-Q 17.0D): A comprehensive, semi-structured, investigator-based interview that assesses a broad range of eating disorder symptoms. Limitations: Requires training to administer and more time to complete

Finding eating disorder treatment in Ontario:

• Eating Disorders Ontario – List of Treatment Programs: A link to the current list of eating disorder services funded across Ontario by the Ontario Ministry of Health (on the Ontario Community Outreach Program for Eating Disorders website)
• Eating Disorders and Stepped Care, and Ontario Service Providers by Step: A Body Brave web page that describes stepped care and lists eating disorder service providers in Ontario according to the level of care provided
• Find a Provider: An interactive tool by the National Eating Disorders Information Centre to help people find eating disorder treatment based on their postal code, virtual or in-person care preference, and insurance coverage

Supporting youth-to-adult care transitions:

• Transitions From Youth to Adult Health Care Services quality standard: A quality standard describing six key opportunities to improve care for young people aged 15 to 24 years transitioning from youth to adult health care services. The quality standard is accompanied by a Patient Guide, a Caregiver Guide, and Resources for Patients and Caregivers containing many useful resources to help smooth the transition process
• mindyourmind Service Transition Plan: A guide to help youth, their families, and service providers prepare for the shift from youth to adult mental health and addiction services

Promoting anti-bias in eating disorder care:

• Eating Disorders and Marginalized Voices: An infographic by The National Eating Disorders Association that presents statistics on eating disorder prevalence among people by race, gender, gender identity, and sexual orientation, and how clinicians are less likely to identify problematic eating behaviour among people of colour
• Eating Disorders and People With Higher Weight: A National Eating Disorders Collaboration (NEDC) web page that addresses important issues to understand about eating disorders and higher weight
• Weight Stigma: A NEDC web page that explains weight stigma, its impacts, and how clinicians can tackle weight stigma in their own practice
• Affirming Care for Every Body: A guide to eating disorders in the 2SLGBTQIA+ community created by the National Eating Disorder Information Centre (NEDIC) and Rainbow Health Ontario. Includes a glossary of terms and resources about eating disorders and 2SLGBTQIA+ people

Resources for primary care providers:

• NEDIC Guide for Primary Care Providers: A concise guide to supporting patients who present with eating disorder concerns, created by NEDIC
• Eating Disorder Toolkit for Primary Care Practitioners: A quick reference developed in British Columbia for primary care providers that promotes recognition and prevention of medical morbidity and mortality associated with eating disorders

Resources for the emergency department: Please note that these guidelines are designed as algorithms for treating individuals with an eating disorder who present to the emergency department. They cannot replace careful clinical observation and judgment.

• Eating Disorders in the Emergency Department: A three-page guide from the Academy of Eating Disorders that summarizes critical points for the recognition and medical management of individuals with eating disorders in the acute care setting. Limitation: “Indications for Immediate Hospitalization” should not replace clinical judgement.
• Pediatric Eating Disorders – BC’s Provincial Community Hospital Guideline: Recommended Care of the Patient with an Eating Disorder in the Emergency Room: a 5-page guideline by the Provincial Health Services Authority for caring for pediatric patients with eating disorders in the emergency department.
• Adult Eating Disorders – BC’s Community Hospital Guideline: Recommended Care of the Patient with an Eating Disorder in the Emergency Room: a 1-page guideline by the Provincial Health Services Authority for caring for adults with eating disorders in the emergency department. Limitation: Although this guideline emphasizes BMI in assessing severity, some patients with higher BMIs may be severely ill.

Descriptions of evidence-based psychotherapies:

• Family Based Treatment (FBT): A handbook for parents and caregivers by Hamilton Health Sciences that describes family-based treatment, its features, phases, challenges, and evidence
• Description of CBT-E: A brief description of enhanced cognitive behaviour therapy (CBT-E) by its originators at CBTE.co

Educational Opportunities for Health Care Professionals

• Ontario Community Outreach Program for Eating Disorders (OCOPED): A provincial training program that aims to increase the capacity of non-fee-for-service practitioners (including physicians covered by OHIP) to respond to the health care pressures of those experiencing eating disorders
• Training Institute for Child and Adolescent Eating Disorders: An organization that provides training and certification in family-based treatment.
• CBTE.co: An organization that provides training and certification in enhanced cognitive behavioural therapy for eating disorders.
• 2SLGBTQ Foundations Course: A seven-module course on 2SLGBTQ health from Rainbow Health Ontario to help health care and social service providers build their foundational knowledge for providing care to 2SLGBTQ people

Additional Resources

For people with an eating disorder:

• Recovery Support Program: An online, self-guided program from Body Brave meant to provide immediate access to low-barrier eating disorder and disordered eating recovery resource and tools
• Peer Support Program: Offerings from Eating Disorders Nova Scotia that include individual peer mentoring, drop-in peer support groups, a youth peer support group, and Two Spirit, Nonbinary, Trans+ peer support groups for people across Canada aged 14+
• Workbook– Break Free from ED: A set of evidence-based learning modules for individuals with eating disorders to guide them through key components of cognitive behavioural therapy for eating disorders (CBT-ED). The modules are designed so that individuals can either complete them independently or with the assistance of a mental health professional

For families and caregivers of people with eating disorders:

• Danielle’s Place Virtual Parent Support Group: A monthly drop-in support group for parents/caregivers who have a child/youth affected by an eating disorder or who have adolescents transitioning to adult care
• Ontario Caregiver Organization: A source of information, tools, and support for caregivers across Ontario. Facilitated, virtual peer support groups for caregivers meet daily, but are not specifically for eating disorders

Other resources:

Quality Standards: Other Ontario Health quality standards that may be relevant to caring for people with eating disorders include:

• Transitions from Youth to Adult Health Care Services quality standard
• Anxiety Disorders quality standard
• Major Depression quality standard
• Obsessive Compulsive Disorder quality standard
• Problematic Alcohol Use and Alcohol Use Disorder quality standard
• Opioid Use Disorder quality standard
• Type1 Diabetes quality standard