W 1.1 - Family-Based Treatment: From the Ivory Tower to the Real World, at All Levels of Care
Ellen Astrachan-Fletcher, PhD1, Daniel Le Grange, FAED, PhD2, Erin Accurso, PhD3
1Eating Recovery Center and Insight Behavioral Health Centers, Chicago, Illinois, USA; 2University of California, San Francisco, San Francisco, California, USA; 3University of California, San Francisco, Department of Psychiatry, San Francisco, California, USA
Although Family-Based Treatment (FBT) is an evidence-based psychological/behavioral treatment for adolescent anorexia nervosa, it is not routinely implemented in community-based clinical settings. In an effort to bridge the research-practice gap (ivory tower vs real world), we have begun research seeking to generate knowledge to inform the adaptation, implementation, and sustainment of evidence-based treatments in community practice. This workshop will include the following outline: We will begin our workshop with a welcome, introduction, and a review of some recent research on FBT (10 minutes). We will then discuss our work that led to the “Family-Based Informed Treatment for Anorexia Nervosa: Handbook for Partial Hospital Program/Intensive Outpatient Adolescent Program” and an overview of FBT in higher levels of care (HLOC). This would include why and how we are adapting FBT for HLOC (30 minutes). Next, we plan to hand out a Questionnaire and give participants time to take the questionnaire regarding attitudes and beliefs about FBT (15 minutes). We will then divide participants into groups to discuss the results of the questionnaire (15 minutes). Following the group discussion, presenters discuss potential solutions for the barriers to using FBT in the “real world,” including role playing difficult situations that might intimidate clinicians and interfere with FBT adoption. The workshop will be concluded by a 20 minute questions and answer period.
Learning Objectives:
- Describe the evidence-base supporting FBT for adolescent anorexia nervosa.
- Identify and understand barriers to using FBT in the “real world.”
- Problem-solve solutions to increase adoption and implementation of FBT.
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.2 - Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR): Children, Adolescents, and Adults
Jennifer J. Thomas, FAED, PhD1, Kamryn T. Eddy, FAED, PhD1, Kendra R. Becker, PhD1
1Eating Disorders Program, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
Avoidant/Restrictive Food Intake Disorder (ARFID) was recently added to the Feeding and Eating Disorders section of DSM-5 to describe children, adolescents, and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of aversive consequences, and/or apparent lack of interest in eating or food. ARFID is so new that there is currently no evidence-based treatment for the disorder. We have recently developed and manualized a novel treatment—Cognitive Behavioral Therapy for ARFID (CBT-AR)—that we are testing in a foundation-funded pilot study at Massachusetts General Hospital in Boston. CBT-AR can be offered in an individual or family-supported format and comprises four stages: (1) psychoeducation and regular eating; (2) re-nourishment and treatment planning; (3) addressing maintaining mechanisms (including sensory sensitivity, fear of aversive consequences, and/or apparent lack of interest in eating or food); and (4) relapse prevention over 20-40 sessions. A case report describing the successful treatment of an 11-year-old girl with CBT-AR is currently in press in the New England Journal of Medicine, and we are actively recruiting CBT-AR trial participants from our ongoing National Institute of Mental Health-funded grant on children and young adults with ARFID entitled “Neurobiological and Behavioral Risk Mechanisms of Youth Avoidant/Restrictive Eating Trajectories” (R01MH108595). Although CBT-AR is still being formally testing for efficacy, we have already achieved promising results in clinical practice, and our workshop will fulfill the critical need of clinicians who are already seeing such patients and as yet have no resources on which to base treatment plans. Our interactive workshop will begin with a brief didactic description of the rationale for and goals of CBT-AR and detailed case examples drawn from a heterogeneous group of children and adults who have benefitted from this treatment (35 mins). We will then use role-plays and experiential exercises (e.g., in-session food exposure for sensory sensitivity, interoceptive exposure for low appetite) to demonstrate CBT-AR techniques across the four stages of this flexible, modular treatment (40 mins). We we will leave ample time for questions and discussion at the workshop’s conclusion (15 mins).
Learning Objectives:
- Describe the basic structure, goals, and session format of CBT-AR for children, adolescents, and adults with ARFID.
- Implement the four basic stages of CBT-AR including (1) psychoeducation and regular eating; (2) re-nourishment and treatment planning; (3) addressing maintaining mechanisms in each ARFID domain; and (4) relapse prevention.
- Tailor CBT-AR to a patient’s unique ARFID presentation by implementing optional modules (e.g., food exposure for sensory sensitivity, interoceptive exposure for low appetite, situational exposure for fear of aversive consequences) as needed.
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.3 - Thinking Critically about Risk and Causality: Implications for Work with Patients and Families
Michael Levine, FAED, PhD1, Janet Treasure, FAED, PhD2, Anne Becker, FAED, MD, MSc, PhD3, Howard Steiger, FAED, PhD4
1Kenyon College, Gambier, Ohio, USA; 2Kings College, London, United Kingdom; 3Harvard University, Boston, Massachusetts, USA; 4McGill University, Montreal, Canada
It is common in publications, conference presentations, and clinical work with patients and families to hear phrases such as “Now we know that eating disorders (EDs) are ´biologically-based mental illnesses’” or “Now we know that EDs are not caused by sociocultural influences.” However, examination of the “evidence base” for these contentions reveals a lack of clarity about logical concepts and evidentiary standards for determining causality and risk. This inattention to detail nurtures an imprecision in language that threatens to render meaningless phrases such as “X is an underlying influence in anorexia nervosa” or “Y sets the stage for bulimia nervosa.” This workshop invites treatment professionals, clinical researchers, and advocates for families to consider in depth several perspectives on the nature of scientific “evidence” in “evidence-based” claims about the causes of EDs. Specifically, this workshop integrates work by a U.S. psychiatrist and medical anthropologist who examines social and cultural mediation of body image and eating disturbance; a Canadian clinical psychologist who studies, and applies in his clinical work, how certain individuals carry real biological susceptibilities that are “switched on” by specific environmental triggers; a British psychiatrist who integrates our understanding of aetiology and how this impacts interpersonal relationships into training for patients, friends, and family; and a U.S. experimental psychologist who applies sociocultural models of risk to prevention programming. Thus, the presenters combine theory, empirical findings, and clinical experiences to help participants improve their ability to be accurate and authentic in talking with patients and families about what we know and do not know in regard to causality and risk, while endeavoring to increase self-acceptance, reduce shame and anxiety, and increase hope and motivation for change.
Learning Objectives:
- Define—in conceptual and methodological terms—and thus distinguish between, a correlate, a risk factor, a protective factor, and a causal (risk) factor for eating disorders
- List three specific ways in which what we know about genetics and brain science can be translated into plain language that will improve work with patients and families in the treatment of anorexia nervosa.
- List two important reasons why standard approaches to thinking about and studying risk factors have limitations
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.4 - Implementing the ´Happy Being Me’ body image intervention programme: Learning from United Kingdom and Australian experiences
Susan Paxton, PhD1, Siân McLean, PhD1, Catherine Stewart, DClinPsy2, Elizabeth Goddard, PhD2, Mima Simic, MSc2, Gill Allen, MA2
1La Trobe University, Melbourne, Australia; 2South London and Maudsley NHS Foundation Trust, London, United Kingdom
Schools are ideal settings for body dissatisfaction prevention; however, dissemination is limited by lack of opportunities for training in evidence-based approaches. This workshop will provide practical training in delivery of the Happy Being Me (Dunstan, Paxton & McLean, 2016) body image programme. The workshop will first review empirical support for the intervention including previous research trials of Happy Being Me in Australia and the UK, and a recent implementation in UK schools by a clinical service to whole classes of 11-12 year old girls and boys (N=150). Preliminary analysis reveals significant changes in body satisfaction, appearance comparison and self-esteem (p = 0.001). The workshop will use an interactive format to involve participants in experiential learning to become competent presenters of body image interventions addressing: peer environments and appearance conversations, media pressure to conform to appearance ideals, engagement with social media, internalisation of appearance ideals, and body comparison. Participants will participate in guided small group role plays of key intervention activities, and engage in collaborative learning to experience media literacy and dissonance approaches to attitude and behavioural change. Program materials will be made available to participants. The workshop will conclude with a discussion of challenges in implementation and dissemination of school-based prevention, including: timetabling; required expertise, training of school based professionals, and alignment of positive body image approaches with curriculum and policies regarding obesity prevention, mental health, and social media engagement. The workshop structure will be as follows: Review of evidence (15 minutes); Role plays (20 minutes); Engagement in media literacy (20 minutes); Exploring social media engagement and effects on body dissatisfaction through representative profile pictures (20 minutes); Challenges of program implementation (15 minutes).
Learning Objectives:
- Apply skills to implement key intervention activities in small group formats
- Apply media literacy strategies to deconstruct traditional and social media messages to reduce persuasive influence of media and social media-based peer interactions
- Identify challenges and implement strategies to overcome barriers to school-based body image intervention delivery
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.5 - Medical Complications of Severe Malnutrition
Margherita Mascolo, MD1, Philip Mehler, MD1
1ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
This workshop will focus on the common medical complications of severe malnutrition and their management, is based on the expertise developed at the ACUTE Center for Eating Disorders at Denver Health. It will include complications special to anorexia nervosa restrictive subtype, binge-purge subtype as well as complications common to both. This is a case-based interactive presentation in which 9 cases are discussed. The cases will focus on common complications of malnutrition and offer practical guidelines for their evaluation and management. There are two cases specific to binge-purge subtype of anorexia nervosa and the remaining 7 are based on complications common to both subtypes. Each case will last about 4 minutes with additional time for questions. Discussion is based on a combination of expertise gained over years of caring for severely malnourished patients as well as based on scientific data and literature review. Case 1: Vital sign abnormalities: bradycardia, hypotension, and hypothermia. When to worry? Case 2: Hepatitis: What’s the work up? What is the mechanism? Case 3: Pancytopenia: Do we need a bone marrow biopsy? What’s the mechanism? Case 4: Hypoglycemia: How do we treat it? Case 5: Osteoporosis: What do we recommend to these young patients? Is treatment different for males and females? Case 6: Refeeding syndrome: With focus on hypophosphatemia and edema Case 7: Gastroparesis: Who is at risk? Do we need radiology studies to diagnose? How do we treat? Case 8: PseudoBartter syndrome seen in bulimia nervosa and binge-purge anorexia: What does it mean? Why do patients become edematous? Can edema be prevented? How can we treat it? Case 9: Purging, diuretic and laxative abuse: how do we detox patients? What long term sequelae can patients have? Do we taper abused laxatives and diuretics? How do we deal with the ensuing electrolyte abnormalities?
Learning Objectives:
- Identify the most common medical complications of severe malnutrition due to anorexia nervosa and bulimia nervosa.
- Understand evidence-based management of severely malnourished patients.
- Recognize criteria for admission to the hospital for treatment of severe malnutrition.
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.6 - International Perspectives on Nutrition Counseling
Marcia Herrin, EdD, FAED, MPH, RD1, Shane Jeffrey, BSc, RD2, Anu Ruusunen, MS, PhD, RD3
1Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA; 2Royal Brisbane and Women’s Hospital, Brisbane, Australia; 3Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
Nutritional rehabilitation is a key element in the treatment of eating disorders. In most inpatient and outpatient settings throughout the world, dietitians provide the clinical management necessary to correct abnormal nutritional status and dietary patterns that characterize eating disorders. Yet, standards for nutrition practice have not been established. This workshop will be a step toward developing consensus-based standards. Workshop leaders will summarize the nutrition guidelines and standard practices from across the world and present the results of in-depth interviews with some of the world's most experienced dietitians. The workshop will conclude with participants having the opportunity to participate in a Nominal Group Technique to reach consensus on best nutrition practices. Lesson Plan: Introduction of speakers and topic (10 minutes); Survey audience (10 minutes); Content (40 minutes); Nominal Group Technique (20 minutes); Concluding remarks (10 minutes).
Learning Objectives:
- Describe the difference in guidelines and practices in nutrition settings across the world.
- Identify best nutrition practices and discuss implications for various treatment settings.
- Integrate three advanced nutrition counseling techniques into their practice.
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.7 - One Size Does not Fit All: How Moderators and Follow-up Data from Randomized Controlled Trials can Inform Integrative Treatments and Matching Interventions to Patients Beyond Eating Disorder Symptoms
Heather Thompson-Brenner, PhD1, Stephan Zipfel, MD2, Susanne Lunn, MSc3, Eytan Bachar, PhD4, Dana Satir, PhD5
1Boston University, Cambridge, Massachusetts, USA; 2University Medical Hospital Tuebingen, Tuebingen, Germany; 3University of Copenhagen, Copenhagen, Denmark; 4Hadassah University Medical Center, Jerusalem, Israel; 5University of Denver, Boulder, Colorado, USA
Ongoing research efforts to improve existing treatment outcomes for EDs often assume homogeneity within groups, in spite of empirical efforts suggesting high rates of diagnostic cross-over as well as significant within group variability in personality and overall functioning. While several randomized controlled trials have compared the relative efficacy of psychodynamic and cognitive behavioral approaches in particular, recent analyses of moderators and follow-up data inform matching treatment approaches to patients beyond manifest ED symptoms and integrating behavioral with affective and relationally focused interventions to promote long-term positive outcomes. The purpose of this workshop is to bring together three prominent clinical research groups from across the world to lead an interactive discussion and answer the following key questions: 1) what particular treatments help specific ED patients subgroups improve and maintain progress; 2) how do the research data, including moderator and follow-up analyses, inform mechanisms of change; 3) and ultimately how can clinicians integrate different theories and tailor interventions at various stages of treatment. We will first present an overview of major theoretical accounts of EDs in the treatment of adult AN and BN. Next, panelists will discuss treatment outcome research and recent data analyses from three separate clinical trials, including predictors of outcome in psychodynamic psychotherapy (PPT), CBT, and nutritional counseling from a mixed community sample of recently hospitalized patients; moderators of drop-out in CBT and PPT for BN; and long-term outcome of CBT, TAU and PPT for AN. Panelists will demonstrate treatment techniques, therapy process and approaches to the assessment of key areas of functioning in EDs and related symptoms. The latest findings in ED research and their direct clinical applications will be reflected in a group process that informs what works best for the individual patient.
Learning Objectives:
- Describe current theories and their evidence bases in the treatment of adult AN and BN
- Identify moderators of treatment outcome and predictors of follow-up in EDs for CBT, PPT, and TAU
- Assess specific interventions by patient subtype
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.8 - A Triple Perspective on Barriers to Eating Disorder Treatment
Mark Warren, FAED, MD, MPH1, Leah Dean, BA, Other2, Mirjam Roelink, BS, MS3
1The Emily Program • Ohio, (formerly Cleveland Center for Eating Disorders), Cleveland, Ohio, USA; 2F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders), Milwaukee, Wisconsin, USA; 3Recovery Warriers L.L.C., Amsterdam, Netherlands
Three members of the Patient-Carer Committee - a clinician, a former patient, and a parent - will offer unique, multi-perspective insights into (perceived) barriers to treatment, in order to spark a dialogue on efforts to improve patient care, strengthen family and community support services, and empower parents to be effective and engaged caregivers. Each presenter will be given equal time and will draw upon personal experience as well as the reported experiences of peers. Barriers presented from the clinician perspective include the lack of access to a full clinical team - especially well trained medical providers, the lack of access to a full range of care services, the tenuous and often misunderstood relationship between research results and clinical results, inadequate treatment options to support connection, commitment and motivation for patients/families, and the need for better quality evidence based treatments overall. Barriers from the patient perspective will focus on internal factors such as anosognosia, stigma, shame, negative attitudes towards seeking help, complex fears, and the walls of resistance that must be broken down in order to allow for recovery. Barriers presented from the parent perspective will focus on external factors, and include compromised standards of medical care, financial limitations, legal complications, lack of communication between treatment team professionals, and the marginalization, blaming and disempowerment of parents. Each presenter will offer solutions for how to identify and address barriers to treatment that pose potential harm to patients and families, and which can derail the best efforts of clinical care. Workshop participants will be able to relate to the barriers presented through a personal and experiential narrative that is authentic, genuine, and heartfelt; and, will better empathize with the frustrations these barriers cause for patients and carers.
Learning Objectives:
- Recognize the importance of including multiple perspectives in formulating a treatment plan, and learn to listen to clinician, patient and carer experiences, observations and concerns in a manner that illuminates the specific barriers that are preventing
- Identify universal and pervasive barriers to effective treatment and integrate into their practices strategies for facilitating better workarounds that strengthen the patient/parent/clinician relationship and maximize the potential for recovery.
- Advocate for improvements to early identification and first interventions, educate others in order to reduce shame, stigma and to debunk myths, provide accessible information about eating disorders that improve public understanding and promote evidence-based treatment.
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.9 - Transforming treatments for child and adolescent eating disorders by investing in early intervention and rapid access to specialist community based services
Ivan Eisler, CPsychol, FAED, PhD1, Rachel Bryant-Waugh, BSc, DPhil, FAED, MSc2, Annemarie van Elburg, FAED, MD, PhD3, Sloane Madden, BA, FAED, MBBS, PhD, Other4, Leora Pinhas, MD, MSc, Other5, Dasha Nicholls, FAED, MBBS, MRCPsych, Other2, Mima Simic, MD, MRCPsych, MSc1
1South London and Maudsley NHS Foundation Trust, UK, London, United Kingdom; 2Great Ormond St Hospital NHS Foundation Trust, London, UK, London, United Kingdom; 3Rintveld Center for Eating Disorders, Netherlands, Bilthoven, Netherlands; 4Sydney Children's Hospital Network, Australia, Sydney, Australia; 5Eating Disorder Unit, Ontario Shores Centre for Mental Health Sciences, Canada, Toronto, Canada
In recent years significant progress has been made in developing effective treatments for ED with a degree of consensus as to what works. Nevertheless, disseminating effective treatments has been slow and for those suffering from ED, finding access to expertly delivered evidence-based treatments is often difficult particularly early on in the course of the illness when the chances of rapid recovery are highest. In December 2014 the UK Government decided address this problem by investing £150m over 5 years to transform services in England for children and adolescents with ED. A specific aim of this investment was to provide easy and rapid access from primary care to specialist community based multidisciplinary services to ensure early, effective treatment is available to all, regardless of the severity of their illness. We will describe some of the factors that led the Government to allocate this funding at a time when other health service budgets were being cut and the way this pledge is being implemented across England. We will present new health-economic data from the London Care Pathways study which had a key role in convincing the UK Government that investing in specialist community based child and adolescent ED services would not only improve clinical outcomes by providing access to expert evidence-based treatments but would also achieve significant cost savings. The major part of the workshop will be to explore the potential applicability of this type of service model in different health service contexts and the range of opportunities, strengths as well as potential pitfalls that large funding initiatives of this kind may bring. Discussants from several countries with different health service contexts will work with the workshop participants to consider a) the range of service provisions for eating disorders available in their country b) how treatment is funded and the opportunities and constraints this provides and c) the extent to which the service model being developed across England might be applicable to their own health service context and how it would need to be modified. Workshop structure: London Care Pathways study • 10 min Access and waiting times transformation plans in England • 20 min Brief comments by discussants • 10 min Discussion in small groups • 30 min General discussion • 20 min
Learning Objectives:
- Following the workshop participants will be able to describe key features of specialist and non-specialist care pathways of child and adolescent eating disorders
- Following the workshop participants be able to demonstrate the cost effectiveness of different service models for treating child and adolescent eating disorders
- Following the workshop participants will be able to evaluate the strengths and weaknesses of different service level approaches to the treatment of child and adolescent eating disorders
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.10 - Becoming a Leader: What Does it Mean for Us and Our Field?
Dianne Neumark-Sztainer, FAED, MPH, PhD, RD1, Debra Franko, FAED, PhD2
1University of Minnesota, Minneapolis, Minnesota, USA; 2Northeastern University, Boston, Massachusetts, USA
As we move forward in our careers within the field of eating disorders, many of us will be asked, or will choose, to move into administrative and leadership positions. The choice provides us with dilemmas and opportunities at both the individual level and in the work we do in our field. In administrative positions, we may have less time to work as clinicians or researchers, after many years of gaining skills in these areas. We may have less time to devote to the field of eating disorders within our specific areas of expertise. On the other hand, these positions offer us opportunities to have an influence in a different manner as we determine agendas, create budgets, and work toward changes in our work environments. Recently, we (i.e., the workshop leaders) have taken on large administrative/leadership roles within our academic institutions and are dealing with new kinds of challenges. The focus of this workshop will be on sharing our experiences • the good, the hard, and the ugly! The format of the workshop will include 15-minute presentations by both of us about our own journeys and experiences, highlighting our trajectories and decision-making processes. This will be followed by an hour of interactive activities and discussion. We will teach leadership skills that participants can take with them to use as they transition over the course of their careers. Hands-on activities focusing on creating teams, understanding power and influence, and identifying strengths will provide a toolkit for participants that can be called upon as they move into leadership roles of any type (research, clinical, or administrative leadership). Small group work, brief assessments, and role play will be used to enhance active learning. We also will promote a discussion among others in the audience who have either moved into administrative or other leadership roles - or are thinking about doing so. Come ready to share!
Learning Objectives:
- Describe factors to be considered in making the choice to transition to leadership positions.
- Learn tools to be better leaders, including, but not limited to, leading better teams, dealing with conflicts, and making decisions.
- Discover strategies for advancing the field of eating disorders from within leadership positions.
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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W 1.11 - The primary prevention programs Healthy and Free and Zippyˆs friends: international collaboration and Czech Reform of Psychiatry.
Jana Gricova, MA1,2, Marketa Cermakova, MA2, and Hana Papezova, MD, PhD1
1Eating Disorders Centre, Department of Psychiatry First Faculty of Medicine Charles University in Prague, Czech Republic; 2Prague Center for Social Services, Prague Primary Prevention Centre, Czech Republic
As we move forward in our careers within the field of eating disorders, many of us will be asked, or will choose, to move into administrative and leadership positions. The choice provides us with dilemmas and opportunities at both the individual level and in the work we do in our field. In administrative positions, we may have less time to work as clinicians or researchers, after many years of gaining skills in these areas. We may have less time to devote to the field of eating disorders within our specific areas of expertise. On the other hand, these positions offer us opportunities to have an influence in a different manner as we determine agendas, create budgets, and work toward changes in our work environments. Recently, we (i.e., the workshop leaders) have taken on large administrative/leadership roles within our academic institutions and are dealing with new kinds of challenges. The focus of this workshop will be on sharing our experiences • the good, the hard, and the ugly! The format of the workshop will include 15-minute presentations by both of us about our own journeys and experiences, highlighting our trajectories and decision-making processes. This will be followed by an hour of interactive activities and discussion. We will teach leadership skills that participants can take with them to use as they transition over the course of their careers. Hands-on activities focusing on creating teams, understanding power and influence, and identifying strengths will provide a toolkit for participants that can be called upon as they move into leadership roles of any type (research, clinical, or administrative leadership). Small group work, brief assessments, and role play will be used to enhance active learning. We also will promote a discussion among others in the audience who have either moved into administrative or other leadership roles - or are thinking about doing so. Come ready to share!
Learning Objectives:
- Describe factors to be considered in making the choice to transition to leadership positions.
- Learn tools to be better leaders, including, but not limited to, leading better teams, dealing with conflicts, and making decisions.
- Discover strategies for advancing the field of eating disorders from within leadership positions.
Category
Workshops Session 1 - Thursday
6/8/2017 2:15 PM
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