Kartini Clinic for Children and Families

Pediatric Eating Disorder Treatment Program

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Kartini School: A Success Story

February 9, 2022 by Morgan O'Toole-Smith

[Ed. note: This is one in a series of guest blogs by our Kartini School administrator, Mary Gunesch. With schools returning to at least partial in-person instruction we thought it a good time to focus on this subject.] 

When a student begins treatment at Kartini Clinic, we reach out to their school.  We find out what they should work on in their classes – what the learning objectives are – and we support them as they work to achieve these objectives.  Some teachers tell us to look at Google Classroom where they post assignments; some teachers stay in regular contact and provide extensive information; some teachers provide very little.

We support students, whatever their school’s response (or lack of response) may be.

We had a student who began with us at the end of January.  She was a senior in high school; she had two required classes to graduate.  We told the school that we could contract with them and partner with them to provide this student (who was very sick) with the support she needed to complete these classes.

The girl’s parents were afraid that she might give up and drop out.  They asked for our help.

The patient was in a dark place.  She was eating nothing.  The doctors were worried about her cognition.  They put in an NG tube.

In school, the girl told us she couldn’t concentrate. We gave her a graphic novel to read. She was able to do that.  

When we talked to her district, they said they didn’t need to contract with us; they would provide a tutor.  I told them that the girl was in treatment all day, each day of the week. They said, “No problem, we can get a tutor who will meet with her in the evening or on weekends.” They said the tutor would call me.  When the tutor called, she said, “I can do any day, Monday through Friday.” I asked about evenings or weekends and she said she couldn’t do that.

When I told the school district what I’d heard they said, “Oh, then the student can just wait until she is better, and we’ll give her a tutor then.”  I told them that the student did not want to wait, she wanted to finish what she needed to do and be done.  The student said she would do the district’s online program.  I asked the district about that and they said that program was full so she couldn’t do that.  They said, “But if you create a learning plan for her, we will be happy to accept the work she does with you.” 

So, that’s what we did. We designed an Economics class and a Senior English class.  She read Fahrenheit 451 and wrote an in-depth response.  She talked about how it was interesting that it was written over 50 years ago, but it is relevant today, with us spending so much time on our screens.  She also studied and discussed what was happening to the stock market in response to COVID-19, and she created a plan for economic recovery following the pandemic.

All along, she was recovering physically, slowly but surely. After 11 weeks, she was well enough to go home.  

The Governor had just announced that all seniors who were “on track in their classes and passing” would be done with school and ready to graduate.

Fortunately, we were able to report to her school that she was “on track and passing” in her classes.  They were happy to get our report.

Our student graduated this spring.

Filed Under: Family-based Treatment, Kartini School

Online Reviews

September 23, 2021 by Morgan O'Toole-Smith

This post is from Kartini Clinic CEO Morgan O’Toole. 

Online reviews have become part of our everyday lives. Who hasn’t glanced at the star ratings when Googling a new hair salon or looking for a restaurant to try out? Most of the time, online reviews are just another useful data point when trying to make a casual purchasing decision.

But more essential services like doctor’s offices and health clinics come with Facebook and Google ratings these days, too. Kartini Clinic is one of them. Unlike restaurants or hair salons, however, we are strictly limited in our ability to respond to reviews, even when they contain content that is factually untrue or even implies active wrongdoing on the part of clinic staff. While we are always grateful to receive constructive feedback and are eager to work with families to resolve any issues they have during their time at Kartini Clinic, when problems are expressed in the form of an online review, our options to respond are very limited.

These reviews have also sometimes become a way for our young patients to express their frustration during a difficult period in their lives. One example occurred very recently: a spate of negative reviews, at least one of which was written under a pseudonym, claiming to be patients or friends of patients at Kartini Clinic appeared in a matter of hours. Though treatment is spent working with parents and patients towards a positive, often live-saving goal, there is no question that the day-to-day process of recovery can be difficult. As we have discussed on this blog before, eating disorders are brain disorders. As with any brain disorder, children who suffer from them may be  looking at the world through a distorted perspective — including, in many cases, an inability to acknowledge that their disordered eating is problematic at all. This is a clinical phenomenon called anosognosia.

(Incidentally, this is also partly why Kartini Clinic believes so firmly that weight restoration must be the first step in treatment. Malnourishment only exacerbates these problems. No one’s brain functions properly when they’re starving.)

Parents, we urge you to engage your children on this subject. Please help us to ensure your child is expressing their fear and frustration in a constructive way. And if you have any feedback for Kartini Clinic, we encourage you to reach out to us at help@kartiniclinic.com, where we will be able to directly address your concerns. We always welcome the scrutiny.

We also invite parents to share their family’s experiences at Kartini Clinic, either publicly or privately. Private comments may be directed to an individual staff member, or to help@kartiniclinic.com. If you are willing to share publicly, you may do so on Google or our Facebook page.

Filed Under: Eating Disorders, Anorexia Nervosa, Eating Disorder Treatment, Family-based Treatment, Recovery Tagged With: reviews

Tips for Motivating Kids in School

January 19, 2021 by Morgan O'Toole-Smith

[Ed. note: This is one in a series of guest blogs by our Kartini School administrator, Mary Gunesch. With schools returning to at least partial in-person instruction we thought it a good time to focus on this subject.]

At Kartini Clinic for Children and Families we take the second part of our title, “for Children and Families,” seriously.  We treat children suffering from a wide range of eating disorders – from anorexia nervosa to high body weight – and in this work we know that the family (whatever that may be: Traditional, nontraditional, foster family, or something else) plays a key role in recovery.  The founding doctor of the clinic, Dr. Julie O’Toole, with 25 years of experience says, “Getting support from the family is critical to success.”

In our current situation, with schools either closed or limited to partial in-person instruction for the rest of another academic year, the same thing could be said about education.

Schools are working hard to provide learning materials. Many activities are accessible online; other resources are available on paper. There’s no shortage of what to learn.

But kids need more than the “what” of learning right now.  They need the “why.” 

Many children and teens rely on their relationships with teachers and friends to get them out of bed and headed to school every morning.  Now, “off to school” means 10 steps to the folding table recently set up as a temporary desk at home.

What can families do to give kids the motivation to learn in this topsy-turvy time? Here are some tips:

1. Do schoolwork with your child.  Whether your child is 6, 12, or 20, you can learn together. Your first grader’s work is cute – read the assigned book with them and ask them to act out their favorite character. Your seventh grader’s work may have you re-learning things you’ve forgotten (like phases of the moon); after they finish the unit, let them refresh your memory, and be sure to show genuine interest. Your 20-year-old’s college work may be something you never learned, but have them explain it to you; the ability to summarize is a fabulous way to understand better what they are learning.

2. This unprecedented time is an opportunity to focus on the content of what your kids are learning rather than how they are doing. Learning management systems adopted by schools in recent years, like ParentVUE and Schoology, tell parents how their kids are doing (they got a 78% on the test, for example) but they don’t tell parents about what kids are learning.

3. As it was with Goldilocks, the learning level needs to be “just right,” i.e., not too hard and not too easy. If the work is just ahead of their current level of proficiency, a little bit ahead of where they are, that is best. If the work provided by school is definitely too hard, communicate with your school. Ask about alternatives. (“My child still doesn’t understand how to add fractions with common denominators yet. Can we work on that before we do the problems with unlike denominators?”) A good teacher will work with you and be thrilled that you noticed. On the other hand, if the work is too easy, that’s boring for kids. Again, ask about something different. If fractions are easy for your child, maybe they can triple a recipe or change the scale of the directions to build a birdhouse.

4. Talk with your kids about what they will get when they complete the learning goal. Some children may need something material to aim for, like a new bike helmet they’ve been wanting.  Other kids will be happiest to get your time. Tell them that when they complete the assignment, you will play a game with them.

5. Speaking of games, there are many great ones for learning: Scrabble, Catan, Code Names, and many others. You can also modify a game to make it an educational game: At Kartini School we play Scattergories revised to have categories like: U.S. Presidents, State Capitals, and famous authors and artists.

6. Foster a growth mindset.  From the work of Carol Dweck, we know that kids do better when they think that effort is more important than innate ability. Try not to let your child believe they don’t have what it takes to do something.  There are many stories of hard work winning out over innate ability (e.g. the story of Rudy). Try to help your child use phrases like “I’m almost there” or “I’m getting it.”

7. Finally, don’t be afraid to ask for help. One school district recently posted a notice that they had been inundated with offers from people who wanted to volunteer. Reach out.

At Kartini Clinic we have a school, Kartini School, where we support students for weeks and sometimes months while they are out of their regular schools for medical treatment. We help kids understand concepts and achieve learning goals. What parents are doing now is the same: supporting kids who can’t be in their regular classrooms. This is challenging for sure, but the rewards are great. So tally-ho, temporary teachers, and remember to model a CAN DO attitude for your children and teens.

Filed Under: Family-based Treatment, Kartini School

Dr. O’Toole to retire at the end of 2020.

December 16, 2020 by Morgan O'Toole-Smith

It is with decidedly mixed emotions that we announce our founder and chief medical officer, Julie O’Toole MD, MPH, will retire at the end of this year.

First I’d like to mention that (for once!) this has nothing to do with the pandemic. Dr. O’Toole’s retirement has been planned for some time; more than anything an exact date has always been dependent on our ability to prepare our clinical team for this momentous transition. And we are ready!

Second I’d like to stress how much things will remain the same. Replacing Dr. O’Toole at the helm will be our current medical director, Naghmeh Moshtael MD, assisted by our excellent team of medical and behavioral health providers, many of whom have been with us for the better part of two decades. We remain the most experienced pediatric eating disorder treatment team in the country (if not the planet), bar none.

Lastly I want to thank all of our families over the years – and for all the years to come – for entrusting us with the care of your children. Dr. O’Toole taught us that it is an honor and a privilege to do so, and we pledge to continue the pioneering work she began back in 1998. The mission continues.

Happy Holidays and a health and prosperous New Year to you and your family.

Thank you.

Morgan O’Toole, CEO, Kartini Clinic

Filed Under: Uncategorized

See Something, Say Something

March 7, 2019 by Morgan O'Toole-Smith

See something, say something is what the anti-terrorist watch tells us at the airport and in public spaces. When people take individual and collective responsibility for reporting whenever they see something potentially dangerous, something not right, it’s possible to prevent catastrophes.

 

An alert went out on the AED (Academy of Eating Disorders) listserv from Wendy Oliver-Pyatt, MD who had caught wind of a weight loss study recruiting subjects in Australia under the auspices of Children’s Hospital Westmead (Sydney) and Monash Medical Centre (Melbourne). The lead investigator is Professor Louise Baur; the Sydney Children’s Hospital Network Human Research Ethics Committee approved her proposal.

I did not respond in great detail on the listserv, except to protest children being dieted in general, as I had not yet seen the actual proposal. But now I have seen it.  For those of you who wish to read it in its entirety, here is the link.

First, let’s be clear, this is not a study for consenting adults which includes some teens, it is a study designed for children and adolescents. The youngest participants will be 13 and the oldest 17. They are looking for the equivalent of a 5% reduction in body weight in an adult or 0.12 point reduction in BMI z score in an adolescent. They say nothing about the sustainability of this weight loss, just that the fact of it will be considered a “successful endpoint”. We all know that dieting causes weight loss in the short term, but nearly always fails in the long term, so how is this progress?

The study lasts an entire year—which in my view is a very long time to starve a dog, much less a child. You have to have a BMI of between 30-45 to participate, which means that someone – likely several someones – has identified you as “fat” with all the psycho-social ramifications of that. A plethora of lab tests and frequent checks by a dietitian make it look medical, but I do not see pediatricians or adolescent medicine physicians referenced anywhere in the protocol. The dietitians are going to weigh the kids, but no one is checking their pubertal status, which matters a great deal when assessing growth and development; they measure their blood pressure but do not mention monitoring their menstrual status.

So if the teen-aged girls stop menstruating with weight loss and dietary restriction, would that still be a successful outcome?

Incredibly, the year-long study starts with all of the children being taken down to an 800 kcal a day, very low fat (less than 20%) diet consisting of “meal replacements”. Study authors think they will have an attrition rate over the year of 30% — I think it might be closer to 90% (run, children, run!). This painfully low level of initial food intake will last one month (4 weeks) for everyone, after which the subjects will be randomly assigned to one of two arms: the Modified Alternate Day Fasting arm and the Standard Hypocaloric Diet arm.  

In the alternate day fasting arm the children will eat 300-600 kcals/day for three non-consecutive days a week and a “healthy diet” not restricted in amounts for the others. The “healthy” bit means they will be “coached” to adhere to the Australian Dietary Guidelines which, if you look at them, state that one should only eat “small amounts of fats” and “mostly low-fat dairy.” Wow! Didn’t they get the memo?  Does anyone in the government actually follow the science as it evolves?  Children need fat to grow, or as one researcher points out: “Long-term dietary deprivation of (n-3) fatty acids results in measurable changes in the visual and neurological function of primates (Neuringer and Connor 1986).”  News flash: we are primates.

There are so many worrisome points (e.g., how does a 13 yr consent to this study?)  it is hard to know where to begin, and as I read on I found myself racing from one point to another, dizzy from the effort. Those children who were randomized to the non-fasting arm, or the “standard low calorie” arm as they put it, eat a diet consisting of 1434-1673 kcals/day at age 13 to 14 or 1673-1912 kcals/day for those 15 to17 years of age. Slim pickins! This so-called “healthy” diet is “high fiber” (> 30 gms/day), “moderate” carbohydrate and “moderate” protein, no mention made of dietary fat.

And the psychological “support”? Let’s remember these are kids and now they are very hungry kids who are already shamed by their size/weight and doubtless would blame themselves for any “failure” to comply. For support they see a dietitian at week 20, 26, 36 and then, as “additional support”,  receive an email, text or phone call lasting 10-15 minutes at weeks 18, 24, and 48.  

You have to ask: they receive support to do what?  Stick to the diet?

And don’t be fooled by a raft of psychological tests administered: the Body Appreciation Scale, the EDE-Q, and various quality of life questionnaires, self-esteem questionnaires and depression questionnaires. These are designed to help the study, not the kids, as it merely reports their symptoms, but cannot address them. Nor do I see a protocol for what to do should severe psychological distress arise as a result of the semi-starvation.

All of this is reason enough, in my view, to refrain from allowing your child to participate in a dieting experiment. Try it out on yourself for a month and see what I mean. Now imagine being a 13 year old kid who weighs 250 lbs and who has to live with hunger every day of their life for a full year, at school, on the playground and at home and who then, after all that, “successfully” weighs 237 lbs.

And here’s one more pressing reason not to allow it: it’s cruel.

So I have seen something, and I’m saying something: cease this madness and end this appalling and unethical experiment on children.  Please join me. Share this with your colleagues, friends, and elected representatives (if you’re in Australia). Let’s speak up and speak out.  And if the authors of this study believe we have misinterpreted their intentions, let’s have an open, respectful, scientific discussion about the merits, before a single child is enrolled.  Thank you.

Filed Under: Eating Disorder Research, Eating Disorder Treatment, Evidence Based Treatment, Family-based Treatment

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At Kartini Clinic we practice only evidence-based, family-centered eating disorder treatment. Our program is a multi-disciplinary medical and psychiatric treatment model rather than an exclusively psychiatric approach to eating disorder treatment.  read more »

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