School strategies for assisting students with eating disorders

Mandated student support programs

Many public school districts are mandated to provide student support in the form of either a Response to Intervention or Multi-Tiered System of Support (MTSS) program. These programs typically cover any area, whether academic, behavioral, or socio-emotional, in which a student might need support. The MTSS approach consists of three tiers increasing in intensity from Tier 1 to Tier 3 as follows:

  • Tier 1: primary, about 80% to 90% of student population. Regular education plan, clearly communicated expectations for behavior and conduct in the school setting. If a student experiences difficulties at this level, core intervention by the teacher is often implemented, with construction of a simple classroom plan designed to increase academic or social skills, or keep behavior on task.
  • Tier 2: secondary, about 10% to 15% of student population. If student continues to have difficulties, an academic specialist (such as a reading specialist) may be introduced, along with an additional time period of extra instruction. For behavioral issues, a mentor or social skills group could be utilized. Tier 2 services can last anywhere from 6 to 20 weeks.
  • Tier 3: tertiary, about 1% to 5% of student population. Most intensive interventions at the school level. A Functional Behavioral Assessment or other comprehensive academic testing may be necessary to determine the extent of the student’s need for additional support. At this level, students are often referred to the school psychologist for evaluation for an Individualized Education Plan, which can address both academic and socio-emotional needs. Individual or group sessions with a school counselor or behavioral specialist may be provided, and this person will communicate with school personnel and the family to develop the best treatment plan for the student.

Public school districts are mandated to provide this support. If they do not have staff to do it, they must find someone. Often a county intermediate unit will have a psychologist or behavioral specialist assist the district in developing interventions for the students.

Creating a school strategy

It takes a village—administrators, teachers, guidance counselors, school nurses, coaches, and parents—to create an effective strategy and check periodically to assess how well it’s working and whether gaps exist. This checklist of “to-dos” is a useful start of things to consider.

Checklist: Developing a school-wide strategy

  √  Develop a student assistance program (SAP) and protocol, if one is not already in place (see sample SAP student information form), for students, faculty, and staff to channel nonacademic concerns about a student. This should create an appropriate pathway that adheres to the local laws and regulations governing communications among teachers/parents/students/outside healthcare.

  √  Designate a subgroup (of at least two members) of the SAP to “get smart” about eating disorders and share their knowledge and expertise with other school personnel and plan an in-service, if possible.

  √  If a full in-service is not possible, plan some time at a faculty meeting to discuss eating disorders or hand out basic information to staff on healthy body image, nutrition, signs and symptoms of eating disorders, and coach and teacher tip sheets. It is extremely important to educate teachers, administrators, and coaches on not only signs and symptoms of eating disorders, but also on ways to support and encourage concerned peers and teammates to express concerns about a student with a suspected or known eating disorder. Many schools do not currently have training on this for school personnel outside the guidance department.

  √  Create specific guidelines on referrals for students suspected of having an eating disorder. Be prepared to refer students and families to appropriate local counseling resources and medical practitioners that specialize in eating disorder treatment.

  √  Update school policy on anti-harassment and anti-discrimination policies to ensure they include provisions about physical appearance and body shape. Ensure that a protocol is in place for students to report teasing, bullying, or harassment based on weight or appearance. Be sure the consequences for bullying behavior are clear.

  √  Decide which staff will take responsibility for monitoring and communicating changes in a student’s well-being through appropriate channels to concerned parties (and in accordance with confidentiality, laws, and SAP protocols). That teacher or staff person should take on the role of “checking in” with the student each week for a few minutes to see how he/she is. This may involve informal chat during lunch, recreation time, or before or after school as appropriate.

  √  Distribute to staff checklists they can use about typical physical, social, behavioral, and psychological signs and symptoms of eating disorders to facilitate monitoring changes that could signal progression to a more serious condition so that a student can be referred to specialist support as warranted.

  √  Make it a policy not to weigh students publicly or in close proximity to fellow students. Consider eliminating weigh-in policies for sports programs if they are not absolutely necessary.

  √  Advocate for nutritious foods in school cafeterias and elimination of unhealthy foods and vending machines with unhealthy (junk) foods.

  √  Consider offering a community outreach program on eating disorders with invited experts.

  √  Review posters/books/materials in the school to ensure they include all body shapes, sizes, and racial groups.

  √  Ensure that students of all sizes are encouraged to participate in school activities, such as band, cheerleading, student government, and theater groups. Ensure that students are not typecast by appearance in drama roles

How to help students

Peers experience anxiety, frustration, and confusion about how to help. Make sure you also address this aspect of support. The friends of the student with an eating disorder can also support a student who has an eating disorder by learning basic information about eating disorders and knowing how to approach a conversation with the individual. Such information can be integrated into health education or lifestyle classes. Two checklists provided here offer pointers on how to assist a student with an eating disorder once that student has disclosed the problem and how to support peers of students with an eating disorder.

This book is a useful resource with more details: Full of Ourselves: A Wellness Program to Advance Girl Power, Health, and Leadership.

Checklist: How to assist the student

  √  If a student discloses a personal problem, consider the setting in which the disclosure has occurred. If it is during a class or other setting where others are present, for example, practice protective interrupting. For example: Thank you for sharing that… I’d really like to follow this up with you after [class, recess, gym].

  √  Be aware that a student who has divulged very personal concerns has chosen the particular teacher or staff person to divulge to for a reason. Acknowledge to the student how difficult disclosing personal concerns can be.

  √  Ask the student with the eating disorder privately how he/she would like teachers (and others) to respond when asked about how the student is doing.   

Checklist: How to assist peers of students with an eating disorder

  √  When supporting the student’s classmates, protect confidentiality and privacy by providing generic information about how to support a friend who is experiencing the eating disorder.

  √  Remind friends that they are not responsible for their friend’s eating disorder or recovery.

  √  Encourage students’ friends to continue usual activities with the person experiencing the eating disorder.

  √  Consider the needs of the student’s immediate friendship group. They may be feeling a loss in their friendship circle or confusion about how to relate to their friend.

  √  Be mindful of other students’ reactions to the eating disorder; for example, provide age-appropriate, selected information.

  √  Support friends and fellow students by providing information and opportunities to talk about

    • emotions they may be experiencing,
    • coping with the changes in their friend (for example, behavioral and social changes such as increased agitation or social isolation),
    • strategies to support their friend,
    • strategies to support themselves (taking time-out),
    • their responsibility as a friend (to provide friendship rather than to “fix” their friend), and
    • the ineffectiveness of focusing on food, weight, or appearance with their friend.