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There is a dearth of research on how to provide trauma informed care for child and adolescent patients with severe eating disorders in the hospital setting, with most of the research being extrapolated from adult data. This workshop will help participants adapt trauma informed care principles to fit the potentially traumatic hospital setting. At its core, eating disorder treatment can ignite conflicting ethical principles. This can be as simple as nutritional restoration which can be perceived as traumatic and also is medically necessary. However, when the patient is a minor, does not want treatment, and is in the hospital with serious physical and psychiatric destabilization, the complexities compile. There is often not a clear path forward and our clinical care guidelines hit their limits. In this interactive workshop, we will analyze a case of an adolescent patient with long-standing anorexia nervosa (restricting type) and multiple medical hospital admissions for severe protein-calorie malnutrition. Admissions were complicated by decubitus ulcers, urinary retention, depression with suicidal ideation, extreme emotional dysregulation with self-injurious behaviors, and family disagreement with care. In particular, participants will examine where the patient's history of trauma and psychosocial complexities interfered with ability to provide standards of care and how to approach those decision points. Participants will imagine how they would proceed and how they would navigate the team and family disagreements while balancing trauma informed care with current practice standards of care. We will assess the moral distress that surfaces when we are not able to provide the best care for patients, both from an evidence based and trauma informed perspective. When our foundational medical ethical values of beneficence, nonmaleficence, autonomy, and justice are at conflict, there is often no clear answer. The conflicting values, and lack of a 'right' path forward can lead to team conflict and worsen distress. Learners will reflect on their own practice setting and think about programmatic or institutional efforts that might support them with this, and what gaps exist. Despite best intentions, when evidence and empathy clash, we are often at the limit of our medical training. When we get to this point, team conflict, provider moral distress, and poorer patient outcomes arise. With the goal of evolving the field, we hope that bringing experts together, to share their clinical perspectives and discuss navigating these tenuous decisions, will help us better understand trauma informed care, standards of practice, core medical values, and provider wellbeing and tenacity.
