ED Transitions Module 1
Setting the Scene - Definitions and Context

This module aims to help eating disorders professionals:

  • Consider why service transitions matter
  • Become familiar with definitions, service context(s) and developmental issues relevant to age transitions
  • Reflect on similarities and differences between services and treatments for young people above or below age 18

This module is also available as a downloadable PDF.

Please note that to avoid lengthy descriptions we will talk about CAEDS (Child and Adolescent ED services) and AEDS (Adult ED services), but CAEDS may also be referred to in some publications and areas as CYPEDS (Children and Young People Eating Disorder Services).

Why do service transitions matter?

Watch the video below to hear what young people have to say about their experiences of service transitions.

The 5 D’s of Poor Service Transitions:



Drop Out



For more information about the potential pitfalls of poorly-managed transitions, you can read the Averil Hart Report. This Parlimentary and Health Service Ombudsman report details the case of a 19-year-old with anorexia nervosa who died after a number of NHS organisations failed to provide adequate care and support as she began her first year at university.

Although this report refers to a university transition, the key themes are also applicable to age-related service transitions between CAEDS and AEDS, and of course age-related service transitions are often complicated by the person going away to study.

Some of these themes in the include:

  • Failures to properly plan, coordinate and assess Averil's care needs during her transition between services;
  • Failures to support inexperienced clinicians managing Averil's transition;
  • Failures in joint working arrangements leading to serious signs of deterioration being missed;
  • Poor communication with Averil's family throughout the final months of her care and after her untimely death.

Meera's story: a typical case

1. GP referred to CAEDS

Meera presents to her GP at age 16 ¾ with anorexia nervosa.

2. Family Therapy for AN

Meera deteriorates despite FT-AN and is referred for in-patient EDS.

3. In-patient admission

There is some improvement and Meera is discharged, to receive further CAEDS treatment.

4. CAEDS treatment

Meera gradually deteriorates again. She turns 18 and is handed over to AEDS.

"When I was seen at CAEDS I was really not ready to have help, but I really liked the CAEDS therapist I had after my first admission. It really sucked having to start with the adult service, but some of the individual work there was useful."

– Meera

5. AEDS Assessment and Review

Meera has a referral from CAEDS. 

6. Treatment Delay

By the time outpatient therapy is available for Meera, her condition has deteriorated so much that she needs another admission.

7. In-patient admission

Meera attains a normal weight post-discharge, but starts to binge eat regularly. Meera then wants to start University away from home and is referred to services there. 

8. University Service Referral

Meera is referred to her university service away from home. They have a long waiting list and say they do not accept people with binge eating disorder. 

“As a family we have been through hell and back. Our darkest period was when Meera had come out of hospital after her first admission. She was getting worse, yet she was handed over to the adult team regardless and they took their time to spring into action, and by then Meera needed a second admission. She is a lot better now, but what if she needs help whilst at University? It seems that the system really is not set up for young people moving around.”

- Meera's mum

Developmental considerations in service transitions: emerging adults

Emerging adulthood, age 18-25, is increasingly recognised as a unique developmental period (Potterton et al., 2021a), with many societal factors also adding potential stresses and pressures.

The period is characterised by a strong drive for autonomy and for the first time combined with the means (legal, financial and practical) for exerting this.

However, 18 year olds will vary enormously in their capacity to steer their own ED care.

Thus, we cannot expect them to have the motivation, knowledge and skills needed to negotiate the NHS by themselves, especially as AEDS often are not resourced to accept self-referrals.

Research has shown that emerging adults in general and those with EDs specifically find help-seeking very hard (Potterton et al., 2021 b).

This has implications for service transitions, as the natural inclination of these young people may be ‘not to bother’ with another service.

How common are transitions between CAEDS and AEDS and what is the diagnostic mix?

The answer depends on which perspective you take:


Of patients seen in CAEDS, 20-30% are transitioned to AEDS.

(Herpertz-Dahlmann and Schmidt, 2022)


In AEDS referrals, transitions from CAEDS make up only about 5%.

(e.g. Viljoen et al., 2022)

Why this difference?

While these referral numbers depend on the specific stud and the region the study was undertaken in, typically in a given area AEDS are larger than CAEDS, and therefore transition patients make up a smaller proportion of their referrals.

Other Potential Contributors to the Referral Gap

  • CAEDS patients may decide they don’t want to start with a new team, even though they still have problems. This can lead to them being discharged whilst still unwell.
  • Some patients, who are initially referred to CAEDS when close to the transition age-boundary, are not seen there and are re-routed to AEDS. These patients are not counted in transition statistics, and instead will have a delayed start to their care.

What is the Diagnostic Mix of Transition Patients Referred to an AEDS Team (Belli et al., in prep):

  • 43% are within 3 years of onset (also making them eligible for treatment under the FREED Model).
  • Over two thirds (69.5%) have AN, atypical AN or ARFID.
  • Taken together, the presence of a referral gap and the high proportion of AN diagnoses amongst those referred for transition suggests that patients with bulimic disorders may be more likely to be "lost" in the system.

What do patients, families and clinicians want?

A recent study assessed priorities of clinicians (CAEDS and AEDS), young people and parents with regards to better manage transitions (Wales et al., 2022).

All three groups highlighted:

  • The importance of a gradual transition with continuity of care.
  • The need to acknowledge that parents/carers want to be involved.
  • The need for solid handover information plus a fresh assessment by the AED service.
  • The option of delaying the transition if indicated.

Patients and Carers:

  • Wanted more flexible, patient‐centred arrangements where BMI was not a determining factor for whether patients should receive further care.


  • Valued clear structures (e.g. fixed transition at age 18 years, with body mass index (BMI) as a determining factor, and low‐weight patients being prioritised for post‐transition AEDS care).

Similarities and differences between CAEDS/AEDS in approaches and treatments

Much has been made of the different culture and approaches between CAEDS (more family-focused) and AEDS (more autonomy/responsibility focused). To some extent, these may reflect differences in developmental, systemic and legal responsibilities.

For example, NICE guidelines recommend family-interventions as the main treatment for young people below age 18 and individual treatments for those age 18 and over.

However these differences are increasingly becoming blurred.

Example 1

NICE emphasise the need for AEDS to involve parents or carers in assessment and treatment, especially where there is high medical risk.

Example 2

It is increasingly recognised that with adaptations, family interventions are effective in those aged 18+.

Example 3

Likewise, individual therapies (adapted CBT-ED or MANTRA) are effective in those below age 18.

Bulimia Nervosa further reading: Schmidt et al., 2007; Anorexia Nervosa further reading: Eisler et al., 2016; Nyman-Carlsson et al., 2020; Dalle Grave and Calugi, 2020; Le Grange et al., 2020; Wittek et al., 2023

Bridging the gap between services

In line with these findings, a recent systematic review on the topic of age-related transitions highlighted that:

  • there are more similarities than differences between CAEDS and AEDS
  • there should be greater integration between these services

Watch the video below to hear Professor Tracey Wade discuss the findings from her review and their implications.

Summary and conclusions

  • Some service models minimise the need for age-related transitions. However, if transitions do occur:
  • Poorly conducted age-related service transitions can be disastrous
  • Patient and carers want to see flexible, patient-centred, well-planned transition arrangements
  • The next modules will focus on how this can be achieved
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