for adults, ages (16+) who struggle with any behaviours as

Eating Disorder Support Group – Brought to you by CMHA Saskatoon and BridgePoint Center for Eating Disorders

For adults, ages (16+) who struggle with any behaviours as a result

of a mal-adaptive relationship with food and/or their body.

• FREE weekly closed group (donations kindly accepted)

• Tuesdays 3:30-5:00 pm Starting April 14th – May 12th

• Participants can self-refer. CMHA will be in contact with you for an intake interview.

• Participants must be medically and psychiatrically stable

• Applications must be received by March 20, 2020.


Our Groups

Professionally-facilitated by CMHA Saskatoon Mental Health Workers and BridgePoint Center team

with extensive backgrounds in eating disorders and mental health.

Intended to support those wishing to continue their path of recovery in a safe, nonjudgmental

environment.

Support groups are not intended to take the place of professional treatment.

Limited to a small number of participants to allow everyone to participate fully and create safety.

Guidelines

The purpose of this group is to offer support, encouragement, and hope that recovery is possible. Group is intended to be a safe, nurturing environments for adults struggling with eating disorders to explore and hear new ways of understanding and processing their behaviours.

This group is free, and is open to any person 16 years or older who struggles with an unhealthy relationship with food and their body that impacts quality of life and the ability to function. Members who do not have a diagnosed eating disorder (either from not seeking support, or not being able to access support), but who have a troubled relationship with food and/or body, are completely welcome here. We aim to provide a safe, non-judgmental space for all.

Any group member who indicates they are at risk of suicide, self-harm or harming another person will be referred to emergency health services.

Please turn cell phones off during meetings, or set to vibrate if you have a pressing need to be accessible. Please leave the room if you must answer a call.

Please refrain from talking about your own weight", size and/or body shape.

Please refrain from discussing details about your food choices as well as commenting on others food choices.

Finally, please avoid graphic descriptions of your behaviours or past traumas. We acknowledge that sometimes it is in the nature of eating disorders to want to share details and we encourage participants to explore why they feel the need to do so.

Any breaches of confidentiality or group guidelines may result in dismissal from the group.

Logistics The group currently takes place on Tuesdays from 3:30-5:00pm Starting April 14th – May 12th at CMHA Saskatoon at 1301 Ave. P North. Space is limited to 12 participants. Group Processes This group is not a 12-step group. Some groups begin with a brief check-in for each member, other groups go directly to discussing a topic or we take time to delve into deeper check-ins. The facilitator(s) will work to ensure everyone is included and welcomed. Based on the number present, and to be responsive to group needs, sometimes we take more time with check-ins and allow the conversation to develop from there. Members are encouraged to expand on any successes, strategies they tried during the week and how they worked, or thoughts and behaviours they are struggling with. The goal is to hear from as many people as possible, with each engaging in honest reflection and providing supportive and thoughtful feedback.

Members try to set realistic and achievable goals at the end of the group to work on during the next week. Members can also use this time to talk about how they are feeling at this time. Facilitators will remain available for a very limited time after the group ends for members who are feeling the need for additional closure of the meeting.


Please return completed form as legibly as possible and return to: CMHA Saskatoon 1301 Ave. P North, Saskatoon, SK. S7L 2X1 Phone (306) 384-9333 Fax (306) 978-5777

INCOMPLETE OR ILLEGIBLE APPLICATION FORMS WILL NOT BE PROCESSED You will be contacted by CMHA Saskatoon for an intake interview.

EATING DISORDER SUPPORT GROUP

Name:

⃝ Male ⃝ Female

⃝ Other ____________

Preferred Pronoun:

DOB: AGE:

Health Card #: Issuing Province: Expiry:

Address:

Box/Street City, Prov Postal Code

Contact Information

Please provide phone numbers where

messages can be left.

Home Phone: Cell Phone: Work Phone:

Email Address:

Preferred Method of Communication: ⃝ Phone Call ⃝ Email ⃝ Other

Safety Contact Which Whom BridgePoint may share/receive your

information.

Name: Contacted in emergency situation or early departure from program

Home Phone

Cell Phone

Relationship: Street Address/City:

Email:

Health Care Provider, Person

or Agency

Doctor: Phone:

Counsellor: Phone:

CONFIDENTIALITY

⃝ I will hold strict confidentiality regarding all matters (names, events, etc.) pertaining to the personal therapeutic work or identity of other participants in the group. I will not disclose information about another group member outside of my group verbally, or through any written or electronic means including email, Facebook, twitter and any other public forums. I have read and understand the limits of confidentiality and I am consenting to participating in the group.

Applicant Signature: _______________________________ Date: ________________


You will be contacted about the status of your application. Spots are not confirmed until verbal or written confirmation is provided.

Eating Disorder Behaviours

Quality of Life- Where has the eating disorder had the greatest impact on your life?

⃝ Employment ⃝ Relationships ⃝ Housing/Food Insecurity ⃝ Financial ⃝ Spiritual

⃝ School ⃝ Social/recreational ⃝ Legal ⃝ Other

External Agency Diagnosis (DSM-5 Feeding and Eating Disorders): Check below (most recent diagnosis)

Age diagnosed: _____ ⃝ Anorexia (AN) ⃝ Bulimia Nervosa (BN) ⃝ Binge-Eating Disorder (BED)

⃝ Other Specified Feeding or Eating Disorder (OSFED)

⃝ Unspecified Feeding or Eating Disorder

⃝ No formal diagnosis Other:

Occupation: _______________________________ Highest Level of Education: _________________________

⃝ Employed ⃝ Unemployed ⃝ Unemployed ⃝ Disability – SAID ⃝ Disability – work plan ⃝ Student

Personal History of Self Harm/ Suicide Attempts

⃝ Past history of Self Harm ⃝ Present Self Harm ⃝ No history of Self Harm ⃝ Past Suicide Attempt ⃝ Recent Suicide Attempt (2 months)

⃝ Service Animal Type: _____________ Contact CMHA to request approval and for separate application. Cannot attend without prior approval.

⃝ Mobility Concerns: ___________________________________________________________________________________________

Current Supports:

⃝ Mental Health Team ⃝ Psychologist ⃝ Therapist

⃝ Psychiatrist ⃝ Dietitian ⃝ Day Program

⃝ Self-help groups ⃝ Group Home ⃝ Others

⃝ Crisis Management ⃝ ⃝

What plays an integral part in your recovery? What other supports or resources would be helpful?

_________________________________________________________________________________________________________________________________________

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What other treatments have you accessed in the past? What are you working on with your supports? _________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

What are your goals for attending this group? _________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

Internal vs. External Motivation Out of 100%, what percentage of you is motivated to be here for yourself vs others? Yourself ____% Others _____% (adds up to 100%)

What strengths do you bring with you on your recovery journey? ie. Humor, perseverance, tenacity, stubbornness, etc

_________________________________________________________________________________________________________________________________________

Client Identified Resources: Who or what plays an integral part of your recovery? i.e pets, spirituality, music, friends, etc?

_________________________________________________________________________________________________________________________________________

for adults, ages (16+) who struggle with any behaviours as

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