The Role of Registered Dietitian Nutritionists in Behavioral Health

About Us / The Role of Registered Dietitian Nutritionists in Behavioral Health

Registered Dietitians Nutritionists (RDN) are trained medical professionals who provide Medical Nutrition Therapy to patients and their support system (i.e., family members, interdisciplinary treatment team, etc.). The RDN also serves as an advocate to ensure adequate resources are available to meet their daily nutritional needs. The setting for this treatment can be psychiatric facilities, group homes, early intervention programs, outpatient clinics, or even the patient’s own home. All mental health conditions (e.g., schizophrenia, depression, bipolar disorder, eating disorders, substance abuse, ADHD, autism, or intellectual developmental disorders) benefit from the services of the RDN.

A RDN will complete a nutritional assessment of the complete diet; including foods, beverages, supplements, and medications that influence the medical status of that individual. Eating patterns, allergies, therapeutic adjustments (e.g., viscosity of beverages), food preferences and aversions, socioeconomic barriers, and any religious beliefs that influence food consumption are also assessed or considered. Individuals with behavioral health concerns may also have co-occurring medical conditions that require attention from the RDN. A few of these include diabetes, heart disease, irritable bowel syndrome, elevated cholesterol, high blood pressure, kidney disease, food allergies, or potential food/drug interactions.

The RDN creates a Nutrition Care Plan that serves as the guide for treatment. This care plan emphasizes a collaborative approach between the patient and their support system to restore wellness to the body and mind. Food-based dietary recommendations, nutritional supplementation to correct deficiencies, as well as, education and resources for patients, families and caregivers are common activities of the care plan developed by or in collaboration with the RDN.

RDNs in:

Addictions

Eating Disorders

Intellectual and Developmental Disabilities

Mental Health

 

**Check out the resources for these practice areas in the “Resources” section of this website.

** To contact the resource professional directly with questions, refer to the Executive Committee Directory for email information.

 

 

RDNs in Addictions

Renee Hoffinger, MHSE, RDN Addictions Resource Professional (3/2016)

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Where services are provided

RDNs specializing in addictions work in a variety of public and private sector inpatient, residential, outpatient, and transitional community aftercare settings. They are usually employed by the institution or organization but may work as an independent consultant or contractor.

 

Typical populations served

The population served and the drugs of abuse vary by setting and region – substance abuse affects people of all ages and backgrounds. The most frequently misused drug in the U.S. is alcohol but many other drugs (cocaine, heroin, prescription pain medications and other opiates, inhalants, etc.) are also abused, either singly or as multiple drug dependencies. Common comorbidities include liver disease, hepatitis, diabetes, pancreatitis, other psychiatric diagnoses, malnourishment and nutrient deficiencies. Diet can support or sabotage recovery. Restoring nutritional status helps to optimize cognitive and emotional functioning so the patient can participate and benefit from the program of recovery. Healthy diet is also a cornerstone of relapse prevention.

 

Typical work and involvement with other professionals

 

The RDN’s duties include nutritional assessment, screening for disordered eating, group education, and may include supervising food service operations, in-service training for other staff, and treatment planning meetings, as well. More and more programs are including hands-on nutrition education activities, such as cooking classes, which are in consonance with the philosophy of developing positive life skills to support recovery.

 

RDNs working in addictions usually collaborate as part of a treatment team with other addiction professionals: psychiatrists, psychologists, addiction therapists, social workers, nurses, nurse practitioners, occupational, vocational, and recreation therapists.

 

Recommended or required education and experience

There is currently no requirement or recognized training for an RDN working in the field. Coursework in drug education, behavior change, counseling methods, and cultural competency are all helpful additions to the dietetics foundation. Many of the other professionals we work with add the credential of CAP (Certified Addiction Professional) to their resume – this would be a great asset for an RDN in the field, as well.

 

 

 

RDNs in Mental Health

Ruth Leyse-Wallace PhD, Retired Clinical Dietitian Mental Health Resource Professional (3/2016)

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Where services are provided

RDNs in Mental Health commonly practice in psychiatric hospitals, in psychiatric units within general hospitals, in out-patient programs of hospitals, and in community mental health clinics. They may also provide nutritional care through their own private practice or by associating with a group practice. Privately owned businesses or organizations may also employ an RDN specializing in mental health.

 

Typical populations served

Nutrition practice in Mental Health serves both male and female populations from adolescence, to adulthood, to the elderly. Psychiatric diagnoses range from anxiety disorder, bipolar disorder, dementia, depression, obsessive-compulsive disorder, schizophrenia and any of the many disorders listed in the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders). Individuals admitted with suicidal, violent, or psychotic behavior are referred to the dietitian only after their mental status and behavior is stabilized and calm. Patients with comorbidities of alcohol and/or substance abuse and eating disorders are included in populations served by clinical dietitians in psychiatric hospitals. Combinations of physical health issues may occur along with a mental health concerns. For example, a woman with major depression may be pregnant and have a history of bariatric surgery and dependency on a prescription drug, requiring a broad range of nutrition knowledge. Individuals with mental health concerns are seen in any health care facility, renal dialysis unit, exercise/sports facility, etc, and may request, or be referred to, a clinical dietitian.

 

Typical work and involvement with other professionals

RDNs provide nutritional assessments, interventions, documentation of care, staff training, individual patient counseling and patient group education. They attend team meetings, work with food service for necessary special diets/ snacks, and meet with family members when requested.

 

The practice of clinical dietetics in mental health includes working with medical teams that include psychiatrists, psychologists, social workers, psychiatric nurses, pharmacists, mental health technicians, substance abuse counselors, activity therapists, speech therapists, occupational therapists, physical therapists, wound care specialists, medical records staff, food service administrators and food service staff.

 

Recommended or required education and experience

Education specific to mental health is included, but not extensively, in the internship experience for RDNs. Coursework in psychology, and counseling methods are helpful for working in Behavioral Health. Additional psychiatric-specific knowledge is acquired through professional networks, mentors, and reading the literature. Practice in mental health may include a multitude of physical health conditions which benefit from nutrition care. Adequate nutrition is increasingly demonstrated to influence mental status.

 

 

RDNs in Eating Disorder Treatment

Marci Anderson Evans CEDRD, CPT, LDN Eating Disorders Resource Professional (3/2016)

marci

Where services are provided

Eating disorder treatment takes place along a continuum of care. Inpatient hospitalization focuses on medical stabilization and the safe introduction of nutrition. Residential treatment may be in a home-like setting or hospital-based with from 5 to 20 beds. It involves medical stabilization as the number one priority. Hospital outpatient facilities focus on therapeutic counseling. RDNS work in all levels of care and may be in private practice or employed by the institution or organization to provide services.

 

Typical populations served

Eating disorders affect a wide range of demographics including race, gender, socioeconomic status, sexual orientation, and age. While many people wrongly believe eating disorders only affect affluent, Caucasian young women, RDNs must work to dispel this myth and be prepared to work with a varied population.

 

Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Eating and Feeding Disorders (OSFEDD) are the most common disorders treated. Becoming familiar with the new DSM-5 criteria will be immensely helpful for the RDN working in the field. Many patients will present with a variety of symptoms and subclinical presentations should be taken seriously. Visit www.dsm5.org.

 

In addition to the eating disorder, co-morbid mental health and medical diagnoses are quite common. Typical mental health diagnoses include anxiety, depression, bipolar, obsessive compulsive disorder, post traumatic stress disorder, and borderline personality disorder. Common medical problems include functional gastrointestinal disorders (i.e. IBS), thyroid disturbances, osteopenia/osteoporosis, dental complications, PCOS, food allergies/intolerances, and diabetes.

 

Typical work and involvement with other professionals

Typical activities will vary based on the level of care. In inpatient hospitalization the RDN works collaboratively with the treatment team to assess the patient and develop an appropriate and safe nutrition care plan. This may include tube feeding.

 

Residential treatment involves the RDN working collaboratively with the other members of the treatment team to support patients in decreasing/eliminating eating disorder behaviors while increasing exposure to feared or avoided foods. The RDN is responsible for repairing nutrient deficiencies and optimizing intake for psychological and physiological well-being. The RDN will help the patient develop cooking skills and facilitate outings to the grocery, restaurants, etc. Counseling with the patient is often minimal at this level of care but can be catered to the psychological capability of the client. At this phase, the RDN will begin offering psychoeducation related to nutrition, metabolism, weight, exercise, and body image.

 

In the hospital outpatient setting the RDN will work with the patient’s outpatient team. The RDN’s responsibilities are the same as listed for residential treatment. Additionally, the RDN will begin providing more counseling to help the client separate eating and emotion.

 

In addition to the responsibilities listed above, the RDN may be responsible for documentation, development of kitchen protocol and systems, staff trainings, and group presentations to staff and patients.

 

As mentioned above, a complete and communicative treatment team is the gold standard of care. Members of the treatment team include the Primary Care Physician and other ancillary medical professionals as needed- i.e. gastroenterologist, endocrinologist, as well as Psychiatrist or Psychopharmacologist. Also included are Mental Health Providers (PhD, PsyD, LICSW, etc. and the client, client’s family and/or personal support network. Additional therapeutic resources include group support, equine therapy, yoga therapy, art therapy, and express arts therapy.

 

Recommended or required education and experience

Developing a specialization in eating disorder treatment takes time, self-leadership, and money. BHN has developed an entire fact sheet on where to go for training and education. Please take time to go through this fact sheet (insert hyperlink when availble).

 

 

 

 

RDNs in Intellectual and Developmental Disabilities

Patricia Novak MPH, RDN – IDD Resource Professional (3/2016)

patricia

Where services are provided

Individuals with intellectual and developmental disabilities (IDD) may independently in their own home, with their parents or family, in supportive semi-independent housing or in larger institutional housing. The RDN may be employed in the community directly by a family/client, part of the staff of a group home or community agency, a consultant to group homes or schools or part of a governmental agency or program. The hospital dietitian, regardless if she/he specializes in this area, will also care for individuals with IDD as they are frequently at greater risk for illness and chronic disease.

 

Typical populations served

The RDN specializing in this population requires an understanding of the etiology, treatment, prognosis and comorbidities associated with people of all ages and backgrounds with some of the following disorders (examples of):

  • metabolic disorders (phenyketonuria PKU)
  • genetic disorders (Down syndrome or Trisomy 21, Prader Willi Syndrome)
  • neurodevelopmental disorders (Autism)
  • neuromuscular disorders (cerebral palsy)
  • traumatic brain injury

Comorbidities include those found in the general population, such as diabetes and obesity but also include concerns more specific to this population such as sensory or communication impairments. Common comorbidities also include celiac disease, sensory impairments (visual, tactile, processing, etc), motor impairments, dysphasia, communication disorders, mental health and behavioral concerns, seizure disorders, growth impairment and dementia.

 

Typical work and involvement with other professionals

In order to be successful, the RDN specializing in IDD has a deep toolbox of assessment tools, therapeutic strategies and resources. Effective nutrition intervention in IDD requires the RDN to be flexible. She/he responds not only to the nutrition imperatives of the disorder but also to the person’s cognitive level, social-emotional status, communication abilities, literacy/numeracy and daily living skills. The RDN assesses, treats and supports the individual while also assessing and supporting the caregivers involved with the person. Collaboration is an essential part of the RDN’s professional life. In addition to collaborating with the individual and his/her circle of support, the RDN works with the person’s education, employment and medical teams.

 

Recommended or required education and experience

Dietitians who specialize in working with individuals with IDD require a unique skill set. In contrast to other clinical specialty areas, IDD does not encompass a single disease state, or manifestations of a single disease state. Rather, IDD encompasses all diagnoses that may “cause significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills.”

 

Specialized training is necessary for the dietitian choosing to work with this complex population. The Maternal Child Health training program has two nationally available programs that provide interdisciplinary training; The LEND Graduate Education program and the UCEDD-University Center of Excellence in Developmental Disabilities. (www.aucd.org). Continuing education for the practicing dietitian specializing in this population can be very diverse; it should include training in low literacy education, motivational interviewing, neuromuscular impairments including dysphasia, drug-nutrient interactions, and updates in all associated disorders.

 

Since there are a vast number of disorders associated with of IDD, what the RDN really needs are resources for locating up-to-date and evidenced based information regarding these diagnoses (see resources – ).