How do you know when you are in the right type of treatment?
Deciding on the appropriate level of care for your loved one can be a daunting task. Because of the complexities of eating disorders the type and level of care needed is not the same for everyone. The first step in deciding the level of care most appropriate for your loved one begins with an evaluation by his or her primary care physician. Your loved one’s medical stability will be a major factor in determining the type of treatment appropriate for his or her situation. We do have a strong belief that recovery happens at home so the more that can be done at home safely and effectively the better.
Inpatient or Residential Care
This level of care requires your loved one live at the treatment facility. Patients are monitored by trained staff to prevent eating disorder behaviors and to monitor for medical complications. This is a good option for people who have not been able to abstain from eating disorder behaviors and need the level of accountability that a 24/7 treatment facility offers. In addition, this is a good treatment option for those who have medical complications related to their eating disorder that require closer medical monitoring or management. Inpatient programs are a better choice in your loved one’s medical condition is severe or poses a significant risk to their health. In essence the treatment staff assumes the role of your loved one’s support team and passes that to you when he or she is discharged to a lower level of care.
A sign of a good residential or inpatient program is intensive family involvement. While your loved one is at this level of care the facility should be taking the opportunity to support you in learning how to support your loved one’s recovery once he or she returns home. Some questions to ask the staff include:
· What type of support will the family receive?
· How will I learn to support my loved one’s recovery one he or she is home?
· What sort of support do you get in setting up your loved one’s outpatient treatment team?
The downside of this level of care is that your loved one is living away from home and has to take time away from work or school to get treatment. For some people this level of care is not offered close to where they live so they have to travel a considerable distance to receive treatment. Having to travel to receive care can interfere with their support team being actively involved in their treatment. It can be difficult for some on your support team to be physically present during treatment to learn how to support you during or after meals. Nevertheless, if you have not been able to abstain from your eating disorder behavior outside this level of care or you need more active medical monitoring residential or inpatient care may be your best option.
Partial Hospitalization Programs
Partial Hospitalization Programs (PHP) are typically 8-12 hours of treatment 5-7 days per week. Patients participating in a PHP receive intensive treatment throughout the day but then go home at night. The benefit of this level of care is that loved one gets to go home at night and practice those things he or she learned in treatment. In addition the support team has an opportunity to practice helping your loved one abstain from eating disorder behaviors outside of a treatment setting. The problem with this level of care is if the support team is not ready to support the patient’s abstinence from eating disorder behaviors being away from treatment in the evenings and overnight may be too much independence for some patients. It’s important to remember that the level of care most appropriate for your loved one is largely based on him or her abstaining from eating disorder behavior. The combination of treatment and support from the support team that enables your loved not to engage in eating disorder behavior is the level of care most appropriate if medical stability is achieved. If that can be accomplished at home, the better.
Intensive Outpatient Programs
Intensive Outpatient Programs (IOP) are typically 3 hours of treatment per day 3-5 days per week. The benefit of an IOP is for patients needing multiple services (education groups, psychotherapy, family therapy, dietary services) they can receive from a collaborative team all in one place. Outside of an IOP patients would need to travel to the different offices of the providers to receive services and collaboration between providers sometimes can be problematic. This is largely due to the fact that providers practice is different locations whereas in an IOP and most other structured treatment program all the providers work at the same location.
Most IOP’s are in the evening so if patients work during the day or go to school they likely can continue to do so while receiving treatment. Many IOP’s are group focused. This can be a positive experience for some in that they can feel additional support from peers. However, for others it can be an environment where they learn about additional eating disorder behaviors.
All of the above levels of care are time limited. Your loved one typically does not stay at the facility until recovery is achieved. Instead, length of stay is typically determined by assessment that he or she can continue in recovery at a lower level of care. Families and support teams should not expect their loved one’s to be recovered once treatment at any of the above levels of care is complete. Treatment to recovery happens at the outpatient level of care.
Family Based Treatment
Anorexia and bulimia typically has been treated in inpatient and residential treatment facilities that require patients to live away from their families. This separation is often disruptive and distressing to patients and their families. Treatment in residential and inpatient facilities is usually successful in restoring the patient’s weight. Unfortunately, the rate of relapse once they leave and return home is high. This often leads to multiple treatment episodes.
Family Based Treatment (AKA Maudsley Approach) is a specific type of treatment for adolescents and young adults struggling with eating disorders. This approach utilizes the parents and/or other loved ones as active participants in the restoration of the patient’s weight, physical health and normalization of eating.
The FBT program at Sierra Center for Wellness consists of weekly family sessions supporting parents and others in restoring their loved one's health. Patients are medically monitored by their Primary Care Physician throughout the program. Once the patient's health is restored the focus then becomes the underlying psychological issues that may be present.
The benefits of this program include a patient's ability to continuing living at home and in the vast majority of cases continuing with school or work obligations. Typically, 85-90% of patients treated utilizing Family Based Treatment are successful in weight restoration and abstaining from eating disorder behaviors.
Do Your Research
Deciding on a treatment environment is a tough decision being made at times emotions are often running high. Try to do as much research as you can and trust your gut.
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