Between the Scylla and Charybdis: Navigating the Rough Waters When Looking for Eating Disorder Inpatient and Residential Programs
Article Contributed By: Mary Tantillo, PhD, PMHCNS-BC, FAED, Academy for Eating Disorders Task Force Chair on Residential/Inpatient Clinical Practice Recommendations and CEO/Clinical Director of The Healing Connection, INC.
The denial, shame, and secrecy characterizing eating disorders make it difficult for individuals to pursue treatment and difficult for family members to convince them of this need. When adults with eating disorders finally agree to treatment or family members are searching for “the right treatment program,” for their adult or adolescent loved ones, there is often confusion, lack of good guidance, and reliance on websites and media advertisements for information. It is overwhelming to navigate the path toward what is the best treatment site and no North Star to guide one’s way. Knowing the challenges and obstacles involved in seeking out residential and inpatient treatment programs, the Academy for Eating Disorders (AED) recently released the Clinical Practice Recommendations for Residential and Inpatient Eating Disorder Programs. This is the first of what will hopefully be several documents providing recommendations about navigating the rough waters when seeking quality care for patients and families. The AED began with recommendations targeting residential and inpatient treatment programs because of the emotional and financial investments required for these levels of care. For a certain subgroup of patients, residential and inpatient treatment are essential foundations for continued recovery in the other levels of care.
The AED Clinical Practice Recommendations for Residential and Inpatient Eating Disorder Programs were developed by the Academy for Eating Disorders (AED) in collaboration with the National Eating Disorders Association (NEDA) and the International Association of Eating Disorder Professionals (IAEDP). A task force comprised of membership from all three organizations helped oversee development of the recommendations.1 Task Force work groups were comprised of more than 50 individuals including professional experts in the eating disorders and related fields, individuals in recovery, and family members, supported by external facilitators. Recommendations are based on empirical data and expert consensus and are intended as a minimal standard of care and should be applied with clinical judgment. Consensus regarding recommendations was reached through extensive intra- and interwork group discussion and review of existing guidance including the National Institute for Health and Clinical Excellence Guidelines for Eating Disorders (NICE Guidelines, 2004), American Psychiatric Association Practice Guidelines for the Treatment of Eating Disorders (2006), the American Academy of Pediatrics Policy Statement for the Treatment of Anorexia Nervosa (2003), and the Australian and New Zealand Clinical for the Treatment of Anorexia Nervosa (2005). The recommendations were then put out for consultation to stakeholder groups including the membership of the AED, NEDA, and IAEDP; program directors; insurer groups in the USA; and recovered individuals and family members. Expert consultation from colleagues in countries outside the USA, including Australia, Canada, and the United Kingdom, was obtained during the development and review of the recommendations. They have also been reviewed by the Scientific Committee and Board of Directors of the AED.
The purpose of the AED Clinical Practice Recommendations for Residential and Inpatient Eating Disorder Programs is to promote high quality, evidence-based residential and inpatient treatment for eating disorders. These recommendations were developed specifically to safeguard patients and families seeking eating disorder residential and inpatient treatment. Additionally, they were developed to improve the quality of care offered by residential and inpatient treatment programs and provide a quality of care benchmark for third party payers to consider as they collaborate with health care providers in the development of comprehensive models of care and its reimbursement. The recommendations can help inform treatment program quality improvement efforts and be used as a guide for credentialing of treatment programs and/or the development of key performance indicators. They may be used by eating disorder residential and inpatient treatment programs, insurers, government health officials, and accrediting organizations willing to integrate these recommendations into a program of accreditation. CARF has already adopted the AED Clinical Practice Recommendations to develop disease-specific certification for residential and inpatient eating disorder programs (www.carf.org/contact-us or toll free (888) 281-6531). The Joint Commission is currently working with task force leadership to identify ways the recommendations can be integrated into their accreditation of these programs.
The AED Clinical Practice Recommendations are helpful in providing information about recommended standards of care for patients and families as they consider possible treatment program options. Standards related to the care of children and adolescents are integrated throughout the document. The recommendations include standards related to areas outlined below:
1. Assessment and treatment planning
- Initial assessment
- Admission process
- Treatment planning
- Continuity of care
- Discharge planning
2. Treatment Delivery
- Licensure adequately described
- Core treatment components: Includes the four core components of eating disorder treatment, i.e., medical/nursing, nutritional, psychological and psychiatric care services.
- Guidelines for nutritional rehabilitation
- Multidisciplinary treatment team providers
- Financial issues
- Utilization review and insurance appeals
3. Standards related to Quality Improvement and Outcome measurement
- Identification of Quality Improvement Indicators
- Identification of baseline, end of treatment, and follow-up outcome measures (e.g., height, weight, frequency of eating disorder symptoms, and standardized measures of patient eating disorder symptoms and associated psychological symptoms, mood and quality of life such as the Eating Disorder Examination Questionnaire [EDEQ-4], Eating Disorder Inventory 3 [EDI3], Beck Depression Inventory, and Eating Disorder Quality of Life Scale [EDQOL])
The recommendations also encourage systematic collection of outcomes standardized across treatment centers in order to demonstrate the effectiveness of inpatient and residential treatment. In addition, each facility should be assessing patient outcomes to inform their own internal monitoring and quality improvement, and the effectiveness of their own treatments.
In addition to the AED Clinical Practice Recommendations for Residential/Inpatient Eating Disorder Programs, individuals with eating disorders and their family members should also review the Worldwide Charter for Action on Eating Disorders and F.E.A.S.T.’s recent publication, “Port in a storm treatment guide,” when seeking inpatient/residential treatment. The first document outlines the rights of people with eating disorders and their carers. These include:
I Right to communication/partnership with health professionals
II Right to comprehensive assessment and treatment planning
III Right to accessible, high quality, fully funded, specialized care
IV Right to respectful, fully-informed, age-appropriate, safe levels of care
V Right of carers to be informed, valued and respected as a treatment resource
VI Right of carers to accessible, appropriate support and education resources
The second document provides guidance regarding how to navigate when on the road to finding the best provider or treatment program for yourself or a loved one.
Finding the best residential/inpatient program for yourself or a loved one can feel like a road with many twists and turns. The AED Clinical Practice Recommendations, as well as the other guides mentioned in this article, should help you raise good questions when interviewing treatment program staff and discerning which program is the best for you or a loved one. One of the most important factors to consider when interviewing program staff is their willingness to include family and patient in evaluation and treatment. Involvement of patient and family should be demonstrated in written program materials, as well as in program staff discussions with you. It “takes a village” to promote recovery and find the best inpatient/residential program for you or your loved one. It is very important to find the village that will help you best establish a foothold for a lifetime of recovery.
1Academy for Eating Disorders Task Force on Residential/Inpatient Clinical Practice Recommendations
Mary Tantillo, PhD, PMHCNS-BC FAED
Ovidio Bermudez, MD, FAED
Douglas Bunnell, PhD, FAED
Jillian Lampert, PhD, MPH, RD, LD, FAED
Julie Holland MHS, CEDS
Craig Johnson, PhD, FAED
James Mitchell, MD, FAED
Pauline Powers, MD, FAED
Benita Quakenbush-Roberts PhD
Janet Treasure, FRCP, FAED
Marsha Marcus, PhD, FAED
Joel Yager, MD, FAED
Page Last Updated and Reviewed By: Jacquelyn Ekern, MS, LPC on
March 26, 2014
Published on EatingDisorderHope.com, Resources for Eating Disorder Treatment Centers