|
Levels of Care
Please note: Eating disorders develop in men, women, girls, and boys. For ease in reading, we have used "she" and "her" in the text below.
The term “level of care” refers to the intensity of services provided by a treatment setting. Which level of care is appropriate for a patient is determined at the time of her initial diagnosis and subsequently whenever a change in her condition may warrant a transition to a different level. Settings include acute care hospitalization, residential care, partial hospitalization and various intensities of outpatient treatment. Many individuals need time in more than one level of care.
In evaluating what treatment setting will best meet the patient’s needs, a number of factors are considered:
- Is she medically stable?
- How severe are her abnormal eating behaviors?
- What is her psychological status? Does she have psychiatric problems that co-exist with her eating disorder?
- How well does she function at school or work and in other activities?
- How motivated is she to recover from her disorder?
- Is there a treatment program in her geographic area that will meet her needs?
- Does she have health insurance?
- Does the insurance cover treatment for an eating disorder?
Continuity of Care
As an individual improves, a less intensive level of care may become appropriate. For example, it is not unusual for a treatment team to recommend that a patient attend partial hospitalization following her discharge from a residential treatment center. Going to a less structured setting can be stressful for an individual, perhaps making her vulnerable to a set-back. The change becomes all the harder if she will have one or more new providers. If it is not feasible for a patient to keep the same clinicians when she changes level of care, it is important for her discharge team to ease her transition by communicating with her new providers and by arranging for her to meet them.
References
Practice guideline for the treatment of patients with eating disorders
American Psychiatric Association (APA). Practice guideline for the treatment of patients with eating disorders. 3rd ed. Washington (DC): American Psychiatric Association; 2006 Jun. 128 p. [765 references].
Increased mortality in bulimia nervosa and other eating disorders
Crow, S., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., Mitchell, J.E. Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry. (In press).
Early response to family-based treatment for adolescent anorexia nervosa
Doyle, P.M., le Grange, D., Loeb, K., Doyle, A.C., Crosby, R.D. Early response to family-based treatment for adolescent anorexia nervosa. International Journal of Eating Disorders. (In press).
Body attitudes in patients with eating disorders at presentation and completion of intensive outpatient day treatment
Exterkate, C.C., Vriesendorp, P.F., de Jong, C.A. Body attitudes in patients with eating disorders at presentation and completion of intensive outpatient day treatment. Eating Behaviors. 2009; 10: 16-21.
Salient components of a comprehensive service for eating disorders
Halmi, K.A. Salient components of a comprehensive service for eating disorders. World Psychiatry. 2009; 8: 150-5.
Psychological treatments for bulimia nervosa and binging
Hay, P.P., Bacaltchuk, J., Stefano, S., Kashyap, P. Psychological treatments for bulimia nervosa and binging. Cochrane Database of Systematic Reviews. 2009; 7: CD000562.
Overview of treatment modalities in adolescent anorexia nervosa
Herpertz-Dahlmann, B., Salbach-Andrae, H. Overview of treatment modalities in adolescent anorexia nervosa. Child and Adolescent Psychiatric Clinics of North America. 2009; 18: 131-45.
The slippery slope: prediction of successful weight maintenance in anorexia nervosa
Kaplan, A.S., Walsh, B.T., Olmsted, M., Attia, E., Carter, J.C., Devlin, M.J., Pike, K.M., Woodside, B., Rockert, W., Roberto, C.A., Parides, M. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychological Medicine. 2009; 39: 1037-45.
Excessive exercise in eating disorder patients and in healthy women
Mond, J.M., Calogero, R.M., Anderson, D.A. Excessive exercise in eating disorder patients and in healthy women. Australian and New Zealand Journal of Psychiatry. 2009; 43: 227-34.
Cognitive behavioral approaches in adolescent anorexia and bulimia nervosa
Schmidt, U. Cognitive behavioral approaches in adolescent anorexia and bulimia nervosa. Child and Adolescent Psychiatric Clinics of North America. 2009; 18: 147-58.
Predictive factors of length of inpatient treatment in anorexia nervosa
Strik Lievers, L., Curt, F., Wallier, J., Perdereau, F., Rein, Z., Jeammet, P., Godart, N. Predictive factors of length of inpatient treatment in anorexia nervosa. European Child & Adolescent Psychiatry. 2009; 18: 75-84.
The assessment of the family of people with eating disorders
Treasure, J., Sepulveda, A.R., MacDonald, P., Whitaker, W., Lopez, C., Zabala, M., Kyriacou, O., Todd, G. The assessment of the family of people with eating disorders. European Eating Disorders Review. 2008; 16: 247-55.
Motivational change in an inpatient anorexia nervosa population and implications for treatment
Wade, T.D., Frayne, A., Edwards, S.A., Robertson, T., Gilchrist, P. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Australian and New Zealand Journal of Psychiatry. 2009; 43: 235-43.
Factors related to motivation for change in adolescents with eating disorders
Zaitsoff, S.L., Taylor, A. Factors related to motivation for change in adolescents with eating disorders. European Eating Disorders Review. 2009; 17: 227-33.
Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial
Zeeck, A., Weber, S., Sandholz, A., Wetzler-Burmeister, E., Wirsching, M., Hartmann A. Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial. Psychotherapy and Psychosomatics. 2009; 78: 152-60.
Photo Credit:
This page was last updated on October 19, 2009.
|
