Choosing the Best Treatment Approach for Patients with Eating Disorders


Patients with eating disorders are more often than not receiving inadequate treatment.  There are so many scenarios where patients remain in a lower level of treatment, such as outpatient therapy when they really need more a more structured program, such as partial hospitalization, intensive outpatient program or even residential or inpatient treatment.  Occasionally patients are referred by their therapists to a level of care higher than what they need.  These scenarios do not need to be happening and should not be happening.  Many therapists “shoot from the hip” when it comes to referring their patients to a certain level of care for eating disorders.  They do not use proper tools and guidelines for assessing the level of care that their patient should receive.

The Tool for Successful Treatment Planning

At the Inner Door Center® we use the Eating Disorder Treatment Guidelines directly from the American Psychiatric Association (APA).  The tool that we have adopted is a continued stay flow chart developed by Lisa Kantor, JD of Kantor and Kantor Law that mirrors the APA guidelines.  Lisa is committed to helping patients with eating disorders access their insurance coverage when improperly denied by their respective insurance company.  She was featured at the March 2011 International Association of Eating Disorder Professionals (IADEP) business meeting where she discussed using these evidenced-based standards (the APA guidelines) across the board.  A great number of eating disorder treatment center decisions makers were in attendance at this meeting, and they agreed to band together to adopt these standards.  You can read more about Lisa’s work with eating disorders at her website: http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx

Does My Treatment Program Use the APA Guidelines?

When searching for an eating disorder professional or a treatment program, you want to choose one that understands and uses the evidence-based treatment guidelines from APA for making decisions regarding your care.  If they do not use these standards, they may not be practicing evidence-based eating disorder treatment.  At the Inner Door Center® our professional staff is fully trained in these APA guidelines and we use them to guide your individualized evidence-based treatment.

A Summary of the APA Guidelines

We use the APA guidelines continued stay flow chart to steer the entire course of your treatment.  When you come to our clinic, you will receive a thorough assessment from a multidisciplinary team of clinicians, including a therapist, psychiatrist, internist, registered dietitian, and registered medical assistant.  Our Utilization Review Specialist then creates your grid which includes 10 areas of focus for assessment:

  1. Medical status
  2. Suicidality
  3. Weight as a percentage of healthy body weight
  4. Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts
  5. Co-occurring disorders (substance use, depression, anxiety, etc.)
  6. Structure needed for eating/gaining weight
  7. Ability to control compulsive exercising
  8. Purging behavior (laxatives and diuretics)
  9. Environmental stress
  10. Geographic availability of the treatment program

The grid is divided into 5 levels of treatment: outpatient, intensive outpatient, partial hospitalization, residential treatment center, and inpatient hospitalization.  Each focus area is assessed for level of care.  You only need to qualify in one focus area to get the highest level of care.  For example, if you are medically stable and have great support at home, but your body weight is <85% of what is considered healthy for your build and you cannot control your purging behavior, you would be referred to the highest level of care – inpatient hospitalization.

What About Insurance Companies?

Currently, Value Options insurance company is the only company that we are aware of that uses the APA evidence-based guidelines when reimbursing for eating disorder treatment.  It is our hope that all insurance companies will eventually adopt these evidence-based guidelines instead of using the “catch-all” guidelines for mental health coverage that leave room for error, and do not apply specifically to eating disorder behavior.

If you are seeking treatment for yourself or a loved one that is struggling with an eating disorder or substance abuse, look no further – we can help you find the best treatment approach at Inner Door Center®.  Visit our website to learn more about the programs that we offer.

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