Your child has been diagnosed with an eating disorder.
You are given pamphlets and handouts for different eating disorder treatment programs and levels of care. But what does all of this mean? What even is a level of care?
Professionals are telling you to act quickly and make a decision on what treatment program to send your child to. You want to choose a program that gives your child the best chance at recovery, but how do you know what that is?
Sound familiar? All of this is overwhelming, intimidating, and stressful. Am I right?
Let's start by breaking down what all of this information means so that you have some clarity (and peace of mind) in making an informed decision in the care of your child.
Reaching out to an Eating Disorder Treatment Center
We want to take the next few minutes to familiarize you with the process and what the recommendations for the various levels of care mean.
Recommendations for admission to a treatment center and what level of care is most appropriate will be made based on your child's symptoms, clinical presentation, and severity of their eating disorder behaviors. No pressure to try to diagnose the level of care most appropriate for your child, this will be up to the treatment to assess during the intake process.
Let’s first answer one of the initial questions you may have when you see the eating disorder pamphlets and handouts, what even is a level of care? Level of care refers to the amount of support your child may receive at each stage of treatment.
Eating disorder treatment can be broken up into 5 levels of care: outpatient, intensive outpatient program (IOP), partial hospitalization program (PHP), acute residential treatment, and inpatient. There is no one starting point for eating disorder treatment. This means that these 5 levels of care we are about to review are not a linear progression. Your child may jump back and forth between different levels and we want you to know this is a normal continuation in eating disorder recovery.
Level 1: Outpatient
If your child is medically stable it may be recommended they get started in an outpatient level of care, which is the lowest level of support. Outpatient treatment includes creating an interdisciplinary team for your child which consists of a therapist, dietitian, physician, and sometimes a psychiatrist. Ideally, all members of the team will specialize in eating disorders and these clinicians will work closely with your child and your family to provide them with the nutrition and support they need to challenge and recover from their eating disorder.
It is important to note, your child’s outpatient team is necessary to create regardless of the level of care they are participating in. The outpatient team will continue to work closely with your family as your child moves between or maintains consistency in the various levels of care. The work that we do here at NourishRX is considered outpatient practice. We typically see clients once a week providing nutrition counseling services. Reach out to us HERE for more information on getting started.
Level 2: Intensive Outpatient Program (IOP)
An IOP is typically a 3-hour program that runs 3-5 days a week. It is normally held late afternoon to early evening, but may also be held in the mornings. IOP includes therapeutic and nutrition education groups, individual therapy, and meal support for a meal and/or snack. In IOP programs, your child will be assigned a case manager or therapist who they will meet with 1-2 times a week. Depending on the program, your child may also be assigned a dietitian.
Those who meet IOP level of care will be able to follow a meal plan and manage other eating disorder behaviors such as exercise, binging, purging, and restriction without intense monitoring and supervision. At this level of care, your child is motivated to recover and is not at imminent medical risk or harm to themselves. Symptoms are generally under control at this point, and individuals are able to function within their daily lives with minimal support.
Level 3: Partial Hospitalization Program (PHP)
A PHP is a day program that runs up to 7 days a week and can last 6-12 hours per day. PHP is typically recommended if your child is medically stable, but would benefit from daily support to not engage in eating disorder behaviors. Your child will have the majority of their meals and snacks at the program with meal support from case managers and dietitians. They will also be assigned a case manager, dietitian, and psychiatrist who they will meet with at least once a week.
Level 4: Acute Residential Treatment (RESI)
An acute residential treatment center will provide 24/7 support for your child. At this stage, your child is medically stable to the degree in which they do not need IV fluids, tube feedings, or daily labs drawn to monitor levels such as potassium, magnesium, and phosphate.
An acute residential treatment center will focus on interrupting your child’s eating disorder behaviors such as restriction, purging, binging, and over-exercise. During their stay, your child will begin to learn therapeutic coping mechanisms to manage eating disorder thoughts and urges. They will be assigned a treatment team, which includes a case manager/therapist, dietitian, and psychiatrist, who they will meet with 1-2 times a week.
Therapeutic meal support will be provided at each meal and snack, along with attending therapeutic and nutrition education groups during the day. Acute residential treatment stays may be 30 days or more depending on your child's individual needs.
As a parent, the thought of acute residential treatment can be a big jump between the previous lower levels of care. At this stage, you may feel like you lose control and you are putting trust in the staff at treatment facilities to take care of your child. Remember these facilities have the professionals your child may need to win the battle with their eating disorder and full, 24/7 immersion in the treatment process may lead to improved outcomes.
Level 5: Inpatient
Inpatient level of care is a medical admission to a hospital where your child will receive 24-hour medical monitoring by professionals who can keep an eye on your child’s vital signs, blood work, and need for nutrition support, such as tube feed or intravenous fluids. At this stage of your child’s recovery, they are preoccupied with intrusive eating disorder thoughts and may be uncooperative with treatment without a highly structured environment requiring constant monitoring. An inpatient level of care is required when your child’s behaviors have significantly compromised their medical stability. An inpatient level of care stay is typically short term and once discharged, it may be recommended your child step down to a lower level of care dependent on need.
Remember you are not alone.
Determining your child’s course of eating disorder treatment can be emotionally and mentally taxing.
Providers at treatment centers are there to help and answer any questions you have about the care for your child. NourishRX is also here to provide any support you may need through your child’s recovery journey. You can sign up or reach out to us directly through our website to learn more about the programs we offer to better support your child’s recovery.