5 levels of care in eating disorder treatment

levels of care

When deciding on a client’s level of treatment for an eating disorder many factors come into play. Following are the five levels of care and a break down of how a person may qualify for each.

Inpatient Hospitalization

Inpatient is the highest level of care available, and it is reserved for those who are deemed medically or psychologically unstable.

A medically unstable person has:

  • Volatile vital signs
  • Lab results that put the patient at possible acute health risk
  • Complications from a separate medical condition that is occurring at the same time

Psychological instability is identified as:

  • Suicide risk without a safety agreement
  • Symptoms which are becoming increasingly worse

In inpatient hospitalization, the focus is solely on getting the patient stable enough to go to a residential treatment facility. Therapy is not provided at this level. Typically, people at this level are too neurologically compromised to process therapy, so it is deemed ineffective.

Residential

To qualify for residential treatment, typically you would

  • Require supervision for all meals
  • Have eating disorder behaviors that are out of control (ie. restriction, purging, binging, exercising, etc.)
  • Need 24 hour care, but medically stable
  • Depending on the type of eating disorder, require weight restoration

Residential treatment takes place in various settings, from a facility that looks like a home to a modified hospital setting.

Partial Hospitalization Program

Partial hospitalization program (PHP) is also known as Day Treatment. It is exactly what it sounds like; you would spend your days at the treatment facility, but sleep at home. At this level of care, you may still have a

  • Preoccupation with intrusive thoughts
  • Need for structure, but not 24-hour care

PHP programs are 5-7 days/week, 8-11 hours/day, depending on the treatment facility. During the day, you will spend your time in individual and group therapy settings with counselors, dietitians and family therapists. You will also eat supervised meals and snacks.

Intensive Outpatient Program

An Intensive Outpatient Program (IOP) is for those who have

  • Higher levels of motivation
  • Need some meal support
  • Require some structure to work on eating disorder behaviors

IOP is usually 2-3 days/week for 3 or more hours/day. Most clients can continue with some level of work or schooling while at this level and will sometimes work with their outpatient therapist and dietitian while doing group and family therapy at the treatment center.

Outpatient

In an outpatient setting, you are living at home and working with a treatment team made up of a counselor, dietitian and physician. Together they will coordinate care. You can typically expect to see your therapist 1-2 days/week for an hour at a time, the dietitian for weekly sessions, and occasional doctor visits.

To qualify for outpatient therapy, you will probably

  • Be medically stable
  • Not be suicidal
  • Have a fair amount of motivation

Everybody is different

Every person is different, and the break down above may not work in every case. It is a guideline that is used by eating disorder professionals to assess for appropriate care, but exceptions might be made for varying reasons.

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Tamara Duarte

Tamara Duarte is a counselor, author, speaker, and activist. Her private practice, Get Centered Counseling in Vancouver WA, helps women with food and body issues learn to love themselves, their body, their life, and their relationships. Her life’s work is steeped in personal experience, having fifteen years in recovery for anorexia, in addition to being a breast cancer survivor. An up and coming force in the counseling community, Tamara has been published in a textbook called Treatment Strategies for Substance and Process Addictions, and has sat on a panel at the American Counseling Association Conference, where she spoke to her peers on strategies and tools to use with clients struggling with eating disorders. Having a deep, personal understanding of what it takes to recover from this condition, she seeks to be an example to those she treats, to let them know that recovery is possible. Currently developing a podcast which addresses the cultural issues that promote body shame, self-esteem issues and eating disorders, Tamara lives in Vancouver, Washington, with her husband and best friend, Adam, enjoying life to the fullest with their two beautiful children, Jacob and Chloe.