NEDA TOOLKIT for Parents
be worth investigating if the patient does not have
financial resources or insurance. If you are having
trouble obtaining insurance coverage for your loved
one’s eating disorder treatment, see page 45 for more
information. Thirdly, determine the philosophy of the treatment
facility and the type of care they provide. Is the center’s
view of eating disorders supported by up-to-date
research? Does it support ideas of eating disorder
causes and recovery that are congruent with your
family’s situation? Does it encourage or require a high
level of family involvement?
In addition, “evidence-based treatment” is increasingly
emphasized, meaning that many eating disorder
programs advertise that they use these types of
treatments. It’s important to check how frequently
these therapies are used, and the qualifications of
the therapists providing them. Many facilities have
also begun advertising their efficacy via outcome
studies. However, residential treatment hasn’t been
studied for efficacy in randomized control trials, and
long-term outcomes have not been followed. Some
treatment centers will only evaluate people who
were not discharged prematurely, or they may only
assess individuals who returned surveys, which could
be biased towards individuals who are doing well.
The eating disorder community also does not have a
standard definition of what recovery looks like, which
can make interpreting these studies even harder. Don’t
ignore these data, but interpret them with caution.
Lastly, think about what will happen after discharge.
Does the program have a step-down program
or is there another one that you intend to use?
Discharge plans can be complicated and require much
coordination of care among different healthcare
providers. That takes time. Effective discharge planning
needs to start much earlier than a day or two before
the patient is expected to be discharged from a facility.
Other factors to consider when selecting a
treatment center include religious affiliation (if any),
multidisciplinary approach to care, distance from
home, staff/patient ratio, professional qualifications
of staff, their experience in treating eating disorders,
and adjunct therapies offered. Some treatment
centers provide therapies in addition to psychiatric
counseling and pharmacotherapy, like equine therapy,
massage, dance, or art therapy. These therapies may
be appealing, although there is no evidence for these
being essential to treatment response, and they may
not be covered by your health insurance.
Determining Quality of Care
Determining the quality of care offered by a center
is difficult at this time. No organization yet exists to
specifically accredit treatment centers for the quality
and standard of eating disorder-specific care. Leaders
within the national eating disorders community
organized in mid-2006 to develop care standards
and a process for accrediting eating disorder centers.
That effort is ongoing. One national organization,
the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO), provides generic accreditation
for healthcare facilities, and some eating disorder
centers advertise “JCAHO accreditation.” JCAHO
accreditation does not link directly to quality of care
for treatment of eating disorders; it assesses safety
and credentials of staff. Another issue regarding
quality of care is that much care is delivered on an
outpatient basis. For individual psychotherapists in
private practice, no special credentialing or specialty
certification exists regarding treatment of eating
disorders. Thus, any mental healthcare professional
can offer to treat an eating disorder whether or not
he/she has experience or training in this specific area.
Therefore, it is important to ask a prospective therapist
about his/her knowledge about eating disorders and
years of experience treating them.
Professionals in a Multi-disciplinary Care Team
• Primary care physician (i.e., family doctor,
internal medicine doctor, pediatrician,
gynecologist) • Psychiatrist
• Nutritionist
• Clinical psychologist
• Social worker
• Claims advocate for reimbursement
• Other professionals who administer
supplemental services such as massage, yoga,
exercise programs, and art therapy
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