NEDA TOOLKIT for Parents
c) Lack of motivation in treatment
i. Discuss external influences on the
patient’s motivation (i.e. stress within
family) and emphasize the need for
ongoing support during this difficult time.
Also emphasize the triggering effects
of these external influences and the
likelihood of relapse if patient is stepped
down too soon.
ii. Highlight anything patient has said or
done which would indicate patient wants
recovery iii. Change something (medications,
structure, schedule, therapeutic approach,
anything that could spark a change)
d) Inconsistent attendance
i. If absences were planned or for legitimate
reasons, the explanation should be
enough. However, it always helps to
discuss the reasons in clinical terms
related to the patient’s recovery. (Ex: The
patient’s schedule was modified to allow
her to work a few shifts per week. This
was discussed with the treatment team
and will alleviate some of the financial
burdens that have distracted her from
focusing 100% on recovery. She has
worked with her dietary team to plan
meals and structure outside of treatment).
ii. If absences were not planned or were not
for legitimate reasons, discuss the next
steps the treatment team plans to take
in order to encourage attendance. It is
important to convey that the treatment
team takes absences very seriously. It is
also important to emphasize the patient’s
need for extra support during this time. It
does not hurt to speculate about the costs
of terminating treatment while the patient
is struggling.
iii. Frame it as “struggling with the ED” and
discuss interventions moving forward
4. Absence of Behaviors (i.e., patient is doing too
well in treatment and may be appropriate for a
step-down) a) Continued weight restoration is imperative
for a successful recovery. Stepping down now
would slow or stop restoration altogether. (This
argument is especially effective with patients
who have previously failed at restoring weight
on an outpatient or IOP basis.)
b) The patient has been using the program very
effectively and is learning healthy coping
skills. The patient is challenging herself with
new skills and will benefit from additional
time to practice these skills in a structured
environment. c) The patient will have several meals off within
the next week. The patient must complete
several successful meals off before we
can determine that a step-down would be
appropriate. If the patient struggles with
the meals off, he or she will benefit from the
continued structure of program in order to
identify and address the issues that arise.
d) Emphasize the emotional/MH issues that
contribute directly to the ED and the patient’s
need for continued structure and support
while beginning to address these issues.
5. No medical complications
a) Emphasize the medical issues that the patient
will likely develop if the behaviors continue.
Serious, internal, long-term damage is not
always apparent right away.
b) Dig for more information from the patient
and/or medical providers. Patients often
minimize or deny medical issues out of
embarrassment and may be more forthcoming
once they understand the benefits of
disclosing the information.
c) Check the medical necessity criteria.
Sometimes this is cited as a reason for denial
even if it is not a criterion. In that case you
have a pretty simple rebuttal.
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