NEDA TOOLKIT for Parents
Treatment settings and levels of care
Several types of treatment centers and levels of care are available for treating eating disorders. Knowing the
terms used to describe these is important because insurance benefits (and the duration of benefits) are tied not
only to a patient’s diagnosis, but also to the type of treatment setting and level of care.
Treatment is delivered in hospitals, residential
treatment facilities, and private office settings. Levels
of care consist of acute short-term inpatient care,
partial inpatient care, intensive outpatient care (by
day or evening), and outpatient care. Acute inpatient
hospitalization is necessary when a patient is
medically or psychiatrically unstable. Once a patient is
medically stable, he/she is discharged from a hospital,
and ongoing care is typically delivered at a subacute
care residential treatment facility. The level of care in
such a facility can be full-time inpatient, partial
inpatient, intensive outpatient by day or evening, and
outpatient. There are also facilities that operate only
as outpatient facilities. Outpatient psychotherapy and
medical follow-up may also be delivered in a private
office setting.
The treatment setting and level of care should
complement the general goals of treatment. Typically,
goals are:
to medically stabilize the patient;
help the patient to stop destructive behaviors (i.e.,
restricting foods, binge eating,
purging/nonpurging); and
address and resolve any coexisting mental health
problems that may be triggering the behavior.
Patients with severe symptoms often begin treatment
as inpatients and move to less intensive programs as
symptoms subside. Hospitalization may be required
for complications of the disorder, such as electrolyte
imbalances, irregular heart rhythm, dehydration,
severe underweight, or acute life-threatening mental
breakdown. Partial hospitalization may be required
when the patient is medically stable, and not a threat
to him/ herself or others, but still needs structure to
continue the healing process. Partial hospitalization
programs last between 3 and 12 hours per day,
depending on the patient’s needs.
Psychotherapy and drug therapy are available in all
the care settings. Many settings provide additional
care options that can be included as part of a tailored
treatment plan. Support groups may help a patient to
maintain good mental health and may prevent relapse
after discharge from a more intensive program.
The intensity and duration of treatment depends on:
insurance coverage limits and ability to pay for
treatment; severity and duration of the disorder;
mental health status; and
coexisting medical or psychological disorders.
A health professional on the treatment team will
make treatment recommendations after examining
and consulting with the patient.
Criteria for treatment setting and levels of
care Inpatient
Patient is medically unstable as determined by:
Unstable or depressed vital signs
Laboratory findings presenting acute health risk
Complications due to coexisting medical problems
such as diabetes
Patient is psychiatrically unstable as determined by:
Rapidly worsening symptoms
Suicidal and unable to contract for safety
Residential Patient is medically stable and requires no intensive
medical intervention.
Patient is psychiatrically impaired and unable to
respond to partial hospital or outpatient treatment.
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