Understanding Eating Disorder Treatment Levels of Care

Travis Stewart, LPC, NCC | McCallum Place Eating Disorder Centers

Finding effective care for an eating disorder can be a considerable challenge, especially if you’re not familiar with the terms and acronyms that eating disorder professionals commonly use to describe treatment options.

Treatment for eating disorders happens along a continuum, and care can be provided in a variety of contexts. These contexts are commonly referred to as “levels of care,” or LOCs. In order to make the best decisions for yourself or a loved one, it is helpful to understand what occurs at each level of care.

Outpatient Treatment

When you take part in outpatient care for an eating disorder, you can continue to participate in everyday activities such as work, school, and recreational pursuits. You will usually have weekly sessions with your treatment professionals. If your symptoms are more severe, then you may have several appointments with your treatment team every week.

As you make progress, your appointments may decrease to every other week or even less. These appointments usually take place in an office setting, which is typically separate from a hospital or other residential treatment environment.

When you’re working on eating disorder recovery in the outpatient setting, it is important to have a full treatment team. Often called a “multidisciplinary team,” your team should consist of a therapist or psychologist, a registered dietitian, and a medical provider.

Ideally, you should look for experienced, credentialed professionals who specialize in the treatment of anorexia, bulimia, binge-eating disorder, or other specific issues that you want to address.

Intensive Outpatient Program (IOP)

If outpatient care is not providing enough support or structure to help decrease your eating disorder behaviors, an intensive outpatient program may be recommended. IOP may also be the right level of care if you need additional time to address the mental and emotional issues that have been maintaining your eating disorder.

IOP generally consists of several hours a day in a treatment setting. Care at this level often includes meal support, therapy, nutritional counseling, and medical supervision. At McCallum Place, our IOP includes the following features:

• Therapy groups
• Weight and behavioral monitoring
• One daily meal
• One weekly session with a psychologist or therapist
• One weekly session with a registered dietitian
• One session with a psychiatrist every other week

Depending upon your needs and the structure of the program, you may take part in IOP three to five days per week. Programming may be available via morning, evening, or weekend sessions.

Partial Hospitalization Program (PHP)

The name of this level of care is a bit misleading, as most partial hospitalization programs do not take place in a traditional hospital setting. A better name may be “day treatment.”

PHP is an ideal level for individuals who need daily structure to help them change food rituals or stop eating disorder behaviors. For many, PHP can be an alternative to residential care, especially if sufficient support is available at home when treatment is not in session.

Depending upon your needs and the structure of the center at which you receive care, treatment at the PHP level may include six to 10 hours of services every day, five to seven days per week.

At McCallum Place, our PHP level of care includes the following services:

• One to two weekly individual sessions with a psychiatrist
• Two to three weekly individual therapy sessions
• Two weekly sessions with a registered dietitian
• Multiple daily therapy groups
• Therapeutic meals and snacks
• Medical monitoring of labs, weight, and vital signs
• Family therapy, education, and support
• Our 10-hour program includes two meals and two snacks
• Our six-hour program includes one meal and two snacks

PHP is a higher level of commitment on the part of families and patients and may require travel to a city some distance from home. This can be a complicating factor, because PHP does not include housing.

To accommodate this, many treatment centers provide transitional living for patients and families who are receiving care at the PHP level. This is often an apartment setting near the treatment center. If PHP is recommended to you, be sure to ask the center about housing options.

Residential Treatment

Residential treatment is exactly what it sounds like – a treatment setting that provides living accommodations and 24-hour supervision. At the residential level, you can receive intensive therapy, nutritional rehabilitation, round-the-clock support, and medical stabilization.

While options vary at each treatment facility, here is a sample of what occurs at the residential level of care at McCallum Place:

• On-site psychiatrists and 24-hour nursing
• Weekly individual sessions with a board-certified psychiatrist
• Three weekly sessions with a therapist or psychologist
• Two weekly sessions with a registered dietitian
• Family therapy, education, and support
• Multiple daily psychotherapy groups
• Three supported meals and three snacks daily

Intensive Inpatient Care

The highest level of care for eating disorders is intensive inpatient, which is often referred to simply as hospitalization. This level of care is reserved for the most medically serious cases, such as individuals who have been suffering from severe malnutrition or who have experienced life-threatening complications such as low heart rate, severe dehydration, or blackouts.

The primary goal of this level of care is medical stabilization so that the individual can then transition (or step down) to the residential level of care to do the therapeutic work that is needed for recovery.

Options for intensive inpatient care for eating disorders can be difficult to find. While someone may need to admit to a local hospital for emergency services or stabilization, adequate eating disorder care at the intensive inpatient level may require travel of some distance.

Please note that McCallum Place does not offer this level of care, but we are happy to provide recommendations for individuals who need intensive inpatient treatment.

Finding the Right Treatment for You

If you find yourself engaging in bingeing, purging, compulsive exercise, lying about food, or other self-defeating behaviors, and you think you may need help, McCallum Place is here for you.

The first step in recovery is connecting with us to have a conversation about your eating concerns. This discussion, along with an exam from your medical provider, will allow us to recommend the type of treatment that we believe is best for you.

There is no cost to contact us, and you will be under no pressure to enroll in our program. If at any point we determine that your needs can be better met in another setting or by another treatment provider, we will refer you to those services.

To learn more, call us today.