Level of Treatment At Eating Disorder Treatment Facilities

There are five main levels of treatment varying in intensity and amount of structure provided to the patient; Inpatient hospitalization, Residential, Partial Hospitalization (PHP), Intensive Outpatient (IOP), and Outpatient. According to the American Psychiatric Association (APA), a number of factors should be taken into consideration when choosing the appropriate level of care. These factors include but are not limited to; the patient's medical and psychological state, the patient’s weight as a percentage of their “healthy body weight”, the patient’s motivation to recover, structure required for controlling eating disordered behaviors, the presence of stress in the patient's home environment, and geographic availability of treatment.

Treatment facilities often conduct in-depth patient interviews prior to admission to determine which level of treatment is most appropriate given a particular patient’s needs. The below criteria for different levels of care have been summarized from the APA.

Inpatient hospitalization is the most intensive level of treatment, appropiate for patients needing medical stabilization, 24-hour attention and the most structured environment. This level of care is most frequently provided in a hospital setting and often aims to stabilize the patient by beginning the refeeding process until the patient is able to step down to a lower level of care. According to the APA, inpatient care is necessary when:
• Patient is medically or psychiatrically unstable (as determined
by medical labs, risk of suicide, and/or severity of other coexisting
psychiatric disorders)
• Patient is less than 85% of their “healthy body weight”
• Patient's symptoms are severe, persistent, disabling and
can not be controlled by the patient
• Patient needs nasogstric feeding and supervision during and after all meals
• Patient is uncooperative with treatment

Residential treatment is a step down in intensity from Inpatient, where patients live at a residential facility, recieving treatment during most of the day.
According to the APA this level of care is appropriate when:
• Patient is medically and psychogically stable, not requiring intensive medical intervention and not at significant risk of scuicide
• Patient is cooperative in a highly structured environment but needs
supervision at all meals to prevent symptom use and increase motivation
• Patient does not respond to a lower level of care andcan not control symptoms on their own

Partial hospitalization (PHP) is a step down in intensity from Residential treatment, where patients live at home or in a transitional living center and spends 3 to 12 hours per day at the treatment at the facility. In PHP programs, patients typically have at least two meals at the facility each day. Bathroom policies are generally relaxed outside of meal times.
Patients at this level of care must be stable and motivated enough to spend multiple hours on their own without engaging in eating disorder behaviors. Typically, these patients have exceeded 80% of their “healthy body weight” and do not need constant monitoring. If a patient is living at home during treatment, stress in the home environment should be relatively low.

Outpatient/Intensive Outpatient (IOP)
Outpatient and Intensive Outpatient is appropriate for patients whose are motivated to recover and are self sufficient in eating, monitoring weight, controlling eating disorder behaviors. These patients do not need daily monitoring to function normally in social, educational or vocational situations. Intensive Outpatient is a step down in intensity from PHP, where patients live at home and spends several hours a day, several days a week in treatment. IOP programs are structured to provide a greater level of care than outpatient services alone, including a schedule of individual therapy, group therapy, meal consumption and processing. Outpatient treatment is the least intensive level of treatment, where patients live at home and receive treatment during short office visits with members of their treatment team on an as-needed basis. Patients may choose to receive what type of treatment they would like to participate in.