Levels of Care Guidelines for Individuals with Eating Disorders
At Veritas Collaborative, we provide the highest standard of care across a continuum of levels. We recognize that each patient comes to us with a unique set of treatment needs based on their current medical status, the amount of structure necessary to decrease their eating disorder behaviors, and their motivation for recovery, among other factors. To create a treatment plan just for them, we consider these factors, as well as individual clinical judgment, to ensure each patient receives the treatment modalities that align best with the severity of their illness. We know that recommending the level of care that is right for each patient provides a solid foundation for long-lasting recovery.
What are the Levels of Eating Disorder Care?
Levels of care refer to the appropriate amount of support an individual needs to recover successfully. We think of the levels of care like a ladder, with each rung symbolizing a different degree of support. In this ladder analogy, outpatient care is at the bottom, and immediate medical or psychiatric stabilization – the highest level of acuity – is at the top. Skipping a step down the ladder can be a risky move; moving step-by-step is the best way to reach optimal success in treatment. Regardless of the level of care, family or community of support involvement is especially important.
The levels of care Veritas Collaborative offers for eating disorder treatment include:
Outpatient care is the foundational level of care, typically one step down from intensive outpatient (IOP) or a starting place for individuals needing a lower level of support. Outpatient treatment is often delivered in an office setting or virtually. This non-intensive, tailored treatment may include individual therapy, nutrition, medical or psychiatric interventions, and group or family therapy (particularly for adolescent patients).
Outpatient appointments generally happen once a week. A rigorous course of outpatient therapy is usually sufficient to facilitate necessary health restoration for approximately 60-70% of individuals who are able to access care – if they are able to access care with expert outpatient providers. The other 30-40% of individuals will need some higher level of care treatment in order to stabilize the medical, nutritional, and psychological aspects of the eating disorder, develop strong recovery promoting skills, and practice these skills with close supervision and support, after which they will need to transition back down the steps of the ladder, ultimately to outpatient.
Intensive Outpatient (IOP)
Individuals who do not respond to outpatient care or in need of more intensive support and intervention may be better suited to the additional structure and supervised intervention offered in intensive outpatient treatment. This group-based program is offered virtually and in-person at our facilities, 3-4 times a week, for roughly 3 hours per day. These sessions provide many of the same components as outpatient care, just at a greater frequency or intensity.
Unlike outpatient care, intensive outpatient sessions include a shared therapeutic meal. Eating disorder treatment is unique from other behavioral health interventions in that eating is one of the most intensive, stressful, and anxiety-provoking interventions. Therapeutic meals allow us to address our patients’ relationships with food during the actual eating experience, as well as provide support and model healthy and realistic eating situations. Patients can then practice with their supporters the recovery supporting skills they are learning in IOP and apply them in their everyday life settings.
Partial Hospitalization (PHP)
Partial hospitalization supports those stepping down from residential programming, but it can also be a starting point for patients after the assessment when they need a higher level of care than outpatient or an intensive outpatient program provides but don’t require 24/7 support. Patients in PHP spend 5-7 days a week in programming, which is focused on relapse prevention and sustained recovery.
Both in-person and virtual PHPs meet a minimum of 30 hours per week and include two therapeutic meals plus snacks each day. This more intensive level of support can provide interventions, supervision, and support to help prevent hospitalization as well as facilitate patients practicing recovery skills in their everyday life environment with their supporters as patients continue to develop these skills in treatment.
Residential care provides treatment for those requiring 24/7 support, supervision, and medical, nutritional, and therapeutic intervention. Patients at this level are medically stable but in need of continual structure to manage eating behaviors and compulsive and/or excessive exercise.
Our residential facilities are designed to be comfortable, safe, and welcoming, allowing individuals to receive robust treatment services while practicing healthy daily living skills they will integrate in everyday living, all with close medical, psychiatric, nutritional, and therapeutic supervision.
Inpatient care is often the first step for patients in significant physical danger and/or patients who need acute medical stabilization. These patients cannot be treated safely without the availability of immediate medical intervention. Veritas is one of the nation’s only eating disorder programs able to treat individuals who require the inpatient level of care before they progress down the ladder of care.
Determining a Level of Care
After you’ve made the first step by reaching out to our admissions team, we will schedule an eating disorder assessment for your child or your patient. An eating disorder assessment allows us to offer an informed recommended level of care. This recommendation is tailored to your child or patient’s clinical needs, our understanding of their relationship with food and body, their symptoms, family needs, and the standard of care guidelines for eating disorders.
Years of evidence-based research and the rich breadth of clinical work in the field inform our standards of care. Veritas’ standard of care includes recommendations from the newly released American Psychiatric Association Guidelines (APA) and the REDC Consortium (REDC).
Per the APA and REDC, we consider the following in determining the appropriate level of care for your child or patient:
- Factors that suggest significant medical instability, which may require hospitalization for acute medical stabilization
- Nutritional intake
- Percent natural body weight or degree of weight change
- Factors that would suggest a need for inpatient psychiatric treatment and stabilization, such as significant suicide risk
- Co-occurring conditions that would significantly alter treatment needs and require a higher level of care
- Lack of response or deterioration in patient’s condition if receiving outpatient treatment
- Symptom frequency and extent to which the patient is able to decrease or stop eating disorder and weight control behaviors (e.g., restriction, binge eating, purging, excessive exercise) without meal support or monitoring
- Level of motivation to recover, including insight, cooperation with treatment, and willingness to engage in behavior change
- Recovery environment and extent and access to support systems
- Extent to which a patient’s access to a level of care is influenced by logistical factors, such as geographical and insurance considerations, transportation barriers, and school, work, and childcare needs
To learn more about how Veritas Collaborative determines levels of care, watch Dr. Jillian Lampert’s presentation titled “After The Assessment: Levels Of Care And Why They’re Important” on our Recorded Presentations page.
Eating disorders are fierce and relentless, but they are treatable. Waiting for symptoms to get better can cause irreversible damage and delay recovery. If you suspect your child or patient needs help for an eating disorder at any level, please reach out today.
About the Author
Dr. Jillian Lampert is the Chief Strategy Officer of Accanto Health, the parent company of Veritas Collaborative and The Emily Program. Additionally, Dr. Lampert is Co-Founder and President of the REDC, the national consortium representing eating disorders care focused on treatment standards, best practices, access to care, and collaborative research. She is also a Board Member of the Eating Disorders Coalition, a DC-based national organization for eating disorders policy and advocacy, and a Board Member of WithAll, a Minnesota-based organization that empowers eating disorder prevention and strengthens support for recovery. She holds an adjunct graduate faculty position in the Department of Food Science and Nutrition at the University of Minnesota.
Dr. Lampert completed her doctorate degree in Nutrition and Epidemiology and Master of Public Health degree in Public Health Nutrition at the University of Minnesota. She earned a Master of Science degree in Nutrition at the University of Vermont and completed her dietetic internship at the University of Minnesota Hospital and Clinics. She has an expansive range of policy, clinical, research, education, teaching, and program development experience in the area of eating disorders.
Dr. Lampert has served on the Board of Directors of the Academy for Eating Disorders as the Electronic Media Portfolio Director and co-chair of the Academy for Eating Disorders Nutrition Special Interest Group. She is a Fellow of the Academy for Eating Disorders (FAED) and a member of the Academy for Nutrition and Dietetics (formerly the American Dietetic Association), and BHN (Behavioral Health Nutrition) dietetic practice group. Dr. Lampert is the author of numerous book chapters and articles addressing the nutritional treatment of eating disorders, body image, sports participation, adolescent health, and disordered eating and she regularly speaks regionally and nationally on numerous eating disorder-related topics.
One of her primary goals in life is to have the kids in her house (and everywhere!) have confident, loving relationships with their bodies and themselves.