Initial Admissions Phone Call
How should I talk to my child about my concerns?
How you approach having difficult conversations in your family is as unique as your loved one. In the case of an eating disorder, the critically important piece is to start a dialogue about your concerns instead of waiting to see if things resolve on their own.
For your younger child (11y & under), share your concerns with your child’s pediatrician, primary care physician or therapist for guidance on the next steps.
The following suggestions are intended for adolescents (12y+). If you are unsure of how to talk to your loved one about your concerns, here are some suggestions.
Consider how, when and where you share your concerns. Share your observations when you can express yourself in a calm way. Choose a time where you are not feeling rushed and can talk openly with your adolescent. In general, limit the number of people who are involved in this very personal conversation and respect your loved one by creating a safe environment. It is helpful to be clear and specific about what you are seeing in your loved one and why this concerns you.
There might be the instinct to confront your adolescent when you have discovered or been told that your child is engaging in harmful eating disorder behaviors. It is understandable that you would be upset or scared in these moments. You will fare better if you take time to gather your thoughts and come together in a less emotionally heightened state.
Many biases and myths exist about eating disorders and it is imperative to educate yourself. That said, recognize that you don’t need to know everything about eating disorders to have this conversation. A reliable source and place to start is on the ‘About Eating Disorders’ section of our Veritas Collaborative website.
There is a chance that your loved one may dismiss your concerns and/or have ardent reasons for why they are doing what they are doing. They may not see this as a problem or a struggle. Alternately, your child may feel relief in feeling seen and heard in their experience. Simply put, reactions can vary. It can be very unnerving for your loved one to have the eating disorder openly talked about and will likely need ongoing conversations.
Eating disorders are highly complex and serious illnesses that are often accompanied by intense feelings of shame and inadequacy. While you may naturally feel concern about the outward behaviors you see your child struggling with (bingeing, restriction, purging, etc.), focusing too intently on those behaviors can reinforce the core beliefs of ‘there is something wrong with me or I’m not good enough or I’m bad.’ This is not to say that these behaviors should be ignored. The outward symptoms of the eating disorder need intervention and monitoring by professionals – doctors, therapists, psychiatrists, registered dietitians – as they have profound and serious effects on their mind and body.
Keep in mind the person struggling needs to know you are taking the eating disorder seriously. If your child isn’t ready to accept your concerns, sharing that they appear to have less energy, focus, joy, or time for the things they once loved can be one way to explain what you are witnessing. Let them know your care for them extends beyond their outward eating disorder symptoms to their internal experience. Your child needs to hear that you care about them as a person and that you intend to get them help for what they are experiencing.
If your loved one doesn’t engage with you, let them know you will give them some time to think about what you’ve shared, and you will revisit the conversation with them at a specific point in time. Consider waiting no more than a couple of days, even if your child downplays what is occurring. Stick to your message, often in the intense experience of the eating disorder, your loved one may desperately attempt to convince you (and themselves) that everything is fine. Assure them that they matter to you and give them options for how they can continue the conversation – by text, email, or in person – after they have had time to think.
Here are some conversation starters:
- ‘I have noticed that you are having a hard time with eating. You often tell me you’ve eaten when it’s time for a meal’
- ‘I have heard you talk very negatively about yourself and your body’
- ‘I have noticed that sometimes large amounts of food are gone’
- ‘I have noticed that you are limiting the foods that you eat’
- ‘I have noticed that you talk about eating only foods with a certain number of calories and don’t allow yourself much flexibility to eat with your friends or family’
- ‘I remember when you wanted to learn more about nutrition, and I’ve noticed that over time it seems that making food/exercise choices have become very stressful.’
- ‘It seems like we continue to fight over what food is in the house and how we prepare it’
Follow up with:
- ‘I care about you so much and am concerned’
- ‘Can you tell me what it’s been like for you?’
- ‘What do you think about what I’ve said?’
- ‘I’d like to hear from you and learn what’s been on your mind?’
- ‘What have the last several months been like for you?’
Now listen and thank them for confiding in you.
Please describe the intake process. How can I prepare my loved one for the intake process?
An admission specialist will assist you in scheduling the phone assessment appointment and can be reached by calling this number: 612-402-3061. This appointment will be completed over the phone with a therapist who specializes in assessing for eating disorders. The therapist will guide you through the assessment and will ask you a variety of questions about your concerns for your child and may also ask to speak to your adolescent individually.
During the phone assessment the therapist will ask about current and past eating patterns and eating disorder related behaviors, any recent changes in eating, mental and physical health changes, and other aspects of their life experiences including their social and emotional wellbeing impacted by their current struggles.
In some cases, your child’s referring providers have recommended your child for intensive eating disorder treatment. It is extremely helpful to have your written consent (signed Release of Information form) to exchange clinical information with those referring providers to provide the best care possible. We encourage you to work with your referring providers to prepare you and your child for the appointment.
If you find yourself questioning whether to tell your child about the phone assessment or your plans for them to start treatment, in our experience, ‘surprise’ admissions don’t go well. It is a reality of this illness that most don’t want to do treatment when it is most crucial for them to get help. It is crucial to provide your child with more information and to remain steadfast in your resolve that treatment is the necessary.
We understand how and why the experience of an eating disorder in a loved one can cause people to parent from a place of fear. From the first phone call, we hope to equip, support, and empower you to do what your child needs through education, skills, and practice.
- It is encouraged that you complete the forms in the intake packet before your loved one’s phone assessment. This will be done via the ‘With Me When’ app.
- The appointment will take approximately 30-60 minutes
- The therapist will guide you through the assessment and may speak separately to your older adolescent.
- The therapist will provide a recommendation for treatment which can include inpatient, residential (both 24/7 care), partial hospitalization, or intensive outpatient. Weekly outpatient appointments may be available depending on the site you are working with, and if it is appropriate for your child and their level of illness.
- An admission coordinator will be in touch to work on the next steps and to provide a time estimation on admission.
If your child is recommended for a partial hospitalization, residential, or inpatient program, a virtual medical intake appointment will be scheduled with a medical provider who specializes in eating disorders to ensure medical safety for the recommended care. This appointment is not in lieu of any ongoing medical care being given by your child’s pediatrician, primary care physician, or other specialists. It also does not take the place of emergency medical or psychiatric care required by your child while waiting for treatment to begin.
If your loved one is concerned about missing school or extracurricular activities, reassure them that their health and well-being is paramount. Often at this stage, it is common that someone struggling with an eating disorder doesn’t see the seriousness of the situation and may downplay your concern. They may urge you to cancel the assessment or even refuse to cooperate. Taking this next step is extremely threatening to the eating disorder, and we encourage you to see it through.
During the assessment or even as they prepare to enter treatment, you may see a ‘different side’ of your loved one – functioning better OR worse than you typically experience them. You may learn things about their mental and physical health and eating disorder behaviors that surprise you or that you were not aware of. This is not uncommon and highlights the importance of having your child talk with a professional who specializes in eating disorders.
I am concerned my child will not participate in the phone interview, but I know they need help. How will you handle this?
Our trained professional intake therapists will treat your child with kindness and respect and will work to make you and your child comfortable. If your child is not available or able to participate, the assessment can be conducted without your loved one present.
It can be helpful to keep in mind that the eating disorder impacts a person’s energy level, mood, focus, and thoughts. You likely have experienced the ups and downs of your child’s struggle. We value your input and perspective. We know that this experience affects your whole family system and can cause chaos and uncertainty. We are interested in assisting your child and family to get through this difficult time and to assist your child in their growth and healing.
How should I talk to my child about eating disorder treatment?
Here are some suggestions for talking with your child about eating disorder treatment:
- ‘We are concerned about what we have noticed lately, and we are going to follow the recommendation that (insert intake therapist) suggested. Here’s what will happen next.’
- ‘We will be a part of your treatment during your appointments, family support groups and during visitation’
- ‘You are not alone. We will work together to help you fight the eating disorder – you will be starting (insert level of care) on (insert date). We will be working with a team that specializes in treating your eating disorder.’
- ‘You will be staying at the treatment center where you will be working with therapists, therapy assistants, teachers, dietitians, nurses and doctors who will be with you.’
- ‘We are going to learn new and different ways to help with the fear and negative feelings you are having about yourself and eating/your body’
Are there recommended support groups, websites, or books to help me make sense of what I’m experiencing with my child? Or what my child is experiencing? Can you describe the possible impacts of the eating disorder on my child?
We encourage you to seek support – the experience of an eating disorder in your family affects everyone in your family unit and often leaves parents feeling frightened, powerless, and overwhelmed. We offer some support resources here.
Your family and your child or adolescent will receive educational materials when they begin treatment.
National Alliance for Eating Disorders – This is a national non-profit organization providing referrals, education, and support for all eating disorders. They host free virtual therapist-led Family Support Groups and has a national, interactive database for finding eating disorder care. www.allianceforeatingdisorders.com
The National Alliance for Eating Disorders also has free therapist-led virtual support group for Friends & Family. You can join and participate as much or as little as you need – listening is OK too. www.allianceforeatingdisorders.com/eating-disorder-support-groups-and-programs
F.E.A.S.T. – Families Empowered and Supporting Treatment for Eating Disorders – A global community offering support, education, and empowerment to families of people affected by eating disorders. www.feast-ed.org
National Eating Disorder Association (NEDA) – This is a non-profit organization devoted to preventing eating disorders, providing treatment referrals, and increasing education and understanding of eating disorders, weight, and body image. www.nationaleatingdisorders.org
ANAD (National Association of Anorexia Nervosa and Associated Disorders) – This is a national non-profit organization that provides free peer support services to anyone struggling with an eating disorder. anad.org
Overcoming Binge Eating: The Proven Program to Learn Why You Binge and How You Can Stop – 2nd Edition.
By Christopher G. Fairburn
Help Your Teenager Beat an Eating Disorder – 2nd Edition.
By James Lock, Daniel Le Grange
Autism and Eating Disorders in Teens.
By Fiona Fisher Bullivant, Sharleen Woods
Skills-based Caring for a Loved One with an Eating Disorder: The New Maudsley Method – 2nd Edition.
By Janet Treasure, Grainne Smith, Anna Crane
Off the C.U.F.F.: A Parent Skills Book for the Management of Disordered Eating.
By Dr. Nancy L. Zucker
Throwing Starfish Across the Sea: A pocket-sized care package for the parents of someone with an eating disorder.
By Laura Collins Lyster-Mensh, Charlotte Bevan
Brave Girl Eating: A Family’s Struggle with Anorexia.
By Harriet Brown
Telling ED No!: And Other Practical Tools to Conquer Your Eating Disorder and Find Freedom.
By Cheryl Kerrigan, Thom Rutledge
Post Intake Decision Making
How are treatment recommendations decided?
Remember that the number and frequency of eating disorder symptoms and the impacts on your child’s physical and mental health inform the treatment recommendation at the phone assessment.
It can be helpful to know the therapist conducting your child’s phone assessment has extensive knowledge of eating disorders and their treatment. The therapist’s comprehensive education coupled with the ethical standards set by their professional organizations and state licensing boards support therapists’ competence and practice quality.
The intake therapist has a minimum of a master’s degree in psychology, social work, or counseling plus several years of supervised practice by an experienced professional in their field. As a part of practice standards for their position, those conducting the therapy and assessments have ongoing yearly training requirements, supervision, and consultation with others in their field and with the multi-disciplinary teams (medical providers, psychiatrists, nurses, registered dietitians, education coordinators, etc.). They are highly trained and supported professionals
Eating disorders are biologically based brain illnesses influenced by environmental and psychological factors. The bio-psycho-social model of eating disorder etiology (cause) highlights the overlap of environmental factors such as weight and appearance pressures, media messages, weight comments and teasing – biological influences such as dieting and food exposure, genetics, puberty, and menopause – experience and traits such as depression and anxiety, substance use, stressors, trauma, or self-image.
There is no one pathway to the development of an eating disorder, and we know that EDs (eating disorders) are about more than food alone and have their roots in one’s experiences, neurobiology, emotional understanding, and expression, coping with loss, messaging about our inherent worth as people, self-image and feeling seen and heard. Having said all of this, a specialized, comprehensive assessment is required.
Our treatment recommendations are informed by guidance of professional and academic organizations such as the American Psychological Association, Academy of Eating Disorders, Amercian Academy of Pediatrics, etc. in conjunction with our collective professional experience and the feedback and needs of our patients and their families.
I am concerned that the recommendation is too drastic and will make things worse for our child? Won’t removing them from their school, family, friends or extracurriculars worsen their mental health?
It is so difficult to see a loved one suffering and the reality is eating disorders are serious disorders with potential catastrophic and devastating outcomes if left unchecked and untreated. They have a high rate of death and increased rates of medical consequences and psychiatric illness regardless of the type of eating disorder or one’s body weight. It is critical to be aware that a life-threatening eating disorder may occur without any physical signs or symptoms.
You’ve seen changes in your child, maybe not even recognizing aspects of your child or their behavior – their thoughts and fears – their declining health – it can be difficult to face the fact that your child is struggling or seriously ill – an eating disorder is exceptionally concerning. Early diagnosis and treatment are vitally important.
Treatment recommendations take into consideration many aspects of your child’s experience with eating disorders behaviors (binge eating, restrictive patterns with food and fluids, compensatory behaviors, etc.) thought patterns, other mental health concerns, preoccupation levels (how much eating disorder based thoughts dominate their daily life), frequency and duration of behaviors and thought patterns, impact on functioning in multiple areas of living and physical health status.
The care recommendations consider many aspects of your child’s eating disorder and your unique life and family. It can feel extreme to hear that your child needs 24/7 care for their eating disorder. We urge you to consider if you would feel the same if it were another serious, life-threatening medical illness. The earlier we can intervene and interrupt the impact of the eating disorder the better outcomes patients have. We aim to provide the best care needed to get your child back to their life and health.
Why can’t we try something less intensive first to see if that helps, isn’t something better than nothing? Can we see a therapist or a registered dietitian before starting treatment?
Our treatment philosophy is to provide your loved one with the care that is needed. We do this by treating the eating disorder aggressively to support your child back into health. By doing this, we aim to limit the duration of the illness; more now helps to limit relapses and ongoing long-term illness. Research in the field and our experience supports that early and focused intervention results in better outcomes. Reversing the impacts of malnutrition, improving mental and physical health, returning to developmentally appropriate experiences and activities, and fulfilling their life trajectory are examples of milestones we hope that treatment will allow.
While waiting for care, please continue to work with your community providers.
When it is appropriate, outpatient services can be a possibility. Our Atlanta, GA Hospital and Center and Charlotte, NC Center have outpatient service options. However, our Durham, NC Center does not yet have outpatient services (weekly individual services). Stay tuned as we plan to expand our outpatient offerings.
How can my child keep up with schoolwork while in treatment?
Your child will have structured education time and opportunities for self-directed study throughout the week while in inpatient and/or residential care. Check with your specific site for details on the schedule.
Our Durham, NC Child and Adolescent Hospital and Center has a unique grant funded hospital education program through the Durham School District offered to patients during their participation in intensive programs. Your child will work with an education coordinator who will assist in communicating and coordinating with your child’s school and supervising your child’s schoolwork while in treatment and as they transition into lower levels of care.
At the end of the 2022/23 school year, the education coordinator program will discontinue for those in our Child and Adolescent PHP (Partial Hospitalization Program) and IOP (Intensive Outpatient Program) at our Durham, NC Hospital and Center. When your child transitions to PHP/IOP, the coordination of education needs will transition to you, the parent and your child’s school.
Our Atlanta, GA Child/Adolescent Hospital & Center utilizes LearnWell Educational Services to assist in coordinating and supervising your child’s educational progress while receiving treatment with us. LearnWell specializes in providing educational support to adolescents in treatment centers. They provide a certified teacher onsite to support patients and coordinate directly with the home school district after admission.
School is important and your child’s health is critical for school. Treatment and health will be the priority and maintaining progress in your child’ education will be integrated into treatment.
Do you have any guides for talking with school counselors, coaches, or directors?
Your education coordinator or LearnWell teacher will be helpful in communicating with the school administration or other key staff to discuss needed academic accommodations and ways in which your child will need support on their return to school.
For directors and coaches of extracurriculars, it is important to inform them of your child’s health concerns, need for treatment and their absence or adapted participation. Depending on your child’s situation and desire for privacy – there may be value in having your child stay in connection with the leader, director, coach, or peers while in treatment.
Is there guidance/advice on how to share with people outside of our family?
People in your life and the life of your child may or may not know about your child’s eating disorder.
If your child is going to be starting intensive treatment that requires them to be absent from their typical routine and activities, you will want to make plans for informing your child’s teacher(s), school, extracurricular activities staff, and any family or friends who are important to your child. Talk with your child about their thoughts and feelings about telling others. You may decide to tell only key people that will honor your child’s privacy and be a positive person for support.
Remember you also need support.
Is there anything we can do in the meantime while we wait for treatment to begin to help our child? Do you offer any services for while we wait for treatment?
Please be aware that if you are concerned with the wait time until admission, we may have other facilities in other states that may have openings and options for care for your loved one.
We highly encourage participation in the free virtual therapist-led Friends & Family Support Groups, offered weekly by the National Alliance for Eating Disorders. Access and information on these groups can be found on their website. www.allianceforeatingdisorders.com
Look for the weekly email and newsletter sent by your admission coordinator with info on admission, eating disorders and support.
Please continue at minimum to see your child’s doctor while waiting for admission. It’s important that someone continues to follow-up on your child’s physical and mental health, vitals, and lab work. It is important that someone asks them about their eating, exercise, or other eating disorder symptoms. In addition, checking in on how they are feeling emotionally and regarding personal safety is essential. Eating disorders are accompanied by a higher prevalence of suicidal ideation (thoughts about taking their own life) and are a higher risk for suicide. The mental anguish that accompanies an ED cannot be ignored.
Here is a guide that can be shared with your child’s physician:
In addition, we encourage you to stay connected to any other professionals – therapists, psychiatrists, etc. Please consider completing a Release of Information (ROI) form to facilitate coordination of care with your child’s physician, individual therapist, registered dietitian, psychiatrist, or any other professionals you would like to contribute.
There is a sobering reality that those suffering from eating disorders experience thoughts about suicide at a much higher rate than those without eating disorders.
As a result, we suggest the following:
- Know about your local mental health crisis resources
- Create a safety plan with your child’s physician or therapist
- Call 988 – National Suicide and Crisis Lifeline
- Go to the ER or call 911 if your child is actively suicidal
How can I help my child with eating before treatment begins?
A key place to start is to understand the role of nutrition in ED recovery, this can assist you in recognizing what your child or adolescent is experiencing both physically and mentally, how malnutrition can affect the brain and help to envision what will be necessary as your loved one recovers.
Here is a guide from F.E.A.S.T. (Families Empowered And Supporting Treatment for Eating Disorders) that will help you conceptualize the importance of nutrition for your child:
A guide for providers from the Academy of Eating Disorder:
Prolonged patterns of disordered eating (binge eating, restrictive patterns with food and fluids, compensatory behaviors, etc.) can lead to serious medical complications as a result of malnutrition. All eating disorder diagnoses impact physical and nutritional health. It is imperative that your child or adolescent continues to work with their doctor (and other professionals) to monitor vitals, weight status and lab work while waiting for treatment to begin.
Once treatment begins, nutritional rehabilitation is a cornerstone of intensive treatment interventions. An overarching theme for your child or adolescent throughout treatment will be rebuilding consistent and adequate eating patterns while incorporating therapeutic skills to manage the anxiety and distress caused by the eating disorder. Food truly is medicine in the recovery from an eating disorder.
Your child or adolescent will start with a prescriptive meal plan. This daily meal plan generally will include 3 meals, 3 snacks with prescribed types and amounts of food. Recovering from an eating disorder isn’t only about eating enough, it is also adjusting one’s relationship with food and self from one of fear and control to trust and peace. The goals and focus for eating will shift throughout levels of care as your child or adolescent progresses.
Our stance on child and adolescent nutrition endorses the inclusiveness of all foods and values the absence of food judgement. We can accommodate most dietary restrictions and utilize the expertise of our Registered Dietitians to assess the origins of an individual’s dietary preferences. We understand the complex role food plays and the diverse eating situations life presents. As such, we aim to provide nutrition and food-related experiences, education, counsel, and skills that enable an individual’s journey to a more mindful, flexible, balanced, autonomous, and sustainable relationship with food. We acknowledge the varying nutritional profiles of food; the individualized nutritional need of each person; and the unique food experience each person has. We want the adolescent client to return to the family table in a way that enables adequate nourishment and promotes recovery, which we understand may look different throughout the recovery journey. We foster a Can Eat Culture believing that individuals can positively influence their eating disorder behavior by engaging in staff facilitated therapeutic supported meals and snacks. Ultimately a Can Eat Culture paradigm supports overall health and well-being, with a sense of freedom and true choice in finding ways to purchase, prepare and consume food.
Do you offer gender-inclusive care?
Veritas Collaborative is committed to fostering a safe and inclusive environment that values patients’ gender identity and gender expression. We strongly believe that all patients shall have access to facilities where they feel comfortable and dignified.
Any resident at Veritas Collaborative shall have access to the shower and toilet facilities that align with their gender identity. Additionally, residents may share a bedroom with a resident whose biological sex differs from that person’s gender identity or gender expression.
Veritas Collaborative does not tolerate any harassment or discrimination on the basis of gender identity or gender expression. Any such behavior at Veritas Collaborative will be taken seriously, given immediate attention, and handled in the same manner as other bullying, harassment, and discrimination.
How do you manage mixed eating disorder diagnoses in treatment and groups? I am concerned my adolescent will learn other ED or harmful behaviors; how do you approach this in treatment?
Thankfully, our field has made significant advancements in the treatments we provide, and we have lots of evidence to show that treatments like CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), and FBT (Family-Based Treatment), and others have strong evidentiary support for all of the diagnoses we treat. We also strive to make sure content in our groups can be helpful to any of the eating disorders we treat, whether that’s BED (binge eating disorder), ARFID (Avoidant/Restrictive Food Intake Disorder), AN (anorexia nervosa), OSFED (Other Specified Feeding or Eating Disorder), or BN (bulimia nervosa). We recognize that even if two people have the same diagnosis, no two presentations of an ED are exactly the same, so in addition to providing evidence-based care, we also work hard to individualize the care and support we provide so every patient and family can get the help they need to pursue recovery.
Many eating disorders do not have just one symptom, and many of our patients have general mental health concerns in addition to their eating disorder. We know our patients can be vulnerable to “picking up” new symptoms in lots of settings, including when viewing social media, at school, on sports teams, etc. We have staff trained to identify and redirect problematic behavior patterns, including comparison behaviors, other ED symptoms, etc. In addition, we value the full representation of all shapes and sizes in our groups and include a variety of examples for our patients as we work to teach and apply helpful skills across different eating disorder presentations. Our goal is to provide interventions that can help our patients replace unhelpful ways of coping with anxiety, body image, depression, perfectionism, and more with strategies that help them live more peaceful, value-centered lives.
How do you manage developmental differences, learning styles, or age differences in adolescents in group settings?
We teach skills and lead groups using a variety of strategies: videos, handouts, discussion, creative activities such as art-based activities, etc. These allow us to tailor our interventions to patients of varying ages and learning styles so that everyone can benefit from every group. We also have staff present in all groups so that we can make sure content remains age-appropriate for all. The power of treatment is often in the group atmosphere, and having mixed ages in groups has often been a positive experience for our patients. While in inpatient or residential levels of care, our patients are grouped together in units and those units are grouped closely by age. We try to place our youngest patients together and all other groupings as developmentally informed as possible.
Our patients find it meaningful to support one another, regardless of age, and often inspire each other to take courageous steps toward recovery as they watch each other do the hard work of healing. Much like our adult patients, who are also in treatment with a variety of age groups, our adolescent patients generally find the experience of group treatment to be empowering and validating because they are with people who innately understand their pain and challenges.
What can I expect on my child’s admission day? First 1-3 days of treatment?
Stay connected with your admission coordinator. They will serve as your guide as you prepare for admission. They will share information on things like the packing list and program schedule, including parent/family group schedules. Included in this will be any COVID-related health/safety guidance that might impact how groups/visitation are offered. You will have an orientation on the day of admission.
If you are working with a referring provider – individual or family therapist in your community, work with them to prepare you and your child for treatment.
Admission day can be an emotional day and while you may be feeling a range of emotions as your child is about to start treatment, it’s worth mentioning that your child will be experiencing many feelings of their own. It is not uncommon that the fear of change and the unknown can intensify the thoughts and behaviors experienced by someone with an eating disorder, especially as the admission date gets closer. In fact, the first 24 hours in programming (or first few days) can be difficult for them and you. It may appear like they are ‘worse’ and at times lead you to question whether you are doing the right thing.
We understand their fears and yours and want to prepare you for common reactions from their loved one that parents encounter in the early days leading up to and after admission:
- pleading & begging – ‘please come & get me, this is the worst thing that has ever happened to me’ – ‘they don’t like me’ – ‘they won’t let me eat my food’ – ‘they are making me eat unhealthy food’ – ‘they are feeding me way too much’ – ‘this is making me worse’
- anger directed at you – ‘why did you make me do this, I hate you’ – ‘it’s your fault I’m here’
- negotiating – ‘I’ll eat anything you ask me to (or as much as you want me to) if you let me leave’
- ultimatums – ‘I’m going to hurt myself or I won’t eat at all if you don’t let me leave’
Please stay in touch with your child’s clinical team during this time. We cannot emphasize the toll the eating disorder takes on your child’s mental wellbeing – at times, you may find it very difficult to hear your child’s distress. Keep in mind that this can feel difficult, because this is difficult, not because you are doing something wrong. We anticipate these challenges.
Once your child has been admitted, you will be in regular contact with the clinical team, you are encouraged to ask who your contact person will be while your child is receiving care. The clinical team consists of the individual therapist, registered dietitian, medical providers, psychiatrist, therapy assistants, education coordinators, etc.
Your loved one needs a variety of interventions for healing; daily structure focused on restoring eating patterns and quantity with specific supports in place, medical care, and therapy to learn about and fight through the brutality of the eating disorder experience and into a life beyond this experience.
What support/education will be given to parents? What do I need to know re; hours of programming, parent expectations so that I can plan for work/care for my other dependents? How will I be involved in treatment? How do others cope with being away from their child?
As a guide, you can expect to dedicate about 5 hours per week to treatment activities; family therapy sessions, dietitian sessions, family meals, medical and psychiatric appointments, psychoeducational and support groups, therapeutic passes and connections with your child’s treatment team. Additionally, you will want time for phone calls and visitation with your loved one. For those who are unable to be on-site, virtual participation is offered.
We believe that families are a potent treatment resource critical to successful treatment, and the experts on their child or adolescent. Recovery happens in community and each family can build a community of support to include in treatment; grandparents, family friends, etc.
COVID-19 health and safety requirements altered families in treatment, ask your admission coordinator before and your team once your child has been admitted about current policies.
Thank you for entrusting us with your child, we recognize this as an incredible responsibility and opportunity for changing the course of your child’s health and wellbeing.
How do I apply for FMLA (Family Medical Leave) if I need to take time away from work for treatment or to care for my child?
The federal Family and Medical Leave Act may be able to help you if you need to take time off from work due to a serious health condition or to care for a loved one. For those who are eligible, FMLA provides employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that eligible employees keep their group health benefits during the leave. Not all employees are covered by FMLA, so understanding your employer’s leave policies is important.
Why are there such specific guidelines on the packing list?
The packing list is specific for your child’s physical and mental safety, in addition to the safety of the entire client community. We are overseen and held to standards set out by JACHO (The Joint Commission) and with state and federal regulatory guidelines for healthcare facilities and adolescent mental health services.
What are the priorities for someone in inpatient ED treatment?
Immediate goals for inpatient treatment at an eating disorder treatment center are focused on stabilization of physical and mental health.
- Medical stabilization
- Nutritional rehabilitation to achieve weight restoration and address nutritional deficiencies
- Management of refeeding and its potential complications
- Interruption of purging/compensatory behaviors
- Other therapeutic and psychological goals can be addressed when appropriate
After the initial stabilization, ongoing evidence-based treatment delivered by a multidisciplinary team of healthcare professionals with expertise in the care of patients with EDs is essential for full recovery.
Why do you need their growth charts?
Growth charts provide historical growth information on your child, essentially, they tell a story of your child’s physical development – height and weight trends.
This is critical information for your team to evaluate your child’s growth history and the changes that have occurred due to the eating disorder which will inform the treatment plan.
How long does treatment last? How is that determined?
Typically, our clients average the following lengths of stay in the following levels of care:
- 1–2 weeks in inpatient
- 6 weeks in residential
- 6–8 weeks in Partial Hospitalization Program (PHP)
- 6–8 weeks in Intensive Outpatient Program (IOP)
Please know that our care is individualized, and we need to get to know your child. Generally, within 2 weeks their team will provide you with an estimation of your child’s length of stay.
Lengths of stay are typically determined by the severity of the eating disorder and the impact on an individual’s functioning in areas such as medical status, mental health, ability to carry out daily tasks, cognitive abilities, social and emotional health. It is important to know that physical improvements or decreasing ED behaviors are only one part of the process of recovering from an eating disorder.
How will my child spend their time while inpatient or residential?
Depending on the level of care your child is receiving – their schedule will revolve around therapeutic supported meals and snacks. They will have daily vitals and medical care as determined by our medical team. Throughout the week, they will have a variety of therapy and skill groups, school time and study hall. Your loved one will also need rest and relaxation for their body to heal.
It is worth drawing your attention to the fact that the eating disorder can make it difficult for our patients to tolerate unscheduled or ‘downtime.’ By design, we build in unstructured time to spend in community while supervised by staff.
The intention is to reintroduce other enjoyable and age-appropriate activities outside of the eating disorder, reconnect or introduce to something they have enjoyed in the past and challenge disordered thinking around need for worthiness through productivity, while offering opportunities for social connection.
How will you help them with their eating? Or other ED behaviors?
Therapeutic supported meals and snacks are foundational for our treatment model. A structured eating schedule, prescribed meal plan guided by a registered dietitian and in-the-moment meal coaching that reinforces a return to adequate nourishment and progress towards a more positive relationship with food. As their treatment progresses, your child will experience more opportunities to normalize their eating behaviors.
Your child will be supported and supervised during all activities while in inpatient and residential care. Eating disorders increase distress around eating which can lead to harmful behaviors that reduce the distress (exercise, purging, etc.). Treatment includes working through those intense feelings and our clients need support throughout the day to interrupt the cycle of distress and eating disorder behavior use.
When can we visit? Or call? When can they use their phone while in treatment?
We know our patients and their parents need to stay connected during their treatment stay. Every facility provides and offers regular opportunities for phone contact and visitation. Please consult with your Admission Coordinator and treatment team for site details.