The Eating Recovery Center discovered a number of trends in eating disorder diagnosis, treatment and referral. This report discusses those trends and provides eating disorder clinicians with recommendations for effectively referring patients when patient situations dictate a need for collaborative treatment.
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Ā
Eating Disorder Referral Practices
1. The Eating Recovery Centerās
Report on
Referral Practices:
Recent Research Reveals Trends in the Process
of Referrals for Eating Disordered Patients
2. The Eating Recovery Centerās
Report on Referral Practices:
Recent Research Reveals Trends in the Process of
Referrals for Eating Disordered Patients
Introduction......................................................................1
The Case for Patient Referral.........................................1
Facility Types and Patient Needs...................................2
Table of
Contents
Factors to Consider When Making
a Referral Decision..........................................................2
How to Find a Referral Source.......................................3
Overcoming Obstacles to Referral . ..............................4
Conclusion........................................................................5
Works Cited......................................................................5
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Eating Recovery Center
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info@eatingrecoverycenter.com
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4. In general, if a patient requires medical stabilization, a referral to an inpatient or residential treatment center
that offers ongoing medical and nursing support may be necessary. If a patient is not advancing in treat-
ment, continues to engage in eating disordered behaviors or fails to restore weight, he or she may require
a higher level of care.
While referral to a higher level of care may be the most appropriate solution in the short run, patients can
often return to their outpatient therapist, dietitian or other care provider after their referral to support and
aid their ongoing recovery from the eating disorder.
Facility Types and Patient Needs
Data show that when referring an eating disordered patient, 73.7 percent of professionals refer to an eating
disorder-specific inpatient treatment center, 72.9 percent refer to an eating disorder-specific residential treat-
ment center, 57 percent refer to an eating disorder-specific behavioral hospital and 44.7 percent refer patients to
a registered dietitian.
As the results show, eating disorder professionals are comfortable referring patients to a number of different types
of facilities. A vast majority (92%) refer to a facility with which they have an existing professional relationship.
One facility type may not fit all. Though a large residential treatment facility may be appropriate for one patient, a
patient with co-morbid conditions who needs to weight restore may require a smaller setting with close access to
intensive medical care. The key is understanding the factors that come into play in each individual referral decision.
Factors to Consider When
Making a Referral Decision
A. Clinical Strength and Reputation. When rating factors that impact their referral decision, the majority
(86%) of respondents identified clinical strength as the most important factor. Reputation was rated as the
second most important factor. Though clinical strength and reputation are the most commonly considered
factors in a referral decision, these two factors are frequently confused. While many clinicians may seek
to base their referral decision on clinical strength, often their understanding of clinical strength is gleaned
from reputation, without consideration of the specific capabilities of the center and its treatment philosophy.
The following two considerations play greatly into determinations of clinical strength.
1. The Level of Medical Expertise. When a patientās disease has escalated to a degree where medically
supervised weight restoration is necessary or their behaviors have caused significant damage to inter-
nal organs, medical supervision is a necessary consideration in a referral decision. Elements that can
be considered when weighing medical expertise include onsite employment of internists or nursing
staff, the centerās capacity for alternative means of feeding or proximity to a hospital intensive care unit,
should the patient require stabilization. A handful of facilities across the country specialize in treatment
of the medical needs of seriously medically compromised eating disorder patients.
2. The Level of Psychiatric Expertise. Every facility is different and the needs of each individual patient
should be considered prior to any referral. One consideration may include access to a full-time on-site
board certified psychiatrist. Though many facilities employ full-time psychiatrists, many utilize the ser-
vices of visiting clinicians. Another consideration could be access to family therapy. Though some facili-
ties incorporate the family into the patientsā individual therapy sessions, a number of facilities employ
family therapists who work with patients and their families outside of individual patient therapy; creating
a sense of neutrality for all participants.
B. Cost. Cost was considered the third most important factor impacting a referral decision. Please refer to
āOvercoming Obstacles to Referralā for more information on cost as a barrier in referral.
C. Location. Location falls next in the ratings as a consideration when making a referral. More than half (55%)
of behavioral healthcare professionals typically refer patients to a treatment center in the same city. Nearly
40 percent have referred a patient to a facility in the same state and 36 percent have referred a patient to an
out-of-state facility.
Sending a patient to a facility in close proximity to their home is the optimal choice if the facility is able to
provide the appropriate resources the patient requires. Should the patient require a higher level of care or
an alternatively structured program, he or she will have a more significant chance at a sustainable recovery
if sent to a treatment center in a different location that is better suited to their specific treatment needs.
D. Aftercare Availability. The least important consideration was aftercare availability. Several respondents
commented that treatment centers āalmost neverā provide aftercare.
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6. guidance and continue to work collaboratively with them in the aftercare process?
ā¢ Does this facility work with insurance companies? Do they offer pointers about how
to secure optimized insurance coverage and are willing to intervene on the patientās
behalf with insurance companies? Does this facility offer a sliding pay scale if needed?
ā¢ What is their experience and how long have their clinicians been
treating eating disorders?
ā¢ How is the facility licensed? What are their training credentials? Do they belong to the
Academy for Eating Disorders (AED)?
ā¢ Does the facility have a quality improvement program in place or regularly assess the
outcome of the treatment provided?
ā¢ Is this facility familiar with either the APA Guidelines or Britainās NICE Criteria for the
treatment of eating disorders?
ā¢ What kind of evaluation process will be used in recommending a treatment plan?
When will we know itās time to stop treatment?
ā¢ Ask the facility to send information brochures, treatment plans, treatment prices, etc. The
more information the facility is able to send in writing, the better informed you will be.
Overcoming Obstacles to Referral
Though referral may be the right decision to make, this choice is not without obstacles. Behavioral healthcare
professionals cited the following obstacles, from most prevalent to least prevalent, as impacting both their and
their patientsā referral decisions.
A. Out-of-Pocket Cost. Often patient financial situations can present a barrier to treatment at an eating dis-
orders facility. Manage patientsā fear of cost by speaking with the intake coordinator at the treatment center
you are considering. Determine which insurance providers they work with, whether or not they are willing
to consider single-user agreements, how they manage patient payment (upfront vs. payment plans) and
the degree of their flexibility and willingness to work with the financial resources the patient has available
to find a creative solution. Every treatment center differs, and many are willing to develop individualized
financial plans to help patients find a way to get help.
B. Distance from Home. Fear of leaving family, school or a job can play into a patientās willingness to travel
for treatment. As mentioned earlier, proximity to home is ideal if the facility is able to provide the appropriate
resources the patient requires. If the patient requires resources that are only available at a distance, the out-
of-town choice is the better choice. A patient will have a significantly better chance at a long-term recovery
if they receive the appropriate treatment from the start. This may require some time away from home, but
will certainly decrease the likelihood of relapse.
C. Difficulty Working with Insurance Companies. The varying processes among insurance providers
can be a hurdle. Thanks to parity laws in some states, insurance companies must provide the same insur-
ance coverage for mental health treatment as they offer for medical and surgical conditions. According to
Pauline Powers, MD, in an article from Eating Disorders Review, when working with an insurance provider,
it is helpful to know the following:
1. The eating disorder diagnosis
2. Any other co-existing psychiatric disorders
3. Physiologic complications of the eating disorder
4. Level of care recommended: outpatient, inpatient, partial hospitalization, intensive outpatient
5. Anticipated duration of recommended treatment
6. Professionals needed and their required expertise
The National Eating Disorders Association also offers advice for working with insurance providers
(http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=286&Profile_ID=56701).
D. Patient preference. From location, to program curriculum to length of stay and other amenities, patient
preference is often an obstacle for referring physicians to overcome. Patient education is key to overcoming
this obstacle. Providing the patient with a realistic picture of the reason they require a certain level of care,
as well as information about the unique benefits of the center you recommend will help to assuage patient
concerns and fears.
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