The Role of Higher Levels of Care for Eating Disorders in Youth

Adaptation of family-based treatment within an inpatient medical stabilization program for children with eating disorders

OBJECTIVE

Eating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family-based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting.

METHOD

The present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting.

RESULTS

The use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed.

DISCUSSION

Though anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings.

PUBLIC SIGNIFICANCE

This article describes how a children's hospital has adopted family-based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings.

Day Programs for children and adolescents with eating disorders: A systematic review

Day programs have received significant consideration within psychological literature as part of a continuum of mental health services. With increasing attention on the prevalence of eating disorders in children and adolescents, and the need for early intervention to minimize the costs and burden of the disorder, eating disorder day programs (also referred as partial hospitalization) have begun to emerge around the world. Despite their widespread use, no reviews to date have examined the efficacy of day programs for the treatment of eating disorders in children and adolescents. The current narrative literature review aims to describe and evaluate the efficacy of day programs for children and adolescents. The literature review was conducted according to the PRISMA guidelines and aimed to explore the outcomes and common program elements of day programs to guide clinical practice and service development. The review found variations amongst the day programs related to program elements, measures utilized and outcomes. Overall, the results suggest that day programs for children and adolescents are effective at restoring body weight, reducing eating disorder symptoms and addressing comorbid mental health concerns.

Adolescent eating disorder treatment outcomes of an in-person partial hospital program versus a virtual intensive outpatient program

OBJECTIVE

Though virtual outpatient psychotherapy for eating disorders is likely effective, less is known about virtual higher levels of care. The current study examined the clinical outcomes of a family-based virtual intensive outpatient program (vIOP) for youth with eating disorders which was developed in response to the COVID-19 pandemic, compared to the same institution's in-person partial hospital program (PHP).

METHODS

Treatment outcomes were assessed via chart review in 102 patients between the ages of 9-23 (M = 15.2, SD = 2.5) who were predominantly cisgender female (84.3%) and primarily diagnosed with anorexia nervosa (64.7%) or atypical anorexia (23.5%). Participants were either treated in the in-person PHP before the pandemic (n = 49) or the vIOP during the pandemic (n = 53). Percent expected body weight (%EBW) was examined at baseline, end of treatment, 3-months post-treatment, and 6-months post-treatment, as well as the frequency of medical, psychiatric, and residential admissions before, during, and after vIOP or PHP participation.

RESULTS

Linear mixed models demonstrated no effect of treatment modality (in-person versus virtual) on %EBW over time. The duration of the vIOP was, on average, 12 calendar days longer, though the amount billed for the vIOP was lower. Survival analyses and Cox regression models did not suggest differences in the frequency of hospital and residential treatment admissions during treatment (vIOP: 9.4%, PHP: 10.0%) or post-treatment (vIOP: 15.0%, PHP: 10.2%).

DISCUSSION

Findings support virtual family-based programs as suitable alternatives to in-person treatment and underscore the potential cost-effectiveness of a family-based IOP versus PHP.

PUBLIC SIGNIFICANCE

This study demonstrates that a virtual, family-based, intensive outpatient program for youth with eating disorders had similar treatment outcomes to an in-person partial hospitalization program. Specifically, the virtual and in-person programs had similar weight restoration outcomes and rates of medical, psychiatric, or residential treatment admissions during or after treatment initiation. Findings support the use of virtual treatment, even for youth requiring a high level of intervention.

Integrating Family-Based Treatment Principles in the Acute Inpatient Treatment of Adolescents with Restrictive Eating Disorders

Eating disorders (ED) are serious psychiatric illnesses with one of the highest mortality rate of any psychiatric disorder. The health sequelae of eating disorders are one of the most common causes of medical hospitalizations at freestanding pediatric hospitals in the United States. The economic impact of EDs on health systems and families is substantial. The Society for Adolescent Medicine (SAHM) recommends family-based treatment (FBT) as the first-line approach for adolescents with restrictive eating disorders due to a large body of evidence demonstrating the treatment's efficacy and cost effectiveness. Although FBT was originally developed as an outpatient treatment, the tenets and principles of the treatment have also been used in higher levels of care. This brief report discusses how components of FBT were adapted for a medical inpatient unit at a pediatric hospital in order to integrate empirically based treatment.

Leveraging general risk surveillance to reduce suicide in early adolescents: Associations between suicidality, disordered eating, and other developmental risk factors

OBJECTIVE

Suicide is a leading cause of death in early adolescents (i.e., children ages 11-14), underscoring the need for a more complex understanding of suicidality in youth. Syndemics framework posits that the overlap of multiple maladaptive behaviors (or risk factors) produces worse health outcomes compared to each behavior alone. The use of this framework in preventing suicide necessitates that identification of developmental risk factors that occur in tandem to suicide (e.g., disordered eating behaviors and substance use) may be important for intervening on those at greatest risk of suicide.

METHOD

The present study uses latent class analysis (LCA) to evaluate the relationship between suicidality and disordered eating behaviors in early adolescence, and associations with other developmental risk factors in an epidemiological sample of middle school students (N = 3,811).

RESULTS

Lifetime prevalence ranged from 6.8% to 18.2% for suicidality, and 5.3%-48.7% for disordered eating behavior. Our final model identified six independent classes, and each class had differential associations with several additional developmental risk factors.

CONCLUSION

By pinpointing specific classes of individuals who may be at risk for multiple developmental risk factors, our results have important implications for public health intervention and prevention efforts for a wide range of adolescent risk behaviors, including suicidality.

Trends in Psychiatric Hospitalization of Children and Adolescents in Spain between 2005 and 2015

Eating disorders are on top of chronic conditions in children and adolescents, and the most severe cases may require hospitalization. Inpatient psychiatric treatment is one of the most expensive ones and therefore the efforts when treating eating disorders should focus on avoiding and shortening admissions, as well as preventing readmissions. Advances in of eating disorders treatment lie in an accurate knowledge of those patients requiring admission. This study examined the Conjunto Mínimo Básico de Datos-the largest public hospitalization database in Spain-to estimate the prevalence of eating and other psychiatric disorders during childhood and adolescence. It is a cross-sectional study of the hospital discharges in Castilla y León (Spain) from 2005 to 2015, in which patients under 18 years old with a psychiatric diagnosis at discharge were selected. Trends in the rates of hospitalization/1000 hospitalizations per year were studied by joinpoint regression analysis. Conclusions: eating disorders were the only group that presented an upward and continuous trend throughout the study period. This statistically significant increase showed an annual change of 7.8%.