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September 15, 2015

Day Treatment vs. IOP – What’s the Difference?

Like many other eating disorder treatment centers, The Emily Program offers multiple levels of care for adolescents and adults. What makes The Emily Program different is that our services are based in outpatient treatment. As The Emily Program founder Dirk Miller says, “We didn’t start as an inpatient program and develop outpatient services to support that model. The reason is pretty simple: most change occurs as an outpatient. We live our lives as ‘outpatients.’ Ultimately we must apply what’s learned to a life of recovery that we live outside the treatment program.”

In addition to our basic outpatient services, individual therapy, dietitian, medical, group therapy, etc. we also offer higher levels of care—intensive programs that meet people where they are with the appropriate amount of support. Intensive programs fall in between outpatient and 24/7 residential care. The intensive programs include our Day Program. Depending on where you are in the country, this may be called an Intensive Day Program (IDP) or Partial Hospitalization Program (PHP), which is a minimum of 30 hours/week, and our Intensive Outpatient Program (IOP), which is a minimum of 12 hrs per week.

These programs are quite different from each other. When someone is looking into treatment, often one of the first thoughts they have is “How do I find an eating disorder program that will not interfere with my day-to-day life?” “Will it allow me to continue with school, work, family, and other activities while still trying to get better?” As a result of these questions, IOP seems like an attractive option.

To be in an IOP clients must be medically stable, able to eat on their own, and able to function in normal day-to-day life without significant risk of behaviors or relapse. As a result, for most people with an eating disorder who have never been in treatment, IOP is usually not the most effective level of care, to begin with. The reasons for this are clear – the very things that must be better for an IOP to be successful are usually the problems people present with when their eating disorder starts to take over their life: difficulty with eating, having behaviors, and medical complications due to the eating disorder.

Day Program (IDP/PHP), a higher level of care, provides accountability and support that is not available at the IOP level of care. This includes supervised meals, regular psychiatric visits (if needed), daily access to dietitians, and daily contact with therapists. Medical monitoring is also different in a Day Program as vital signs, including orthostatic vital signs, are checked on a regular basis. At The Emily Program, we tend to view IOP as a step down from a Day Program, rather than as a starting point for treatment. Certainly, there are situations where an IOP may be an effective entry point, such as when clients are coming from an outside program, are currently at a lower level of care but require a step up to IOP, or if someone has previously been in DTP/IDP/PHP and is looking for additional support to maintain their progress. However for the majority of clients, in particular those coming out of a hospital or residential setting, or those with medical instability and active symptom use, a DPT/IDP/PHP is a minimum level of care to truly see progress.


Mark Warren, MD

Mark Warren is the chief medical officer of The Emily Program. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the national Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.

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