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March 28, 2019

Why Some Clients Need Residential Treatment

Why Some Clients Need Residential Treatment

Eating disorders occur at different levels of severity, which is why we offer multiple levels of client care, from outpatient to residential. Whenever possible, our goal is to minimize the disruption to a client’s day-to-day life. However, when an eating disorder presents as a crisis, more intensive care becomes necessary so harmful behavior patterns can be interrupted as soon as possible. Some examples of eating disorder related crises include:

  • Medical instability
  • Inability to control one’s own behaviors
  • Extreme changes in BMI to the degree that physical health may be at imminent risk

 In each of these situations, residential care is most often recommended. In residential care, medical safety for at-risk clients can be maintained because of the presence of 24/7 nursing and medical providers. Residential care exists so that clients who are medically unstable or unable to improve in other care levels can avoid hospitalization, which is a far more restrictive experience. Residential care is not forced care and it is not designed to limit freedom. It is designed to provide safety, rapid results, and to prepare clients for long-term recovery.

In a residential facility, there is an extensive treatment team to provide clients with personalized care that is both evidence-based and highly effective while also being flexible enough to address the specific needs of each client. This team includes a psychiatrist, a medical provider, a therapist, a dietitian, and a nurse. Around-the-clock staffing ensures medical stability can be maintained 24 hours a day. There are also eating disorder technicians that work in residential facilities to provide help and support for each client as they move through treatment.

Residential care also offers an environment where meal plans can be monitored and managed to produce safe, effective results. When clients step down to lower levels of care following a residential stay, they have much greater success in recovery.

To determine if someone is the correct fit for residential treatment, The Emily Program walks each individual through an intake process, which includes an assessment of that person’s medical history and eating disorder symptoms. This information is critical for determining the right level of care. The Emily Program is keenly focused on placing clients in the level of care that is right for them because appropriate care is the best way to ensure effective treatment and lasting recovery.

The average stay in residential treatment is typically between 3-4 weeks. However,  there is a spectrum, and some stays are longer or shorter than others. Generally, an individual remains in residential treatment until their behaviors are under control and they are on their way to weight and medical stability. In general, someone exiting residential treatment should step down to a day program–partial hospitalization program/intensive day program (PHP/IDP). Day programs at The Emily Program meet 7 hours a day, 5-6 times a week and can provide significant support around meals and behaviors while allowing for greater freedom than residential care. This treatment team is similar to the residential team, including a medical professional, psychiatrist, therapist, dietitian, and nurse.

While residential care is the best type of intervention for many severe eating disorders, some individuals may require full hospitalization due to their level of medical instability. Part of the intake process to ensure that no individual comes to residential care when they first require hospitalization. Examples of situations that may require hospitalization include changes in electrolytes, changes in cardiograms, or having a BMI so low that it makes weight restoration dangerous in a non-hospital setting. There are other indications, but in general, individuals with those levels of medical instability are best served with a short hospital stay. Most often, someone discharged from the hospital will enter residential eating disorder treatment and proceed with treatment and recovery there.

It is important to remember that eating disorder recovery is possible at any level of care but to increase the chance of lasting recovery, it is key to find the appropriate level of care for each individual’s situation. Complete an eating disorder assessment at a treatment facility like The Emily Program to determine what is best for you or your patient. From there, we’ll work with you to ensure that you receive treatment that’s right for you.

Interested in learning more about levels of care at The Emily Program? Looking to complete an assessment to start eating disorder treatment? The Emily Program is here for you. Call us at 1-888-364-5977.


Mark Warren headshot

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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