Initial Admissions Phone Call
The approach to difficult conversations is unique to each family. In the case of an eating disorder, the critically important piece is to start a dialogue about your concerns early, instead of waiting to see if things resolve on their own.
For younger children (ages 11 & 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 conversations with adolescents (ages 12 and older):
Consider how, when, and where you share your concerns. It is important to express yourself calmly. Choose a time when you are not feeling rushed and can talk openly with your adolescent. In general, limit the number of people 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 that they are 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 meet in a less emotionally heightened state.
Many biases and myths exist about eating disorders and it is imperative to educate yourself. That said, please recognize that you don’t need to know everything about eating disorders to have this conversation with your adolescent. A reliable source and place to start is our About Eating Disorders web page.
There is a chance that your loved one may dismiss your concerns and/or have ardent reasons for their behaviors. They may not see this as a problem or a struggle. Alternatively, 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. They 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 concerned about the outward symptoms (bingeing, restriction, purging, etc.), focusing too intently on these behaviors can reinforce core disordered beliefs, such as “There is something wrong with me,” “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, and registered dietitians – as they have profound and serious effects on the mind and body.
Your struggling loved one needs to know you are taking the eating disorder seriously. If your child isn’t ready to accept your concerns, one way to explain what you are witnessing is by sharing that they appear to have less energy, focus, joy, or time for the things they once loved. Let them know your care for them extends deeper than their outward 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 connected to help.
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 that you will revisit the conversation with them within a specific timeframe. Consider waiting no more than a couple of days, even if your child downplays what is occurring. Often in the intense experience of the eating disorder, your loved one may desperately attempt to convince you (and themselves) that everything is fine. Stick to your message. Assure them that they matter to you and give them options for how they can continue the conversation (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 already eaten when it’s time for a meal.”
- “I have heard you talk very negatively about yourself and your body.”
- “I have noticed that large amounts of food are sometimes gone.”
- “I have noticed that you are limiting the foods that you eat.”
- “I have noticed that you talk about eating only 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 has 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.
An Admission Specialist can be reached by calling 612-402-3061. They will assist you in scheduling an eating disorder assessment with a specialized therapist. The therapist will guide you through the assessment and will ask you a variety of questions about your concerns for your child. They may also ask to speak to your adolescent individually.
During the assessment, the therapist will ask about your concerns for your child related to their health, eating, and relationship to food and their body. This conversation will cover topics ranging from your child’s current and past eating habits, to assessing eating disorder-related thoughts and behaviors, to changes you have noticed in their approach to eating and their mental and physical health. The therapist seeks to understand how their struggles are impacting their life and development in order to make recommendations for treatment.
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 (a 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.
You may find yourself questioning whether to tell your child about the 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 treatment when it is most crucial for them to get help. It is crucial to provide your child with more information, coupled with your resolve that treatment is the necessary next step.
We understand how and why the experience of a loved one’s eating disorder 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.
- We encourage you to complete the forms in the intake packet before your loved one’s assessment. You can do this within the ‘With Me When’ app.
- The therapist will guide you and your loved one through the assessment and may speak separately to your older adolescent.
- The therapist will provide a recommendation for treatment which can include residential (24/7 care), intensive day program (PHP/IDP), or intensive outpatient program. Weekly outpatient appointments may be available depending on the site you are working with and whether 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 estimate for admission.
If your child is recommended for residential treatment or an intensive day program (PHP/IDP), a virtual medical intake appointment with a provider who specializes in eating disorders will ensure medical safety for the recommended care. This appointment is not in lieu of any ongoing medical care provided 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 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 your loved one prepares to enter treatment, you may see a ‘different side’ of them – functioning better OR worse than you typically experience them. You may learn things about their mental and physical health and eating disorder-related behaviors that surprise you. This is not uncommon and highlights the importance of your child working with a professional who specializes in eating disorders.
Our trained professional intake therapists will treat your child with kindness and respect and work to make you and your child comfortable.
It can be helpful to keep in mind that an 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 here to assist your child in their growth and healing and help your family through this difficult time.
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 of (insert name of Intake Therapist). Here’s what will happen next.”
- “We will be a part of your treatment during your appointments, family support and education groups, connections with your treatment team, visitation, and phone calls.”
- “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 and your body.”
Your loved one may have a strong emotional reaction to learning your intentions to seek eating disorder treatment for them. We understand their fears and yours and want to prepare you for common reactions that parents encounter:
- “Honeymoon period” – a quick turnaround/improvement with eating disorder symptoms as your child is trying to prove they don’t require intensive care
- Shutting down – not talking, responding, or reacting to your attempts to talk with them
- Rejecting or downplaying your concern – “Why are you making such a big deal about this?”
- Pleading & begging – “Please don’t make me do this,” “It won’t help me,” “I want to try to do this on my own.”
- Anger directed at you – “You don’t understand,” “I hate you,” “This will make it worse.”
- Negotiating – “I’ll eat anything you ask me to (or as much as you want me to) if you let me try to do this at home.”
- Ultimatums – “I’m going to hurt myself or I won’t eat at all if you make me do this”
We cannot underemphasize the toll the eating disorder takes on your child’s mental well-being. At times, you may find it extremely upsetting 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 and strongly urge you to seek support. See below for more specific resources for support.
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.
Your family and your child or adolescent will receive educational materials when treatment begins. In addition, you will have the opportunity to take part in the parent support and education groups and family sessions.
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 have a national, interactive database for finding eating disorder care. www.allianceforeatingdisorders.com
The National Alliance for Eating Disorders also has a 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
See our Resources for Families page for more.
Post Intake Decision Making
The number and frequency of eating disorder symptoms and their impact on your child’s physical and mental health inform their treatment recommendation.
Know that the therapist conducting your child’s assessment has extensive knowledge of eating disorders and treatment. The therapist’s comprehensive education, coupled with the ethical standards set by their professional organizations and state licensing boards, supports their 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 multidisciplinary teams (medical providers, psychiatrists, nurses, registered dietitians, 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; and 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 eating disorders (EDs) are about more than food. EDs have their roots in one’s experiences, neurobiology, emotional understanding and expression, strength in coping with loss, messaging about the inherent worth as people, self-image, and history of feeling seen and heard.
Our specialized, comprehensive treatment recommendations are informed by the guidance of professional and academic organizations, such as the American Psychological Association, Academy of Eating Disorders, and American Academy of Pediatrics in conjunction with our collective professional experience and the feedback and needs of our clients and their families.
It is so difficult to see a loved one suffering. The reality is that eating disorders are serious disorders with potentially catastrophic and devastating outcomes if left unchecked and untreated. Regardless of the type of eating disorder or one’s body weight, eating disorders have a high rate of death and increased rates of psychiatric and medical consequences. 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. Perhaps you haven’t even been able to recognize aspects of your child: their behavior, thoughts and fears, and/or 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, and impact on daily functioning.
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 or specialized 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 clients have. We aim to provide the best care needed to get your child back to their life and health.
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 to health. We aim to limit the duration of the illness; more intensive care now helps to limit relapses and ongoing long-term illness. Research in the field and our years of experience support 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 one’s life trajectory are examples of milestones we hope that treatment will allow.
While waiting for care, please continue to work with your loved one’s community providers. Outpatient services at The Emily Program may be an option depending on your location while waiting for admission to care; however, outpatient services aren’t always immediately available. Speak with the therapist who conducted your loved one’s assessment about this possibility and their recommendations.
School is important for your child, and your child’s health is critical for school. Treatment and health will be the priority, and maintaining progress in your child’s education will be integrated into treatment.
At The Emily Program, several factors influence how school is offered in treatment:
- Level of care: In residential care programs, school or study hall is incorporated into the programming hours during the school year. Study hall during programming hours is only included in certain partial hospitalization programs (PHP), so we recommend checking in with your specific location. While participating in intensive outpatient (IOP), schoolwork time is not included due to shorter programming hours.
- School vs. study hall: All students in residential care are given time during the programming day to work on schoolwork. Some students enroll in the treatment facility’s school district to work with a licensed teacher for added support, while others choose to manage schoolwork independently through their home school district.
- State and school district variability: The educational options for students in treatment vary by state and school district policies and procedures. Be sure to reach out to your child’s school for information.
- In-person vs. virtual programming: Typically residential in-person treatment includes an option for the student to enroll in the school district where the treatment facility is located. Students in virtual programming (PHP/IDP) work with their home school districts.
- Student and family preference: Each family will choose what is most supportive for their child’s situation.
School overview for The Emily Program’s adolescent residential facilities:
Our Anna Westin House for Adolescents (AWHA) in St. Paul, MN offers the option of enrolling your child into the St. Paul School District while they are in care. This option will provide instruction with a St. Paul district-licensed teacher. This teacher will communicate with you directly about progress and your child’s home district as needed.
If you prefer to keep your child in their home school district, you will need to coordinate with your child’s school. Your child will have daily study hall to do independent schoolwork. They will be supervised, but there is no monitoring by staff for schoolwork completion.
Our Columbus, OH Residential for Adolescents site utilizes LearnWell Educational Services to assist in coordinating and supervising your child’s educational progress while receiving treatment with us.
For lower levels of care (PHP/IDP, IOP), please check with your specific Emily Program Admission Coordinator for school details for the level of care/programming you intend to pursue.
Deciding whether or how to inform your child’s school about your child’s eating disorder can depend on several factors, including the severity of the eating disorder, recommendations from professionals, the stage of your child’s recovery or treatment, and whether they could benefit from accommodations at school.
Communication with your child’s school about absences for appointments or upcoming extended treatment stays is critical. Key school staff include your child’s school counselor, social worker, or nurse. A trusted teacher may also be helpful in connecting you to important staff members who can assist in making arrangements.
School accommodations may include:
- Supervision at or after meals
- Supportive eating spaces
- An identified person to check in with if needed as they navigate their day
- Distress management options, such as passes to leave class, the ability to bring fidgets to class, or the ability to listen to music, etc.
- Modified workloads or extensions for schoolwork
If your child participates in extracurricular activities, it’s crucial to inform their directors and coaches about your child’s health concerns and need for treatment, as well as any necessary adjustments to their participation or potential absences. Depending on your child’s situation and preference for privacy, it may be beneficial for them to maintain communication with their extracurricular leaders or peers while they’re in treatment.
People in your and your child’s life may or may not know about their 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. Ask your child for 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 that you also need support. We encourage you to take part in educational and support opportunities, as we realize how hard it can be to support a loved one through this process. Some parents find it incredibly helpful to see their own therapist (outside of The Emily Program) and utilize the resources such as the National Alliance for Eating Disorders’ 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.
Once your child starts programming, you will have the opportunity to take part in our parent support and education groups and family therapy sessions. You will also be involved in other aspects of care, including communication with the treatment team (your child’s registered dietitian, therapist, and medical and psychiatric providers).
Please be aware that if you are concerned with the wait time until admission, we may have facilities in other states with 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 the Alliance’s website.
Look for the weekly email and newsletter sent by your Admission Coordinator with info on admission, eating disorders, and support.
While waiting for admission, please continue to see your child’s doctor, at minimum. It’s important that someone continues to monitor their physical and mental health, vitals, and lab work. It is also 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:
The 3rd edition is available in multiple languages here.
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 include.
It 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
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 with envisioning what nutrition 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 three meals and three snacks with prescribed types and amounts of food. Recovering from an eating disorder isn’t only about eating enough, it is also about 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 judgment. 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.
The Emily Program is committed to fostering a safe and inclusive environment that values clients’ gender identity and gender expression. We strongly believe that all clients shall have access to facilities in which they feel comfortable and dignified.
Any resident at The Emily Program 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.
The Emily Program does not tolerate any harassment or discrimination on the basis of gender identity or gender expression. Any such behavior at The Emily Program will be taken seriously, given immediate attention, and handled in the same manner as other bullying, harassment, and discrimination.
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 client and family can get the help they need to pursue recovery.
Many eating disorders do not have just one symptom, and many of our clients have general mental health concerns in addition to their eating disorder. We know our clients 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 who are trained to identify and redirect patterns of behavior that are problematic, 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 clients as we work to teach and apply helpful skills across different eating disorder presentations. Our goal is to provide interventions that can help our clients replace unhelpful ways of coping with anxiety, body image, depression, perfectionism, and more with strategies that help them live more peaceful, value-centered lives.
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 clients 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 clients. They 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 clients, who are also in treatment with a variety of age groups, our adolescent clients generally find the experience of group treatment to be empowering and validating because they are with people who innately understand their pain and challenges.
Stay connected with your Admission Coordinator. They will serve as your guide as you prepare for admission to residential treatment, an intensive day program (PHP/IDP), or an intensive day program (IOP). They will share information on things like the packing list for residential and the program schedule, including parent and family group schedules. Included in this will be any COVID-related health and safety guidance that might impact how groups and visitation are offered. You will have an orientation on the day of admission.
If you are working with a referring provider, such as an individual or family therapist in your community, connect with them to prepare you and your child for treatment.
Admission day can be an emotional day. 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. The first 24 hours in programming (or the 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 that parents encounter in the early days leading up to and after their child’s admission:
- Shutting down – not talking, responding or reacting to your attempts to talk with them
- 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”
- ‘Honeymoon period’ – A quick turnaround/improvement with eating disorder symptoms around admission as your child is trying to prove they don’t require intensive care
Please stay in touch with your child’s clinical team during this time. We cannot underemphasize the toll the eating disorder takes on your child’s mental well-being – 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, and behavioral health technicians and specialists.
Your child may go through periods of high distress, not only at the beginning of treatment but throughout their treatment stay. Eating disorder behaviors have been a way for your loved one to cope. When working to utilize new, healthy skills, there can be times when urges for self-harm increase, or they return to past maladaptive behaviors. You may be the person your loved one goes to ask to stop or leave treatment. While it can be very difficult, we encourage you to stay connected with the treatment team and allow your loved one to work through these times with your encouragement. If helpful, you can think about this as ‘holding the hope’ for your loved one, even when they are pushing back on recovery or feeling discouraged or hopeless.
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 and into a life beyond this experience.
As a guide, you can expect to dedicate about 3-5 hours per week to treatment activities such as family therapy sessions, dietitian sessions, family meals, medical and psychiatric appointments, psychoeducational and support groups, and connections with your child’s treatment team. Additionally, you will want time for phone calls and visitation with your loved one when they are in residential care. For those who are unable to be on-site, virtual participation is offered. The level of care your child is receiving will influence how many and which appointments parents attend.
We believe that families are a powerful resource critical to successful treatment, as well as the experts on their child or adolescent. Recovery happens in community, and each family can build a community of support to include in treatment, such as grandparents, family friends, etc.
COVID-19 health and safety requirements altered families in treatment. Ask your child’s Admission Coordinator 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 well-being.
The Federal Family and Medical Leave Act (FMLA) 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.
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 CARF (Commission on Accreditation of Rehabilitation Facilities) and with state and federal regulatory guidelines for healthcare facilities and adolescent mental health services.
Growth charts provide historical growth information on your child; essentially, they tell a story of your child’s physical development through 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. This information will inform the treatment plan.
Typically, our clients average the following lengths of stay in the following levels of care:
- 6 weeks in Residential Program (Res)
- 6–8 weeks in Partial Hospitalization Program or Intensive Day Program (PHP/IDP)
- 6–8 weeks in Intensive Outpatient Program (IOP)
It can take time for you and your child to adjust and for the team to get to know your child. The treatment team meets weekly to discuss each client’s progress and adjust the estimated length of stay depending on the needs of the client. This will be discussed with families throughout their stay. As your child gets closer to discharge or a transition to a lower level of care, the treatment team will aim to confirm the discharge date two weeks prior to that date.
There are instances when a client requires increased support and is recommended by the treatment team to transition to a higher level of care (PHP/IDP to Res for example).
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, and 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.
Your child’s 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 clients to tolerate unscheduled or ‘downtime.’ By design, we build in unstructured time to spend in the community while supervised by staff.
The intention is to reintroduce and practice taking the time for enjoyable and age-appropriate activities outside of the eating disorder. This can assist in challenging disordered thinking that links worthiness to productivity.
Therapeutic-supported meals and snacks are foundational for our treatment model. This includes a structured eating schedule and a prescribed meal plan guided by a registered dietitian and in-the-moment meal coaching by staff. This aspect of treatment reinforces a return to adequate nourishment and progress toward 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 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.
We know our clients and their parents need to stay connected during their residential treatment stay. Every facility provides and offers regular opportunities for phone contact and visitation for those in residential care. Please consult with your child’s Admission Coordinator and treatment team for site details.