F.E.A.S.T's Around The Dinner Table forum

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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Alwaysthere
Hello Again,

I feel like I bother this group a lot with random questions because I have another one now...

It has been decided that my sister will go to a treatment center for a month. She doesn't really want to talk about it because she feels very overwhelmed. She has three options in terms of location and I guess she can go at anytime. Can someone explain what this place will be like? 

-What will she do all day?
-Will it be different because she's an adult vs. an adolescent?
-Do most of these places encourage family visits?
-Will they make her eat?

She's trying to decide if she wants to go far away so there is less stress on her to have us visit, but I feel like family support is/should be a big piece of this, so if she goes far away, that will make it more difficult. Just curious on any info people can provide about places like this...

Thanks again
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scaredmom
Honestly every treatment facility will have their own protocols and routines.
i would expect if her team is recommending a specific treatment facility, they would know what to expect. 
I would suggest she make a list of all her questions and ask her team. Or if possible is she able to call each facility and ask them directly what the treatment entails? 
There are so many ways to tackle this. Ultimately, the goal should be full nutritional rehabilitation for sure. How they do that will be specific/ unique to that institution. 

if you have the names of the treatment places, maybe you could call/email and ask them directly? 
Sending my best
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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formygirl
I can share with you my 19 year old daughter's experience. She has been in two different residential facilities. There are a few groups daily, including yoga and art and group sessions. There is plenty of down time and you will want to verify what is permitted. One facility did not allow her internet access and she found it exceedingly difficult to be so cut off from family and friends (she was able to call, but 19 year olds do not generally talk on the phone). They are encouraged, though not forced to eat, they do require supplements (Boost, Ensure) if a meal is not finished. They do have daily visiting hours and encourage families' visitation. My daughter was at one facility in another state but chose to return to a local residential facility. She does not want us to visit often, but it is a comfort that we are a short drive rather than a plane flight away. Also, when she gets passes, she will be able to come home for a few hours rather than be in a strange city alone. I hope this helps.
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kazi67
Hi alwaysthere
to answer a few of your questions 
my d spent most of the day eating and resting in bed (she was very medically unstable and underweight when admitted)
we were encouraged to visit even though sometimes my d didn’t want us or anyone there and sometimes I think it’s important to respect their request of no visitors 
my d found it very overwhelming when her friends came so one person at a time was best for my d and we really had to be firm with her friends 
she found it very upsetting as they do go through a lot of emotions whilst IP
my d SH a lot after her friends came (I think it reminded her of what she was missing)
my d did some art sessions and group therapy sessions (although half the time she didn’t want to participate but it was a condition of admission to be involved) plus it passes the time
as she improved and was able to eat she was allowed on a short walk 
I would say each clinic is different though and best to call them but I’m not sure they will tell you much either unless your sister gives permission as she is an adult? 
We don’t get told anything anymore as that’s how my d wants it
My d last 2 admissions we didn’t even get told 
I think the best way to support you sister is to encourage her to get treatment and stay in treatment 
which is what we do for our d
i think it’s different for child/adult as they do want to take ownership of their recovery themselves 
Each case/journey is different though and also there are the co-morbids that may need addressing to: anxiety and depression 
its all very complex and complicated 
wishing you and your sister all the best 

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blondie
Are you in the USA or..?
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mommiful
My daughter has been in 4 different residential programs, and I've spent hours on the phone with several others as we were choosing programs. She was also in 2 different partial hospitalization programs (PHPs) and 3 different intensive outpatient programs (IOPs). So, we've seen a sampling of the various levels of care (LOCs). There are definitely some common threads, though each program is different. There are some programs that fall outside of this common framework. For instance, UCSD and Johns Hopkins offer inpatient programs for those needing medical stabilization and PHPs with longer hours and options for housing for those who don't live nearby, but no residential program. 

First, I thought it might help to have an overview of the levels of care. USCD Eating Disorders Center has a nice overview not just of their own programs, but of how the system works in general. From what I've seen, it's very common for individuals starting treatment at the outpatient level to find that challenging the eating disorder brings about intensified symptoms. This can result in medical instability and a hospitalization, or in hitting a wall in treatment and needing a more structured environment for a while. Individuals are usually encouraged to step down through each of the steps (residential ==> Partial Hospitalization Program ==> Intensive Outpatient Program) for a gradual reintegration into life at home, although this is not always practical. Whether using PHP and/or IOP for step-down or not, it can be quite a challenge to switch from an environment that strongly supports adequate nutrition without compensatory behaviors (purging, exercise, etc.) and where the individual has little choice in the matter, to the home environment where problematic behaviors were part of the daily routine. The week-long intensive programs for adults and their supports at UCSD and Center for Balanced Living in Columbus, OH, help individuals and their supports work out detailed plans for how they will deal with their own specific circumstances at home. This is quite a contrast to what I have seen with other PHPs and IOPs.

Although the format is pretty similar at many of the programs, how well the program is run can vary a lot, as can the overall tone, which has a lot of impact on how you might feel there. (By "tone" I mean, above all, whether you feel you're being treated like an individual who has a challenging problem you want help fixing, or like an individual who is a problem and needs to be fixed. This is very subjective and how you feel in a given setting can change over time.) Unfortunately, at the programs I have interacted with, the marketing/admissions personnel don't have a very clear idea of what actually happens in the program. They have talking points, not personal experience with the program, and may be located in a different building or even a different state. If there are questions you need to get an accurate answer to or if you want to get a better sense of the tone of the place, you can try to get a call with one of the professionals at the program delivery end of the organization. I've had mixed luck with that, but it's worth a try. If you're located near the program, it's worth a try asking for a tour or to meet with one of the providers. 

The admissions process usually takes a while, especially if you're not transferring from a hospital. There are generally 2 or 3 phone calls over the course of a week or so, covering whatever questions you might have about the program, administrative questions for filling in forms, and a clinical assessment. The program will probably make some preliminary calls to insurance and let you know whether that level of care will be covered. Once they have assessed you and determined that you meet the requirements of the program and insurance, you'll be on the list for a bed to open up. You will probably need to go to your own physician for a physical and get blood work and an ECG done shortly prior to admission. All this can take a few weeks. It's good to ask about availability of beds early in the process, so you don't end up being left hanging too long. 

The day of admission can be a bit hectic. You'll probably come in first thing in the morning, fill in yet more paperwork, and meet with each your providers  (therapist/psychologist, MD/nurse practitioner, psychiatrist, nutritionist) individually, have your bags searched in your presence, and get shown to your room (probably shared), all before lunch. That gives you some time to settle in during the second half of the day. 

The specific rules at each program will vary, but here are some common ones:
  • There are restrictions on how much movement you can engage in. There is usually some outdoor space you can use, but only under supervision or at certain times. New residents are generally placed on extra physical restrictions, like being on bedrest or chair rest. 
  • Completion of all meals and snacks within the set time is generally required. There is some variation on how flexible they are about giving extra time. Generally, when your time is up, you are given a meal substitute (Ensure, etc.) roughly equivalent to what you didn't consume. If you don't finish that, you may be tube fed at some places. Other programs may transfer you to an inpatient program they partner with, either immediately or if it becomes a trend that you're not able to complete your meals.
  • Meals are generally based on a meal plan made up by the nutritionist. They generally start you off on a smaller meal plan and increase it until you're gaining weight at the rate they're shooting for. How much choice you have varies from place to place. Some places you sit down with the nutritionist and make up your meal plans for the week, with a few limited choices. Some places you can list a few items that you particularly dislike, but other than that and allergies, everyone gets the same thing. Some places have a cafeteria line where you can pick out items to meet the requirements of your meal plan. 
  • You need to earn a pass before you are allowed to leave the site. This depends on meeting some set of criteria that may include medical stability, weight, rate of weight gain, compliance with rules, and meal completion. This is likely to take a couple of weeks, maybe more.
  • Access to electronic devices is usually pretty restricted. Some places allow you to use your phone for a few hours a day; others just give you access to a phone where you can use a calling card or receive calls. Some allow you to bring a laptop, which will be stored securely for you to use supervised during approved times. Most have computers for client use during approved times.
  • Bathrooms are kept locked. There is typically some sort of bathroom observation (talking with a counsellor through cracked door or from bathroom stall) during the initial period for all patients, and continuing for anyone with a history of purging. 
  • Bedrooms are usually shared and usually kept locked or "off limits" during the day. 
  • Visits are usually restricted to set visiting hours, which may happen every day or just on weekends. Sometimes there is more flexibility.
  • You are required to attend all therapy groups that you are assigned to.
The schedule typically looks something like this:
  • Early rise (often 6 AM or earlier) for weights, meds, possibly blood work, showers, etc.
  • Three meals and 2 or 3 snacks daily, followed by observation time. You are generally given 30 minutes to complete a meal and 15 minutes to complete a snack. This ends up filling a good bit of the day. Meals are generally supervised by direct-care staff (counselors with a Bachelor's degree or less); sometimes clinicians take part in meals as well.
  • Therapeutic groups fill up much of the rest of the day, probably about 5 hours per day. These may be run by the clinicians and/or by the direct-care staff.
  • You will probably meet with your individual therapist at least once a week, maybe 2 or 3 times. You'll probably see a doctor or nurse practitioner and maybe a psychiatrist briefly about once a week; you may also meet with a nutritionist once a week or so. You will spend most of your time with peers and direct-care staff.
  • Once you are considered ready, you will get to go out on "therapeutic passes." These are designed to give you the chance to eat in the real world, so the include a meal and enough time to do a little something else as well, say, dinner and a movie. Depending on the program, you may be allowed to go out on passes with a peer or two who have also earned passes. Once you have reached this level, you may to get as many as a pass or 2 each week for up to 4 or 5 hours. 
  • Some programs offer outings and fancy groups like equine therapy, at least on their websites. The extras are generally available only to individuals who are fairly well along in their treatment, if at all.
  • Some programs have programming for families on some weekends. 
  • There is generally a lot of simply lounging about, maybe watching tv, talking, knitting, doing puzzles. School-aged youth are given a couple of hours a day to do schoolwork. 
The look and feel of facilities varies. I've seen places with the look and feel of a sorority house, a small college dorm, a large house in a posh suburb, and a hospital unit. 

I hope this helps. Best wishes. 

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