Higher Levels of Care 101
Understanding Higher Levels of Care for Eating Disorders
For those new to the eating disorder treatment process, the term “higher level of care” can feel overwhelming. What does it mean, and how might it apply to you or your loved one? This guide breaks down the different levels of care and explains why they can be beneficial.
Higher levels of care go beyond outpatient therapy, offering more intensive support to address complex needs. Each level serves a specific purpose, and understanding them can help you choose the best fit.
Why Professionals Recommend Higher Levels of Care
Higher levels of care are often suggested when:
• The client is medically unstable (e.g., abnormal labs, orthostasis, rapid weight loss).
• Frequent, professional meal support is needed.
• Comorbid issues require intensive, wrap-around care.
• Group therapy is needed to stimulate therapeutic growth.
These factors typically determine which level of care is most appropriate. Here’s an overview of each level, starting with outpatient.
Outpatient
Outpatient care involves weekly therapy sessions with a therapist and often biweekly or weekly appointments with a dietitian.
Best for: Clients who can complete meals consistently, work on challenges from nutrition sessions, and engage in life with minimal disruption from their eating disorder.
Next steps: Clients may remain in outpatient care, step up to a higher level, or step down to outpatient after completing a more intensive program.
The Assessment
Before entering a program, clients complete an assessment with a clinician who determines the appropriate level of care. This assessment includes:
• Information from the client, parents, or supports.
• Collaboration with outpatient teams (if applicable).
• Pre-authorization with insurance to confirm coverage and explain costs.
Intensive Outpatient Program (IOP)
IOP is often a stepping stone between outpatient therapy and more intensive care.
Structure:
• Typically 3 days per week, 3 hours per day (about 9 hours total).
• Includes one supervised meal per session, group therapy, and access to a dietitian.
• Clients may continue working with their outpatient therapist if they choose.
Best for:
• Clients feeling “stuck” in outpatient who would benefit from supported meals and group therapy.
• Those whose symptoms don’t significantly disrupt work, school, or relationships.
Duration: Stays typically last 6–8 weeks but vary by individual.
Partial Hospitalization Program (PHP)
PHP is more intensive than IOP and often requires adjustments to work or school schedules.
Structure:
• Programs range from 5–10 hours daily, 5–7 days per week.
• Includes 2–3 supervised meals per day, snacks, individual therapy, family therapy, weekly dietitian sessions, and psychiatry appointments.
• Groups focus on distress tolerance, connection, body image, and other key recovery topics.
Benefits:
• Removes pressure from families to monitor meals.
• Provides rapid collaboration between providers under one roof.
Best for:
• Clients with daily symptoms interfering with life or difficulty completing meals at the outpatient level.
• Those with lower motivation to change than IOP clients.
Duration: Stays typically last 4–6 weeks but vary.
Residential Treatment Centers (RTC)
Residential care offers 24/7 support, allowing clients to focus entirely on recovery.
Structure:
• Clients live on-site, receiving medical monitoring, individual and group therapy, nutrition support, and psychiatric care.
• Family involvement is often included, regardless of age.
Best for:
• Clients with low motivation to recover who experience physical effects of malnutrition.
• Those unable to gain insight into their eating disorder due to nutritional deficits.
Duration: Stays are often around a month, depending on the client and insurance.
Inpatient Treatment
Inpatient care is the highest level of treatment, reserved for clients in medical crisis.
Structure:
• Primarily medical, with little to no therapy provided.
• Clients are often tube-fed to address malnutrition and stabilize vital signs.
Best for:
• Clients with dangerously low heart rates or other life-threatening physical symptoms.
Duration: Stays typically last about a week, with clients transitioning to residential treatment afterward.
Higher levels of care may feel intimidating, but they can significantly accelerate recovery in ways outpatient care cannot. In the next blog, we’ll explore the key questions to ask during the assessment process to help you make informed decisions about treatment.