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What does "Higher Level of Care" of care mean?




Have you or someone you love noticed symptoms of disordered eating or an eating disorder? Or has a friend or medical provider recommended that you seek support for an eating disorder? Maybe you’ve been Googling symptoms, treatment options, or even received pamphlets from your doctor… But how do you know what type of support you or your loved one needs? Should you look for outpatient or inpatient (admitted to a hospital/medical facility) care? What do those words even mean?


While each person has their own specific needs, there are some general guidelines that may be helpful for you to know when determining what level of care you or a loved one would likely benefit most from in recovery.


Let’s start with what we do at Bloom Counseling & Nutrition: outpatient treatment. Outpatient treatment is what we are typically talking about when someone sees a therapist or other provider once per week. Bloom offers many different outpatient services: individual therapy, group therapy, and nutrition counseling, in person or virtually, for adults and adolescents. Depending on a client’s severity of eating disorder symptoms, we may recommend one or more different outpatient services at Bloom, and we may also refer out to a doctor or other provider for specific healthcare needs.


Generally speaking, outpatient therapy is appropriate for persons that are medically stable and interested in addressing their eating disorder behaviors. During a client’s first session at Bloom (the intake), we perform a comprehensive assessment so that we can form a plan for care that is tailored to our client’s unique needs and circumstances. Following this intake session, we will recommend what level of care is appropriate regardless of whether that includes support at Bloom or services outside of Bloom. Our team assesses the following criteria during this intake session: medical status, motivation to recover, levels of structure and support, environmental stress, accessibility to resources and care, and other aspects related to one’s holistic health. If we recommend a different level of care than we provide at Bloom, we have a collaborative conversation with our clients to explore these options and find the best fit for support. We also continue to work with our clients until they secure other treatment, as well as oftentimes during and after that level of treatment.


It is common and normal for people experiencing eating disorder symptoms to utilize various levels of care and services during their treatment and recovery, and not necessarily in a linear fashion. However, for the sake of illustrating each level of treatment, the following options are referred to as “Higher Level of Care” (HLOC) and are listed below in increasing order with regard to the amount of support and time required.


 

Intensive Outpatient Program (IOP):

This is a step up (next highest level of care) from outpatient treatment, in that IOP treatment typically requires 9-15 hours per week of group therapy, individual therapy, and dietetic support, as well as meal support. Most programs in the Fort Collins area are currently conducted virtually, but IOPs can also take place in person. Those participating in IOP treatment may also have a separate outpatient therapist and work with their outpatient team concurrently while attending IOP treatment. IOPs vary in length from a few weeks to months at a time depending on the client’s needs. As IOP treatment often takes place in the evenings (typically 3 evenings per week), IOP treatment can allow the flexibility to be able to attend school or work without taking a leave of absence.


Partial Hospitalization Program (PHP):

PHP treatment is a step up from IOP treatment. PHP is sometimes called “day treatment”, and despite the name, PHP programs do not usually take place in hospitals. These programs typically provide support 6 to 10 hours per day, from 5 to 7 days per week. Depending on the specific program, various meals are provided and programming often includes individual, family, group, and nutritional therapy. Most PHP programs also include medication management and psychiatric care. While participating in PHP treatment, clients are free to go home or to another temporary stay location at the end of each day. While engaging in PHP treatment, it is uncommon for clients to also engage in school or work at the same time due to the intensive hours of programming.


Residential Treatment:

This is a step up from PHP treatment. Residential treatment offers medical, nutritional, and therapeutic support in a non-hospital, overnight stay setting. At this level, a person typically does not require medical stabilization but does need more structured meals and intensive nutritional and therapeutic support. As with inpatient treatment, all meals (breakfast, lunch, dinner, and snacks) are provided. A feeding tube may be used at this level of care if a person refuses to eat and/or cannot maintain appropriate caloric intake for other reasons. Individuals participating in residential programs stay overnight at the treatment location, which often resembles a college dormitory or apartment-style living. The length of stay for residential treatment again varies by individual and diagnosis and often lasts at least 4-6 weeks at a minimum. It is typically not possible to engage in school or work while participating in residential treatment. Some long-term residential treatment centers might integrate grade school into their programming.


Inpatient Hospitalization:

This is the highest level of care available and is recommended for those exhibiting physical symptoms of malnutrition or bodily distress. Inpatient refers to staying in a hospital or medical facility in an effort to monitor and stabilize various symptoms. These symptoms might include but are not limited to, a low heart rate, low blood pressure, low blood glucose, low potassium, low body temperature, dehydration/electrolyte imbalance, poorly controlled diabetes, or liver, kidney or cardiac issues that require acute (i.e., severe, immediate) treatment. A feeding tube may be used at this level for those that refuse to eat and/or need to slowly begin increasing specific nutrients. Someone experiencing a high level of suicidality may also require inpatient hospitalization for safety. The length of stay for inpatient hospitalization is dependent upon the severity of symptoms as determined by medical providers.


 

As mentioned earlier, an individual may start at any one of these levels of care and then step up or down to another level, sometimes more than once. Because eating disorder behaviors are often a way a person copes with stress and life changes, future stressors could cause symptoms to escalate leading to an increased need for support and care. If you or someone you know have more questions about outpatient care or would like an assessment to determine what level of support would be best, we would be happy to help as we know this journey can feel overwhelming and confusing at times. Please feel free to reach out at 970-893-7600 or info@bloomcounselingandnutrition.com.


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