Roadmap for admission to sustainable success
As the most lethal of psychiatric conditions, an eating disorder require timely and effective treatment. Recovery is possible. However, maintaining positive outcomes is often a challenge. Recovery is complex. Individuals struggling with eating disorders often feel compelled to keep their symptoms as a coping mechanism in spite of all of the chaos their disorder creates.
If you are considering residential treatment for yourself or a loved one, making a reasoned choice can be difficult leading to many questions and confusion.
Some questions that you might have are: “Where can I get help?” “What kind of treatment should I be looking for?”, “Where do I start?” You may need help in finding your way in this process.
We hope this roadmap acts as a guide through this process - we offer the following ideas and tips whether or not you select Avalon Hills as your program of choice. We have successfully helped hundreds of clients access care and understand the path to success and lasting recovery. It is our goal to help inform, educate and acknowledge the difficult truth about accessing quality and effective treatment.
Step 1: An advocate must be willing to insist on residential treatment at the appropriate time. Eating disorders are ego syntonic - meaning it is difficult for the person suffering to ‘want’ treatment. The advocate needs to research and decide on the program that fits best. The suffering person may choose a program that may inhibit their recovery.
Step 2: Consider trusted referrals
Usually a client is receiving care from a local treatment team (doctor, therapist, dietician, etc). The home team professionals likely have had patients who have attended residential treatment programs and returned home to continue their recovery. These professionals will have valuable information regarding programs that may guide in your decision.
Step 3: Research treatment programs
Since the rollout of the Affordable Care Act, the residential treatment program landscape has drastically changed. Most treatment facilities originated with a desire to help those suffering from eating disorders. The founders may have had an altruistic focus on recovery and quality treatment. Nearly all of the US based programs are now owned by publicly traded corporations, private equity firms and venture capitalists. The founders are typically gone and the focus has shifted to shareholder profits. Much of the industry now treats to insurance coverage vs treat to outcome and this has created a revolving door of treatment. Short stays and discharges when coverage runs out are the norm. Quality treatment is markedly absent much of the time. To gain an understanding of treatment center culture and staff satisfaction, you may review www.glassdoor.com entries. It is important to know who owns and manages the program and what their goals are - successful treatment or profits?
Step 4: Determine your payment options
Generally, people seeking treatment have insurance coverage, but self pay is also an option or a combination of both. If you plan to use your insurance, it is vitally important to obtain a copy of your policy! Read the behavioral/mental health section carefully. Every insurance plan covers treatment differently for in and out of network services and it is crucial that you understand your covered services. Insurance plans vary in their compliance with federal and state mental health parity regulations. We recommend comparing your mental health benefits with mental health parity regulations to ensure your plan is in compliance. A good resource is Know Your Rights from paritytrack.org.
If you are covered by a self-funded group plan, you may consider discussing treatment coverage and options with your HR department and CEO. They may be able to help the approval process move quicker. Additionally, you may want to review the work from Kantor & Kantor, LLP. They have developed a specialized legal practice representing clients whose claims for treatment of eating disorders, and dual diagnosis (substance abuse and other co-morbid conditions) have been unfairly denied by their health insurers or benefit plans. You can review their work here.
Step 5: Contact the programs admissions department
The admission department is the gateway to the program. They will be able to discuss your care and treatment options as well as help you get a feel of how they operate.
- Does the program specialize in the type of care I am needing? Do they treat any other issues that are occurring along with the eating disorder (depression, anxiety, PTSD, etc)?
- What is the treatment philosophy or mission of the program?
- How is the program different from other programs?
- What treatment components does the program offer?
- What are the average lengths of stay for their clients?
- Short lengths of stay may not address the severity of the disorder and are often not successful
- How do they determine when a client is discharged?
- Is insurance accepted?
- Will admissions help me understand and navigate my insurance benefits and potential challenges?
- If my insurance is not accepted or they aren’t contracted, what other coverage options can they discuss?
- Do they assist with single case agreements?
- Does the program treat to the minimum standards of care set forth by the American Psychiatric Association? You can view the treatment guidelines here. Table 8 starting on page 37 gives the level of care guidelines based on 11 criteria.
Step 6: Admission and treatment
Once you have completed your program research, it is time to decide from which program to seek admission. Eating disorder treatment can be difficult and taxing on both the client and families. With hard work and quality, compassionate care, it is our sincere belief that you will be able to find sustainable success, well-being and health.