Legislative Gudieline 2
Comprehensive Care Centers for Eating Disorders will have the capacity to provide directly or arrange for all required levels of care appropriate for individuals with eating disorders.
Discussion:
Article 27-J requires Comprehensive Centers to provide a continuum of care tailored to the specialized needs of persons with eating disorders including at least, individual health, psychosocial and case management services in both non-institutional and institutional settings; medical surgical, psychiatric and rehabilitation care in Article 28 or Article 31 licensed facilities; and residential care and services specifically oriented to the needs of persons with eating disorders in nursing homes or adult homes, or facilities licensed under Article 31 of the Mental Hygiene Law. The care of individuals will be managed and coordinated at each level and throughout the continuum of care.
The services for the treatment of individuals with eating disorders range from intensive inpatient settings to varying levels of outpatient care and support services. At a minimum, a Comprehensive Care Center for Eating Disorders will have the capacity to provide or arrange for the following levels of care consistent with the American Psychiatric Association's "Practice Guideline for the Treatment of Patients with Eating Disorders" and the National Institute for Clinical Excellence's (National Health Service, UK) "Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders".
- Partial Hospitalization (Full-Day Outpatient Care);
- Inpatient Hospitalization (both medical and psychiatric);
- Residential Care;
- Intensive Outpatient care;
- Outpatient care; and
- Long Term Monitoring.
All levels of care must be appropriately licensed. Services to be provided or arranged at each level of care are described in Guideline 3. At all levels of care and for all types of treatment, services must be provided in segregated settings that provide services specifically for people with eating disorders. The Center and its affiliates will display a strong commitment to family involvement. Treatment settings will be separated by age, be developmentally appropriate and take into account cultural differences among participating individuals. Mechanisms must be in place for individuals to access the clinical team across all levels of care.
Comprehensive Care Centers for Eating Disorders will clearly articulate the criteria used for initial admission into care and for movement between levels of care (in either direction — increasing or decreasing intensity). Any exclusion criteria, and discharge criteria must be included, stating any situations in which the provider is unwilling or unable to provide treatment. Policies regarding individuals who do not comply with the treatment plan or act out must be specified. These criteria serve as guidance for the treatment team in coming to consensus about the direction and timing of changes in service intensity and settings. Flexibility at all levels of care is important to take into account individuals' needs and to adjust program modalities as new treatment evidence becomes available.
The provision of transitional services, to facilitate successful progression among levels of care, is a critical component in the eating disorder recovery process. Transitional services, appropriate to the level of care, shall be incorporated into all treatment plans. Follow-up care and contact for individuals as they move out of the treatment program must be available for a period of 5 years from the individual's eating disorder diagnosis, or longer, if clinically indicated.
Comprehensive Care Centers for Eating Disorders will have the capacity to provide weekend and evening support for individuals with eating disorders and their families, if clinically indicated as part of the plan of care. In addition, crisis services must be available 24 hours a day, 7 days a week for clients and their families.
