Kartini Clinic's regular outpatient program constitutes the most important and demanding part of eating disorders treatment. Our outpatient treatment team is a multi-disciplinary team of dedicated eating disorder specialists, all working together under one roof. Many families attempt to pull together a "team" of their own, consisting of a physician, a therapist and a nutritionist, all of whom work separately, and who then must try to communicate to coordinate care effectively. Our experience with this has not been positive; it is simply too difficult to provide effective, integrated multi-disciplinary treatment over the phone, particularly over the long term. Kartini Clinic had weekly staff meetings of all team members to discuss our patients' progress. We believe the result is a superior form of care for your child.

The demands of outpatient care should not be understimated, however. Kartini Clinic outpatient treatment is highly structured. A typical patient undergoing outpatient treatment at Kartini Clinic will be required to see our pediatricians once a week, our family therapist/educator at least once a week for nutrition and family issues, and attend group therapy once a week. Some children may also be required to meet individually with one of our psychiatric nurse practitioners or masters' level therapists, if deemed necessary by our medical director. As a patient's condition improves and the disease goes into remission, the frequency of visits are cut back substantially. However, parents need to be prepared for this process to take many months to arrive at this point. Travel to and from appointments, especially for families who don't live in the Portland Metro area, is a considerable hardship. Unfortunately, it is our clinical experience that without this level of outpatient care - at least until remission is achieved - all of the previous hard (and expensive) work in the hospital and day treatment will be rendered ineffective, and the patients and their families find themselves right back where they started.

Other Common Concerns:

School attendance

As you might imagine, this level of treatment inevitably causes school absences. Our patients are typically excellent students and do not like to miss school. However, parents must realize that, as hard as this is, an untreated or partially treated eating disorder will almost certainly ruin a child's school career, often just as they are about to graduate from high school, or once they get into the far more rigorous competitive environment of American higher education.

Medication

We are often asked whether or not we use medication. The answer is yes, of course we do, but always and only on a case-by-case basis. As we are a medically-based pediatric and adolescent clinic, we tend to be very conservative about medication, but we do not hesitate to use medications that work on the brain to alleviate suffering, obsessionality, anxiety or purging.

Group therapy

Because we strive to implement only evidence-based medicine at Kartini Clinic, we mandate the use of group therapy in children. Research has validated only two types of therapy for children with eating disorders. These are family therapy and group therapy. In children, individual therapy has been shown to play a much less effective role. Yet over the years families have consistently expressed concerns about group therapy, commonly in the belief that in "group" their child might pick up "bad ideas" from others, specifically about vomiting, hiding food, etc. Our providers are very concerned about this as well, which is why we do not mix children with binge/purge variant anorexia or bulimia with those who have pure restricting anorexia in the same therapy group. These two groups of children meet at different times for therapy and both are always under the supervision of an adult group therapist who directs the conversation during the session. Our adult patients (18 to 21 years of age), however, may be in mixed groups. As adults, they are more mature and able to process differences constructively.

Another common concern related to group therapy is more a belief that their child is "not the same as the other kids in Group," for example they may not have the same body image issues. There is much more variation in kind and severity of illness within the category Anorexia Nervosa at childhood than in adulthood. Some children will have the full-blown "adult form" with emaciation, food phobia, fear of fat and the feeling of being fat. Others will actually recognize themselves as too thin, some deny that they fear eating at all. Just as not all children with diabetes will have the same range of lows and highs on their blood sugars, and some will have kidney problems while others never do, there is a range of disease expression among our patients. However, they all have a variant of childhood anorexia nervosa and benefit from the input of other people their own age who know what it's like to go through what they are going through.

There is another, equally important function that "Group" serves. At Kartini we say that the treatment of anorexia nervosa takes a team. The input of the group therapist to the rest of the team is invaluable. The team perdiatricians tend to see patients for briefer, more "cut and dried" sessions, like most doctors. The family therapists are focused on family issues. Only the group therapist is able to give us a glimpse into the "real child", the one you know and love. The group therapist tells us what the child is like without a "white coat" or a parent in the room, what they are like when they are laughing and talking to other children or teens and this becomes very important as we move on to tailor your child's treatment to them personally.