As Dr. O’Toole is away this week, I thought I would try to fill her rather roomy shoes and take a stab at this week’s blog. As CEO I’m often asked by parents and providers: what makes a good eating disorder treatment program? What specific criteria should one use to compare programs? What questions should one be asking?

And you won’t be asking these questions only of prospective treatment programs. These will come in handy talking to your insurance company, when they make the inevitable “in-network” treatment recommendation.

Firstly it’s important to remember that insurance companies make treatment recommendations based on commercial relationships with providers (i.e. network contracts). These have zilch to do with appropriate treatment for your child. That’s not to say they couldn’t make an appropriate recommendation. They might; then again they might not, and it falls to you, as parents, to make the right choice based on what really matters: the health and welfare of your child.

And contrary to popular belief, you don’t actually have to take their treatment recommendation(s). You have options.

Secondly, insurance companies are always at pains to stress they never make medical decisions. Oh no, that’s strictly between you and your doctor. Well fine, in that case you and your doctor will determine if their treatment recommendations are appropriate. If you (parents) think they aren’t  - and even if your doctor doesn’t agree with you - be prepared to fight. You should know that insurance companies are legally obligated to furnish “appropriate” treatment options within 50 miles of your home or pay in-network reimbursement rates (i.e. higher rates)  for you to see an appropriate specialist, even if that specialist is not contracted with your insurer and/or is located far away (i.e. out of state). This is called an out of network exception, four words you are unlikely ever to hear uttered by an insurance company representative.

So then, what does an appropriate treatment program look like? Since Kartini Clinic is a pediatric eating disorder program specializing in children and young adults, particularly those under 12, we have strong opinions about the proper qualities of a program for this age group. The following are five questions to ask.

(1) Is the program truly a program for children or merely an adult program that treats kids?

This might sound obvious but too often I hear insurance companies insisting that an adult program should be able to treat a 15 year old (never mind a 12 year old). Nonsense. Children and young adults need a program tailored specifically to their needs, and not just one where the “adolescent treatment group” is staffed by providers who are really trained to treat adults.

(2) Does the program bill itself as a “dual diagnosis” program?

There are a lot of programs out there that say they treat children with eating disorders, but in fact they will treat anyone who will will pay their fees. Sorry, but it’s true. We are very skeptical of places that purport to be “experts” in such disparate and unrelated fields as eating disorders, substance abuse, behavioral issues, and developmental disorders. And all this with a single treatment team?! Chances are very good your child will be in the same treatment group as children who have wildly different diagnoses and treatment needs. That’s not appropriate care, in our professional opinion.

(3) Does the treatment team include a medical doctor with expertise in eating disorders?

In our opinion, any treatment team must contain at least one board certified pediatrician and/or pediatric psychiatrist, as well as therapists with specific training in the treatment of eating disorders in children. Don’t be shy about asking for this up front, and don’t be put off with platitudes and excuses. Remember: board certified pediatricians or pediatric psychiatrists. Period. And if these medical doctors don’t supervise your child’s condition daily, move on. There are programs who do, and they’re almost certainly going to be better for your child.

(4) Is there continuity of care?

Eating disorder treatment is complicated. It necessarily involves both expert medical and mental health providers. A good eating disorder program will have the same team of providers working together at all stages of care, whether inpatient, day treatment or outpatient. In other words you don’t want a different doctor or therapist for your child at each stage of treatment. And you don’t want a program that does one phase but not the next, i.e. provides inpatient but not day treatment, or day treatment but not outpatient. This just ensures you’ll have to start all over again with yet another group of providers who don’t know you or your child (or worse, give conflicting advice). Insist on a program that will see your child’s care through from the very first appointment to the last.

(5) Does the program place families at the core of the treatment team?

We are very heartened to hear how everyone now does “family-based treatment”. We’ve been doing it since 1998. And though all the brochures are certain to mention it, the fact is there’s family-based treatment and then there’s family-based treatment. Once a week conference calls with a family member is not family based treatment, in our opinion. True family-based treatment begins by placing the family at the core of the treatment team, not relegating them to the periphery. That means face-to-face family therapy at least weekly with all parents, if possible. It also means parent instruction and training on things like preparing appropriate meals for their child. After all, every child must eventually return home, to be cared for by parents who will need an in-depth understanding of proper treatment for their child. Without this there is little hope of lasting remission. And family-based therapy is not just nice to have, it’s been shown to be more effective in treating children and young adults with eating disorders than anything else out there. Be sure to insist on a program that doesn’t just pay lip service to family-based treatment but really practices it too.

I hope parents find this information helpful when discussing eating disorder treatment options with their insurance company or when looking into programs in their area. Just remember, you may have to insist on the right program for your child. But in order to do that you’ll first have to know what the right program should look like.