Mission Statement DAY TREATMENT PROGRAM PARTICIPANTS. Purpose 11/9/2012

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Sharon Thompson
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1 Short Term Outcomes of a Day Treatment Program for Youth with Eatg Disorders Presented by: Dr. Kathere Henderson C.Psych. Authors: Kathere Henderson, Nicole Obeid, Annick Buchholz, Wendy Spettigue, Mark Norris, Megan Harrison, Steve Feder, Annik Mossiere, Danijela Maras Children s Hospital of Eastern Ontario Emergency Admit Inpatient Medical stabilization Therapeutic milieu Individual & family therapy Group based psychotherapy Normalize eatg behaviour Medical Instability and Severe CHEO EDP Contuum of Care Comprehensiv e Assessment Diagnosis & Treatment Day Treatment Group based psychotherapy Normalize eatg behaviour Family volvement Relapse prevention Moderate to Severe Short stay Long stay Outpatient Medical clic Psychoeducation Group psychotherapy Individual & family therapy Mild to Moderate Severity Mission Statement The CHEO Eatg Disorder Program aims to provide excellent, evidence-based medical and mental health care through specialized, family-focused services across the contuum of treatment for youth with eatg disorders. DAY TREATMENT PROGRAM Outcome Highlights Purpose PARTICIPANTS Is our day program effective meetg the short term treatment goals for youth? Measurement: Entry to Program, Program and 6 month Program SHORT TERM GOALS 1. Medical Rehabilitation 2. Normalization of Disturbed Eatg 3. d Psychological Functiong 65 Female Youth Mean age 15, range 11 to 17 years (SD 1.34) 63.7 AN 10.2 BN 26.1 EDNOS Length of Treatment: weeks (SD 5.99) 1

Mean Subscale Total Score Analysis: Repe Measure & Reliable Index Reliable Index (RCI): Determes whether the magnitude of change for a given client is statistically reliable Clically significant:

2 Mean Subscale Total Score Analysis: Repe Measure & Reliable Index Reliable Index (RCI): Determes whether the magnitude of change for a given client is statistically reliable Clically significant: Reliable positive change & Time-2 score falls to the target terval (normal range): 68th percentile or T-Score less than 60 A BMI greater than 19 Day Program Goal #1 Medical Rehabilitation Body Mass Index Jacobsen & Truax, 1991; Jacobsen, Roberts, Berns, & McGlchey, 1999; Kordy, Percevic, & Martovich, 01 BMI: Repe Measures Reliable Index BMI N=62 N=60 F(1.72, )=26.98 p<.001 Pairwise: Time 1 & 2; Time 1 & 3 significantly different Time 2 & 3 not significantly different Make significant change that is mataed for 6 months Mean BMI kg/m Assessment Timepots BMI Day Program Goal #2 EDI-2 Drive for Thness: Repe Measure Normalization of Disturbed Eatg EDI-2 Drive for Thness N = 41 F(2, 80)=12.10 p<.001 Pairwise: Time 1 & 2; Time 1 & 3 significantly different Make significant change mataed for 6 months EDI DT EDI BD Assessement Timepots 2

3 Mean Total T-Score Mean Subscale Total Score RCI EDI-2-DT N= (10.7 (10.8) (24.6) (41.5) ) Reliable 4 (6.2) () 26 (40) 39 (60) () Total Day Program Goal #3 Psychological Functiong EDI-2 Body Dissatisfaction CDI Depression MASC Anxiety EDI-2 Body Dissatisfaction: Repe Measure RCI for EDI-2 BD N=50 N = 41 F(1.64, 65.81)=5.40 p<.01 Pairwise: Time 1 & 3 Make significant change between pre and 6 months EDI DT EDI BD Reliable (16.9) (33.8) (26.2) (23.1) (6.2) (23.1) (24.6) Total (16.9) 10 Assessement Timepots CDI Total Score: Repe Measure RCI CDI N=54 N=48 F(1.78,83.78)=8.49 P<.002 Pairwise: Time 1 & 2 and 1 & 3 significantly different Make significant change mataed at 6 months CDI MASC 9 (.8) 15 (23.1) 30 (46.2) 9 (.9 ) Reliable 7 (10.8) 12 (18.5) 26 (40) (30.8) Total Assessment Timepots 3

8) 24 (36.9) Total 22 70.6 (33.8) 55 Assessment Timepots Conclusions Day Treatment Program appears to be successful meetg short term goals of: 1. Medical rehabilitation 2.

4 Mean Total T-Score MASC Total Score: Repe Measure RCI MASC N=52 N=47 F(2, 88)=5.78 p<.005 Pairwise: 1 & 3 significantly different Make significant change between Pre and 6 months post program CDI MASC (23.1) (.8) (43.1) Reliable (18.5 ) (.8) (10.8) 24 (36.9) Total (33.8) 55 Assessment Timepots Conclusions Day Treatment Program appears to be successful meetg short term goals of: 1. Medical rehabilitation 2. Normalization of disturbed eatg 3. d psychological functiong pre to post program ments appear to be mataed at 6 month follow-up Usg a Qualitative Approach Helpfulness of the Day Treatment Program: A Patient s Perspective Objectives Qualitative and Quantitative Approach Determe overall helpfulness of the day treatment program Determe specific aspects of treatment that patients found most and least helpful their recovery 4

5 Participants Helpfulness of Entry to DTP Cohort of 25 DTP patients from January to December 09 2 excluded due to short stay (<2 wks) 17 participants completed the terview (~65 response rate) Age range: to (M=15.90) 7 to 25 weeks DTP (M=14.60) 16 female, 1 male 71 tx completers 29 partial tx completers 53 AN-R, 18 BN 53 comorbid axis I disorder 59 comorbid axis II disorder Mean helpfulness: 3.65 (SD=0.86) No participants described entry as not at all helpful Ratgs of Program Components Ratgs of Program Components Program Component Helpfulness Ratgs Sum Mean SD Family therapy Meal outgs Interactions with peers Goals group Yoga School Group therapy Weekly review Friday outgs Food experience Support from staff Creative copg/art Medical review : Fairly to very helpful Rankg Most Helpful ( votes) Least Helpful ( votes) 1 Creative Copg (21) Teen Issues (18) 2 Body Image (18) Creative Copg (15) 3 Open Therapy (15) Menu/Weekend Planng (12) Participants were asked to state the two groups that they felt were most and least helpful their recovery Top three were ranked based on a count of votes Turng Pots y Transition Back to School Program Entry/Exit Group Friendship/Support Shared Experiences with Peers Helpg Others their y 70 Majority returned to school gradually A few days per week to start Peer Role Models of y Trust of/support from Staff Seeg Life Beyond the Eatg Disorder Please describe a memorable moment that made a difference or was a turng pot your recovery 5

Transition Out of DTP Overall Helpfulness of the DTP 33 Mean helpfulness: 2.67 (SD=1.29) 47 Mean helpfulness: 3.82 (SD=0.

Staff Rules/Structure Interactions between Patients Summary Quantitative and Qualitative Data suggest that the program is effective meetg short

If you were charge of the program, what would you change or do differently?

6 Transition Out of DTP Overall Helpfulness of the DTP 33 Mean helpfulness: 2.67 (SD=1.29) 47 Mean helpfulness: 3.82 (SD=0.88) Not correl with: ED diagnosis Comorbid disorder Completion status 7 Length of stay Age Chronicity of ED Suggestions for Programmg Staff Rules/Structure Interactions between Patients Summary Quantitative and Qualitative Data suggest that the program is effective meetg short term goals. Patients perceive program and program components to be helpful. If you were charge of the program, what would you change or do differently? Future Directions Use our data to better understand predictors of success the day treatment program. This will help us improve the program and better match patients and families to treatment. Use our data to better understand trajectories of illness and recovery for youth our program. Thank you! Questions? 6

Avoidant/restrictive food intake disorder: Introducing a new DSM-5 eating disorder

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