The RD Road Map: Journey to Eating Disorder Expertise

Episode #14 The 14ers: Understanding PHP and IOP with your tour guide Jill Sechi, RDN, CEDS-C

Today we welcome your tour-guide Jill Sechi, RDN, CEDS-C to discuss her experience with starting up one of the first PHP/IOP programs in Houston, TX called Houston Eating Disorders Center (HEDC). Houston was a desert when Jill started in the field and now its a thriving rainforest of many RTC and PHP/IOP programs. PHP programming generally is 5-7 days a week and usually upwards of 12 hours a day. Most PHP programs have IOP programs as "step downs" in which the patient often gets to work with the same treatment team for consistency and support. Learn from Jill when to refer to this level, when not and the functions of PHP and IOP programming. Most states have PHP and IOP programming. Some even have apartments connected to them so that they do not have to travel to and from home which can be difficult. We hope you find this informative and helpful as you navigate when and HOW to refer patients! Join us on Apple Podcasts to listen to the full extended episode in our Subscriber Backend episodes!

Episode #13 The 14ers: Understanding Residential Level of Care with guest Amanda Mellowspring, RDN, CEDS-C

oday we welcome guest Amanda Mellowspring, MS, RDN, CEDS-C who is currently the COO (Chief Operating Officer) for a large outpatient business called Healthier Tomorrows. Learn more here: https://healthiertomorrows.com/dietitian/amanda-mellowspring-ms-rd-ceds-c/ [https://healthiertomorrows.com/dietitian/amanda-mellowspring-ms-rd-ceds-c/] Amanda previously was the VP of Monte Nido and has worked in a residential treatment for many years. She has hired and trained dietitians in residential as well. Residential treatment or RTC is a level of care that can provide some medical monitoring but generally provides 24/7 containment for patients that need much more support to restore weight or interfere with behaviors so that they can nourish themselves and their brain to do the hard work of recovery. There are MULTIPLE residential facilities throughout the United States. Amanda will provide a back end view of understanding the function and purpose of this level of care. Enjoy!

Episode #12 Understanding Inpatient Level of Care with Guest Meghan Foley, RDN, CEDS-C

Today we welcome guest Meghan Foley, MS, RDN, CEDS-C who is the clinical nutrition manager at Denver Health ACUTE. ACUTE is the "highest 14er" you can climb. It was founded by Dr. Philip Mehler and the main focus is helping medically stabilize individuals with severe malnutrition before they hopefully step down to residential care. Generally, those that admit here meet certain criteria such as a very low BMI (less than 15), very low or high electrolytes, at very high risk for refeeding syndrome which requires the patient to have 24/7 medical monitoring. Not only is ACUTE a medical stabilization hospital, it is also a renowned research facility. Their research has provided the field with amazing understanding of medical complications of eating disorders and how to treat the medical symptoms.

Episode #11 The 14ers: Understanding Higher Level of Care and Beyond

If you are a hiker, you know what "The 14ers" are; they are mountains that many like to climb located around the world. Not all of the hikes are difficult. What makes them difficult are the elevation changes. They are over 14,000 feet to the top and usually require a hiker to start at 6 am and "get back down" before noon as thunderstorms can develop quickly. We titled this new series The 14ers because we feel that understanding a Higher Level of Care (HLOC) can be difficult without exposure and a basic understanding of how to navigate: * When to decide to refer a patient to a HLOC * What are the different levels? * What facility do you refer your client to? * What level do you recommend? We will be having guest speakers that have worked in the various levels of care to give you perspective and an "inside look" into each level. If you are new to the field, knowing the basics and lingo is vital so that you can more accurately coordinate care and provide a good recommendation. Here are some resources on your journey from your tour guides! Know the lingo: * IP: Inpatient * RTC: Residential Treatment * PHP: Partial Hospitalization Program * IOP: Intensive Outpatient * OP: Outpatient Most states now have most levels of care (RTC through IOP). However, that doesn't mean those programs take your client's insurance or that they are a solid program. Ask around to other colleagues who are more seasoned in the field about which programs they might recommend. Keep in mind, not all clients do well in residential care on their "first round." They may not be ready or motivated, they may not have "stepped down" appropriately, or they may be too young and need family-based treatment, for example. We hope you find some good nuggets or perhaps just some validation of how difficult a 14er is. Experience, supervision, and knowledge are a good starting point even if you have never worked in that level of care.

Episode #10 Navigating the Rocky Path of Medical Complications Part 4

This is our last installment of medical complications to look for in eating disorder care. Today's episode covers refeeding and underfeeding syndrome in eating disorder care. Now we are looking beyond the basics of what to pack in your backpack and more so of navigating what trail to take, what additional things to pack and how much time you have in a given day with the trail you've chosen. Refeeding syndrome can evoke fear and underfeeding syndrome (the less common one most think about) can evoke confusion! As your "tour guides" here are some things to consider before your journey. What additional things to pack beyond the basics and knowing where you are going and what is waiting for you on your journey. * Know the continued labs to follow and other considerations when working with someone with malnutrition. How little have they been eating, how rapid has their weight dropped or what is their BMI are all items that can place a person at higher risk for refeeding syndrome (pack a medical kit). * Know what physical symptoms can be present with refeeding such as night sweats, sore muscles upon waking or heart palpitations and weight restoration. Make sure you are requesting they visit with a doctor to monitor this things (pack a rain jacket and light coat. The weather can change fast!) * Understand underfeeding syndrome (which is way more common than refeeding). How much energy is added and when is vital to keep internal organs functioning (including the brain) and keeping up with metabolic demands as the body is repairing itself. How much weight do they need to gain and where to start calories all need to be considered. (Avoid overpacking and starting too late on your journey. Eating disorders are like an 8 miler over several days. Make sure you have adequate fuel along the way).