The Initial Assessment: What to Expect
As Admissions & Program Director for an eating disorders center, I conduct initial assessments for those seeking treatment. The overall purpose of this assessment is to determine the level of care needed for the patient and to outline an appropriate treatment plan. Our center offers partial day treatment, an intensive outpatient program, individual and group psychotherapy, an ANAD support group, and weekly groups for parents.
Parents often feel powerless over these diseases, and for this reason I spend much of my time answering their questions and attending to their concerns. The most common question I hear during the first phone call is, “What treatment level does my child need?” However, it is not ethically possible to diagnose or determine an appropriate level of treatment until we conduct an initial assessment.
Our First Meeting
Once the appointment is set, we encourage potential patients who are under 18 years of age to come with their parents. Older patients can come alone or with their family. Our goal in either case is to get as much background information as possible in order to best understand the specific underlying issues for each individual patient.
Parents fill out a “Family Questionnaire” which gives us insight and perspective into the family history and their perceptions of the situation. Patients complete their own set of standardized assessments and questionnaires, which usually include the Eating Disorder Inventory – SC (EDI-SC), Beck Inventory, Compulsive Exercise Questionnaire & Yale -Brown Obsessive Compulsive Scale (Y-BOCS), and a Symptom Checklist. This portion of the assessment takes approximately thirty minutes.
The Assessment Questionnaires
The EDI-SC has questions regarding past and current eating disorders behaviors. It provides us with a history of dieting, compulsive exercise, purging, etc., as well as a time line of when these behaviors started and their current frequency. This form is extremely detailed, and when we arrange for the appointment, we suggest that patients refresh their memories to give us as specific and accurate information as possible.
The Beck Inventory is a clinical tool used to assess for depression. Patients are asked to rate, on a scale of 0-3, how they identify with a series of 35 statements about their present feelings, any changes they may have experienced recently with appetite, sleep, and any decrease in their emotional states and overall enjoyment of life
The Compulsive Exercise Questionnaire consists of twenty questions and determines the frequency, type, and length of the patient’s exercise sessions. This is used to help us clarify whether the patient is exercising at unhealthy or unsafe levels. Identifying this excessive behavior is particularly critical if the patient is underweight and/or medically compromised.
The Y-BOCS checklist assesses for a diagnosis of obsessive compulsive disorder (OCD) by pinpointing past and current behaviors which are considered obsessive compulsive. It also rates the severity of these behaviors. Patients are asked to recall any “Repeating Rituals” (i.e. need to repeat routine activities), “Ordering /Arranging Compulsions”(i.e. can’t complete activity until just right) or “Cleaning/Washing Compulsions” (i.e. excessive hand washing/showering). It is common for patients suffering from an eating disorder to show signs of these compulsive behaviors, which are important to address in the initial stages of recovery. If the existence of obsessive compulsive behaviors is determined, we will also refer the patient to a psychiatrist for a medication evaluation.
Once the patient has completed these standardized assessments, I get a thorough verbal history of the patient’s story, addressing areas of importance, such as:
- Frequency of current eating disorder behaviors
- Outline of specific nutritional intake
- Exploration into the onset of the eating disorder (age)
- Precipitating events (past and current stresses)
- Family history of addiction, depression, OCD, etc.
- Relationship with family members
- Past history of trauma/abuse
- Current medications
- Readiness for change and recovery
Of particular importance in the above list is the patient’s “readiness for change and recovery.” It is normal and quite common for a potential patient to feel a certain amount of fear and ambivalence surrounding the beginning stages of recovery. However, a substantial amount of resistance and an unwillingness to let go of the eating disorder is imperative to address up front.
Determining a Treatment Plan
Although the initial assessment is extremely detailed and thorough and can be emotionally draining for the patient, it is essential that all necessary and pertinent information be compiled. Assessment results are reviewed with members of the therapy team, and together we determine a diagnosis and appropriate treatment options for each patient.
We then meet with the parents and patient to discuss what we have determined to be the appropriate level of care. This happens either at the end of the initial assessment or at a second meeting. Ultimately, our goal is to provide our patients and families with a comprehensive treatment plan that will give them the best care possible and make recovery a reality!
By Mollie Coughlin, M.A.,CEDA & Divya Kakaiya, Ph.D., CEDS
Reprinted with permission from Eating Disorders Recovery Today
Winter 2003-2004 Volume 2, Number 2
©2003 Gürze Books
About the Authors
Mollie Coughlin, M.A.,CEDA is Program Director and Director of Admissions at Healthy Within in San Diego. Mollie has her M.A. in Counseling Psychology, is a registered MFT Intern, and is also a Certified Eating Disorder Associate (CEDA).
Divya Kakaiya, Ph.D., CEDS is Clinical Director of Healthy Within and has been treating eating disorders since 1985.