Dedication to Effective, Evidence Based Treatment
At The Healthy Teen Project we are continuously striving to offer high quality, effective care. This means our staff are proactive in sharpening their current skills, staying up to date with current research, and are being trained in a variety of interventions indicated for teens with eating disorders.
Family Treatment: Family-Based Treatment as a Foundation
We are committed to providing evidence-based treatment. This means we use research-backed methods with person-centered care to provide our clients with high quality, effective treatment.
Families are an integral part to an adolescent’s recovery and are at the center of treatment at The Healthy Teen Project. We have woven in Family Based Treatment (FBT) concepts and interventions into the foundation of our treatment approach.
FBT is currently the front-line treatment for adolescents with eating disorders in the outpatient setting. We have adapted FBT to apply it our PHP/IOP program setting. The main tenant of FBT is that parents take the lead in their child’s recovery by focusing on re-nourishing their child and intervening with any eating disorder behaviors. In practice at Healthy Teen Project this looks like:
FBT at The Healthy Teen Project
- Adult caregivers, often parents, hold the vital task of feeding their child. This means creating, serving, and supervising meals and snacks.
- A transitional period at the start of treatment with parents providing full supervision before the teen has more independence to practice feeding themselves. Treatment may start with parents supervising all meals and snacks during a transitional period before having the teen become more involved with their food. The teen may begin to create meals side by side with their parent, go to the grocery with their parents, and eventually eat meals without supervision. The rate of independence reintroduction is determined by the individuals’ ongoing clinical progress.
- During the program day clients will eat meals and snacks on-site with our trained staff. To assure we uphold the main tenant of FBT, caregivers create and bring their teen’s meals to program daily. It’s like sending a pack lunch for school, with an enhanced focus on meeting the adolescent’s meal plan.
- We provide daily meal logs for caregivers to complete so staff can act as extensions of parents and ensure meals are plated as parents intended. Our registered dietitians review these logs multiple times throughout each day and will write down specific feedback on the sheet to provide caregivers. This assures caregivers are offered timely and consistent feedback so they know what is going well and what can be improved on a day-to-day basis.
- Family therapy sessions often focus on caregiver alignment (working as a team), specific tactics for helping a teen eat and discontinue eating disorder behaviors, distress tolerance and emotion regulation skill building, and caregiver self-care.
- Our entire staff leads with compassion and the understanding that parents/caregivers DO NOT CAUSE eating disorders. Our therapists will support caregivers with processing and dispelling any self-blame that may be experiencing. Our entire staff is dedicated to building caregivers up to directly support the well-being of their loved one with an eating disorder.
- Outside of specific appointments such as family therapy and nutrition appointments, caregivers are supported through proactive communication with all team members as needed. This includes emails, phone calls, and in-person touch points on an as-needed basis.
- A parent-support group is offered twice a month: This group provides caregivers with space to connect with one another—to have emotional space to be supported by others who truly “get it”, and to learn specific concepts, tools, and tactics that can be directly and immediately applied to the treatment process they are in the midst of.
Beyond Family-Based Treatment: Emotion Focused Family Therapy (EFFT)
Our program takes an integrative approach that goes beyond using Family-Based Treatment as the sole intervention. Both FBT and EFFT focus on the role of the caregiver. While FBT focuses on empowering parents to modify their own behavior to elicit behavioral change in their teen, EFFT focuses on eliciting enhanced parent self-efficacy and enlisting the caregiver as a recovery coach for their loved one.
Specifically, EFFT focuses on:
- Emotion coaching skills
- Facilitating relational repair
- Processing emotional blocks
- Therapeutic apologies (when applicable)
At HTP our therapists have received training in EFFT and tenants of EFFT are also woven into our program, specifically in family sessions and in parent group.
Alternative Approaches to FBT
We recognize that not every teen and every family is best served with Family Based Treatment (FBT) as the main component of treatment. We also recognize that we use an adapted model of FBT to work within our day program model. In outpatient treatment, FBT is currently considered the “go to” for adolescent eating disorder treatment. If FBT is found to be not effective or is not clinically indicated for specific reasons, alternative treatment methods are considered. Adolescent-Focused Therapy (AFT) is the runner up intervention that is most often considered when FBT is not used.
Parallel to the outpatient approach, at HTP we start with a Family-Based Treatment framework before exploring Adolescent-Focused Therapy. Outcomes research on FBT and AFT informs us that both treatment interventions have positive prognosis rates, yet FBT has demonstrated greater positive markers of recovery in a shorter amount of time, and AFT has shown to be less effective on more severe cases.
During the intake process and ongoing throughout treatment, our team will gather information collaboratively (from teen, caregiver, treatment providers, and current evidence-based research indications) to assure we tailor the treatment approach to the needs of the client.
If Family-Based Treatment is not indicated, we will work to restructure treatment in a way that utilizes caregivers as a resource as appropriate and available, while focusing more on resourcing the individual teen.
Adolescent-Focused Therapy (AFT), like FBT, is a treatment approach that is focused on assuring adequate weight gain (if weight gain is needed) and decreasing engagement in eating disorder behaviors such as restricting or purging. Unlike FBT, where caregivers take the lead for refeeding their child, AFT empowers the teen to take the lead in their symptom reduction through collaboration with a trained therapist. The teen and therapist work collaboratively to identify what topics, processes, and behaviors to address. With this model caregivers are encouraged to be involved in a supportive way versus as the team leader.
Transitional Age Youth
We provide care that meets the unique needs of our clients by considering where each client is at developmentally. We recognize that as a teen progresses in age, independence typically increases as well. This independence may look like wanting to spend more time with friends than family, testing limits, exploring preferences, and seeking new experiences.
When a teen enters treatment an increase in caregiver involvement typically occurs. Although not the case for everyone, we have heard many teens and caregivers state, “I feel like we’re moving backwards.” Or “I can’t believe my parents have to feed me again.” We hold a high level of compassion and empathy for this unique experience and are dedicated to creating a treatment approach that fosters agency and dignity, while also assuring that the caregiver is a central player in the treatment process.
We integrate family-based treatment with our older teens, typically between ages 17-early 20’s, in a collaborative way. In practice at The Healthy Teen Project this may look like:
- Collateral communication with caregivers to focus on relational repair, communication skills, and case management.
- Teaching older teens how to put meals together, grocery shop, and plan ahead for their daily needs.
- Empowering older teens to let their parents help them where it’s needed and also gain the confidence to know when they are doing well without additional help.
- A client example: A 20-year client may be managing all their own food, and then have weekly family sessions that focus on family dynamics and skill building. This client may know she needs her parents’ help on the weekend but also may want to do it on her own. Her therapist will support her in identifying her reasonable needs, accepting the reality of when and how she’s struggling, and identifying an action plan that encourages the teen to let her parents in, while supporting her with reasonable boundaries that align with her stage in life.
As we’ve shared above, caregivers are at the heart of treatment. We know that families heal one another and that caregivers need unwavering respect, support, compassion, and gratitude for the role they play in their loved one’s healing process. We believe that caregivers are essential into the daily workings of our program. While we know that not all of our clients will have their caregivers as a primary part of their treatment (for circumstances outlined above), the vast majority of caregivers are involved on an ongoing basis from admit to discharge.
In practice, this looks like:
- Caregivers attending the initial program assessment with their loved one
- Caregivers attending intake appointments (first week) with each provider on the team. These appointments will focus on introductions to the team and to the treatment process, and information gathering.
- Weekly family sessions that may include caregiver only meetings, or entire family meetings, depending on what is indicated.
- Weekly nutrition appointments with a registered dietitian to address nutritional needs, eating behaviors, and meal planning.
- Close communication on an as-needed basis with all providers on the team. This includes emails, phone calls, and in person check-ins when indicated.
- Attendance in our twice monthly parent group.
- Caregivers most often are tasked with “refeeding”, meaning we ask caregivers to prepare and serve their loved one’s meals and snacks. Our RD’s and therapists will support everyone in this process.
We use the term “client” to refer to the young people we work with, while in practice we are working with the entire system. We focus a great deal of our time and efforts on caregivers through therapy sessions, support groups, check-ins as needed, and ongoing communication through various mediums. We are acutely aware of the tremendous amount of stress that comes with having a loved one with an eating disorder. We are committed to being a source of support, knowledge, and strength for all caregivers in the midst of a recovery journey. We also welcome and encourage feedback from everyone we serve so that we can adapt to and better serve our caregivers.
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