“What are your results and how do you measure them?”
It’s the most important question you should ask when seeking treatment for eating disorders. Here’s what you should look for in an answer:
A measure of eating disorder outcomes. It’s not enough to measure “satisfaction.” You want to know that patients actually got better.
Outcome measures that include symptoms (e.g. preoccupation with food), behaviors (e.g. bingeing), and biometric values (e.g. weight).
A rigorous tool that has been thoroughly tested and refined by research.
Comparison to a database of other similar patients. In other words, how do your outcomes compare to patients treated elsewhere?
A measure of how long it took to achieve those results. Six months? Twelve months? Years?
Here’s how we measure eating disorder outcomes at Columbus Park, and what it means:
- Symptoms. At Columbus Park, we use a survey questionnaire from ACORN (A Collaborative Outcomes Resource Network) designed specifically for eating disorder patients. Patients answer eleven questions about the frequency of their symptoms at the beginning of each treatment session on a tablet computer (e.g. “In the last week, how often did you feel preoccupied with your shape and/or weight? 0=Never; 1=Hardly ever; 2-Sometimes; 3=Often; 4=Very often”).
When the items on the questionnaires are viewed collectively, they provide a measure of what’s called global distress. Global distress is the measure common to virtually all patient self-report outcome tools used in psychotherapy, and it allows Columbus Park data to be compared against ACORN’s database of over 750,000 cases.
ACORN then uses multivariate statistics to calculate projected change and what’s called the severity adjusted effect size. Essentially, effect size is a measure of the magnitude – or size – of the treatment effect. ACORN Criteria for Effectiveness (ACE) pegs 0.5-effect size as the threshold for “effective” and .8 as the threshold for “highly effective.”
When we started tracking outcomes at Columbus Park, our effect size was in the .5 range. What we found—which is consistent with the literature*—was that questionnaire completion by every patient at every session, coupled with weekly reviews by clinicians and adjustments to treatment as indicated, resulted in much better outcomes. It makes sense: measure patient symptoms at treatment onset and along the way (together with Alliance, see below) and use the feedback to adjust treatment.
Another way of looking at outcomes is to examine the distribution of patient change. At Columbus Park 73% of our 2016 patients through June showed measurable improvement.
The Columbus Park questionnaire also includes questions on drug/alcohol use and self-harm. We have found these to be especially valuable—therapists don’t routinely ask about these at every session, and positive responses on the questionnaire have provided early red flag warnings.
2. Alliance. Our Columbus Park Questionnaires include an additional three questions to assess the working alliance between patient and clinician. (e.g. “Please take a moment to give feedback on your most recent session with your therapist: I felt that the clinician understood and respected me. 0=True; 1=Sort of; 2-Unsure; 3=Not Really; 4=False”). Alliance scores are predictive of outcomes and are used to identify areas of concern the patient may have regarding the treatment process.
3. Eating disorder-specific behaviors. Our Columbus Park Questionnaires include an additional four questions on eating disorder-specific behaviors (e.g. “In the last week, how many times did you binge?”) The answers allow us to track, by patient, the frequency of these behaviors. We’ll post a future blog on these results.
4. Weight. Patient weights are taken and recorded at every session. It is an important part of treatment and an important measure of outcomes (especially for our anorexia patients). We’ll post a future blog on these results as well.