The most important question consumers should ask when seeking treatment for eating disorders:
“What are your results and how do you measure them?”
Consider for a moment, treatments for cancer…If you were to interview an oncologist about his/her recommended treatment course, most likely you would ask about prognosis: “What is the chance of recovering?”
You’d also want to know the doctor’s success rates and the success of his/her treatments: “What percent of your patients get better with this intervention?”
In behavioral health, few providers offer empirical data to represent how their patients are actually doing. Additionally, very few consumers/patient ask about results. I know this because I, myself, respond to every inquiry that comes through by phone or email at Columbus Park. It is rare that people ask about the actual outcomes (rates of recovery/change) of our patients, so I miss out on an opportunity to brag about our results.
Results That Are Beyond Satisfaction
You may find that some treatment centers offer satisfaction scores. But satisfaction results are not particularly representative of clinical improvement since they tend look pretty good when patients who drop out of treatment are excluded. More importantly, there is little evidence that patient satisfaction represents actual efficacy of the treatment. So patients may express feeling satisfied but they may not actually be measurably improved.
Reliable outcomes in behavioral health are measured by having patients complete standardized questionnaires that track symptoms throughout the course of treatment. For the outcomes to mean anything, these patients must be compared against hundreds of thousands of other patients who begin treatment with similar levels of symptoms or distress.
For the purpose of this blog, I will try not to pull you through the muck with too much statistical analysis, but here’s a basic sense of how we, at Columbus Park, track our outcomes:
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 problems and 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 factor common to virtually all patient self-report outcome measures 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.”
The Columbus Park severity adjusted Effect Size for all 2016 patients January 1, 2016 through October 31, 2016 was high by any standard: 0.87.
Feedback Informed Treatment
When we started tracking outcomes at Columbus Park, our effect size was in the .5 range. What we found—which is consistent with the literature1—was that questionnaire completion by every patient at every session, coupled with weekly reviews by clinicians and adjustments to treatment as indicated, resulted in a dramatic improvement in our outcomes. It makes sense: measure patient symptoms at treatment onset and along the way and use the feedback to adjust treatment. With access to ongoing data, we can tweak treatment sooner and more effectively if/when someone is not responding.
How Much Change Do We See?
Another way of looking at outcomes is to examine the distribution of patient change. At Columbus Park, 70% of our 2016 patients through October showed measureable improvement. Given the well-documented persistence of eating disorders – many sufferers go in and out of protracted treatments throughout their lifetimes – these results are very encouraging.
Additional Measures for Results
- 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.
- 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. If we don’t see behaviors decreasing, we immediately consider ways we can adjust the treatment to optimize success. We’ll post a future blog on these results.
- Weight: Tracking weight trends is an important part of eating disorder treatment. It is a particularly critical measure of a successful outcome in our anorexia patients. We’ll post a future blog on these results as well.
1 Goodman, JD, McKay, JR, DePhilippis, D, Progress Monitoring in Mental Health and Addiction Treatment: A Means of Improving Care, Professional Psychology: Research and Practice 2013, Vol. 44, No. 4, 231–246.