Telehealth Treatment May Bridge The Gap to Cost-Effective Intervention on College Campuses

It has been reported that nine percent of college students today screen positive for ED symptoms (Eisenberg, Nicklett, Roeder, & Kirz, 2011). There are a number of factors that may contribute to this rate (read more about the pressure for perfection by founder Melissa Gerson), though declines in health, academic performance, social functioning and overall quality of life are consistently reported among this population. While mental health services are available on most US college campuses, these services are often difficult to access due to a number of barriers (denial, availability, scheduling, stigma etc.,) and often, students do not present for or receive care consistently (Eisenberg et al., 2011; Eisenberg, Hunt, Speer, & Zivin, 2011; National Research Council, 2015). As studies have demonstrated that a key indicator of long term recovery from an eating disorder is early intervention, these barriers and delays to treatment may contribute to poor prognosis and relapse rates in this population. High-quality, evidence-based, gold-standard treatment options are typically delivered at treatment centers (off-campus) and may be out of budget for undergraduate students and, depending on their geographic area, inaccessible as well. In recent years, telehealth programming has helped to provide individuals in rural settings increased access to quality treatment options.

An article published in the International Journal of Eating Disorders  notes “discrepancies between access to and demands for care suggest the need for novel care delivery models that optimize resource delivery while conserving costs.” Digital health technology that utilizes mobile screening tools and online interventions may assist college campuses in overcoming barriers and closing treatment gaps. This article proposed that a stepped care model for screening & treatment delivery uses online screening to assess risk for ED and offers them an intervention based on severity (e.g. low risk = online self-help intervention, subclinical or clinical ED= guided self-help (GSH), full-syndrome anorexia = referral to in-person care).  If individuals do not show symptom reduction via the stepped care model, they are then directed to more intensive intervention.

Researches utilized the stepped care model paired with existing data from an online GSH study as they estimated the costs of implementing a US college-based Telehealth screener & intervention. Researchers estimated a stepped care model would cost less and result in fewer individuals needing in-person psychotherapy (after receiving less-intensive intervention) compared to standard care. The costs were calculated for a population of 1,000 college students and when compared to a standard care model, cost-savings was estimated at $13,862.54. Within this stepped care approach model, 37 individuals with EDs and 77 individuals at risk would need in-person psychotherapy, equating to 114 individuals total. Comparatively, in standard care, 146 individuals would need in-person psychotherapy. While these numbers are mere estimations and a number of components were unaddressed in the study (generalizability to other countries, individuals with AN who need higher levels of care, costs of screening, costs of dissemination etc.,), it was clearly illustrated that there is a need for additional research to fully evaluate the cost-effectiveness of telehealth treatment.

These results also demonstrate the clear benefit of cost-effective, telehealth treatment options for college students at risk for eating disorders. It is an exciting time for the field of eating disorder treatment, as new and effective telehealth treatment options are beginning to gain credibility and demonstrate their efficacy. Be sure to check back in with Columbus Park in the coming weeks as we unveil an innovative Telehealth application, designed to reach well beyond our NYC location.