The most important question consumers should ask when seeking treatment for eating disorders is:
“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 the behavioral health field, few providers offer empirical data to represent how their patients are actually responding to treatment. Additionally, very few consumers/patients ask about results… which is surprising considering just how critical – life changing – the treatment outcome really is.
If you’ve had any kind of treatment or medical care in the past, you may have been given a survey asking questions relating to your satisfaction with the care experience. Satisfaction results are helpful as a very basic form of concrete feedback but they are not particularly representative of clinical improvement. Further, these scores are skewed since they tend to look pretty good when patients who drop out of treatment are excluded. 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. AND, 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.
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.”
Columbus Park collects concrete data on how our patients are responding.
Our effect size (magnitude of change) for April 2015-July 2018 is 1.02.
An effect size of 1.02 is well above the baseline value to be considered “highly effective” treatment.
Effect sizes of 0.8 or larger = large or “highly effective”
Effects sizes of .5 to .8 = moderately large or “effective”
Effect sizes of 0.3 or less = are small; likely equivalent to no treatment at all
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.
Columbus Park outcomes are excellent and getting even stronger over time. How do we achieve these results?
1. For one, we’re paying attention; if a patient is not responding promptly to treatment (and we can see this clearly as we track the treatment response via regular surveys), we take action immediately to address whatever may be getting in the way.
2. We use the most potent treatments available. We are an evidence-based practice which means that we use well-defined, structured, behaviorally-oriented treatments. We deliver these treatments with skill and with fidelity to the treatment models. So we don’t dabble in these treatments; rather, we deliver them in the way they are intended and see how this impacts our results.
3. Our clinicians are recruited via a rigorous selection process. And then once part of our team, they get an extraordinary level of training and ongoing consultation and development. This leads to a professional culture in our practice of committed, stimulated providers – true experts with vast breadth of knowledge – who are wholeheartedly engaged in their work of helping people recover.
About a Measurable Practice
Whether you turn to Columbus Park or another reputable provider for your eating disorder treatment, when it comes to choosing the best course, be sure to ask about outcomes. Being an educated consumer is essential. And results matter.
1Goodman, 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.