Day Programs for Children and Teens

Most day treatment programs for young patients with eating disorders involve 6 to 10 hours of treatment, and supervised meals for 3.5 to 5 days per week. These programs can provide more intensive treatment than outpatient therapy while avoiding some of the high costs of inpatient and long-term residential services. Day programs may be particularly helpful for young patients whose symptoms are too severe to be successfully treated by a traditional outpatient team, yet are not severe enough for hospital-based, inpatient, or residential treatment (Child Adolesc Psychiatr Clin. 2019. 28:573). The literature on such programs has grown. What does it show?

A recent paper by Krishnamoorthy and colleagues reported the results of a literature review of 21 day treatment program studies (Eur Eat Disord Rev. 023.31:199). The authors concentrated on the benefits and efficacy of day programs for children and teens, and used PRISMA guidelines to conduct the review. Most program were in the US; others were in Canada, Australia, Spain, Germany, the United Kingdom, and Italy.

The 21 programs involved 1366 participants. The individual programs involved from 19 to 160 participants, most of whom were female. Follow-up at 3 and 6 months showed that the participants maintained their gains and benefits.

The programs varied widely. For example, one program included motivational enhancement strategies (Int J Eat Disord. 2011. 44:29) and sibling psychoeducation sessions. Another program used telephone counseling between the therapist and parents, which involved talking about appropriate ways for the parents to handle meal support for their children over the weekends. In another program, parents were required to provide support when a patient refused to finish his or her meals. Most day programs included individual patient psychotherapy sessions, group counseling, individual counseling with a patient and at least one parent or parents’ group counseling, and multi-family counseling. Most included at least two supervised meals and nutritional counseling each week. Parents were usually asked to attend at least one supervised meal a day; in contrast, another program allowed patients to have staff-supervised meals without their parents. A few programs included art therapy sessions, one included yoga classes, and six studies reported including school-based activities in the patients’ daily schedule.

How effective are day treatment programs?

The authors reported that overall, the day programs they studied were effective for restoring body weight, reducing eating disorder symptoms, and for examining comorbid mental health concerns.

Of the nine studies that reported dropout rates, the average dropout rate was 21%. Most reasons given for dropout (when available) resulted from eating-disorder-related medical conditions. At follow-up, six studies noted that patients maintained their weight gain for 3, 6, 12, or 31 months after discharge. The authors pointed out that weight was measured and reported in various ways. Of all the studies, six calculated body mass index, or BMI, and seven studies evaluated changes in weight by BMI. The studies also used a wide variety of measures that assess eating attitudes and behaviors associated with AN and BN.

The authors reported that day programs produced significant improvement in eating disorder symptoms among children and adolescents. The effects ranged from small to large. The review did underscore the variations in low body weight that were measured and reported among the programs and studies. All studies used family-based therapy and a few added cognitive-based therapy, enhanced (CBT-E) and dialectical behavior therapy (DBT).

Suggestions for future programs

Krishnamoorthy and colleagues’ literature review concluded that eating disorder day programs for children and adolescents are beneficial for promoting physical and psychological recovery. It remains unclear, however, which components of the day treatment programs contributed to recovery. Variations exist between the outcomes or components of these day programs, and these can be attributed to several elements. These elements include the differing clinical and demographic profiles of the clients, issues related to the existing mental health service infrastructure within the country in which the program was situated, inclusion of novel interventions, and lack of evidence‐based practices.

The authors suggested that day program research could be enhanced by reporting other physical health indicators, including heart rate and blood pressure. Such periodic physical health assessments may alert physical health professionals to possible comorbid health conditions. While specific expertise relating to family-based therapy and other specific interventions may be important, there is evidence to suggest that recovery-oriented interventions aimed at improving overall functioning rather than only focusing on the remission of mental health symptoms may be helpful for all patients (Aust NZ J Psychiatry. 2014. 48:1009).