Legislative Gudieline 3
Comprehensive Care Centers for Eating Disorders will have the capacity to provide or arrange for the full range of services appropriate for the care of individuals with eating disorders.
Article 27-J requires Comprehensive Centers to coordinate individualized plans of care, across a continuum that includes all necessary non-institutional, institutional and practitioner services and treatments, from initial screening and evaluation to treatment, follow-up care and support.
Comprehensive Care Centers for Eating Disorders will provide a comprehensive intake evaluation for all individuals presenting for care at the Center. This initial evaluation shall include discussions with the individual, their family and consultation with a team of providers. Based on the evaluation and in consultation with the individual, an individualized service plan will be developed. Service plans will be multidisciplinary and will follow practice guidelines. Service plans will be developed to address medical stabilization, nutritional recovery and psychological recovery, provide the necessary supports through the treatment process and also enhance individuals' life skills and improve overall quality of life and functioning.
Case management activities will be an integral part of ensuring that individuals' service plans are developed and implemented. A case manager will be assigned to each individual. The case manager will coordinate clinical services (e.g., obtaining evaluations and other documents form all members of the multidisciplinary team, assisting in scheduling appointments, coordinating clinical testing), ensure periodic team meetings and patient reassessments, assist in accessing reimbursement and social support services, coordinate with the educational system (as appropriate), and serve as a main point of contact for the individual and their family during the care experience.
The Comprehensive Care Center for Eating Disorders will provide or arrange for all services included in individuals' service plans. A treatment team will be designated for each person including, at a minimum, individuals representing the following disciplines: internal/general medicine, psychiatry, psychology, nutrition and dietetics, case management, and social work. Additional disciplines may be necessary depending on the needs of the individual. Individual choice of practitioners shall be available. Arrangements must be in place for the team to be accessible at all levels of care and case management must continue to be provided as the individual moves among levels of care. The following services should be readily available to all, either provided directly by the Center or through affiliation as described in the organizational plan:
- Internal Medicine
- Pediatric/Adolescent Medicine
- Specialty Medical Care as needed including but not limited to gastroenterology, cardiology and endocrinology
- Psychotherapeutic Interventions
- Individual Therapy (Cognitive Behavior Therapy, Dialectical Behavior Therapy, Cognitive Analytic Therapy, Interpersonal Therapy)
- Family Therapy
- Group Therapy
- Nutritional Rehabilitation and Counseling
- Case Management including assessment, reassessment, care planning and service acquisition
- Social Work
- Support Groups (Peer and Family)
- Vocational Services
- Educational Services
- Dental Care
- Transitional Services
- Monitoring and Relapse Prevention
Other services in the individualized service plan may be provided or arranged on an as needed basis across all levels of care. Examples of such services include occupational therapy, physical therapy, substance abuse treatment, exercise physiology, support and treatment for survivors of sexual and physical abuse, and pastoral support.
Comprehensive Care Centers for Eating Disorders will have the capacity to provide weekend and evening support for individuals with eating disorders and their families, if clinically indicated in the plan of care. In addition, crisis services must be available 24 hours a day, 7 days a week for clients and their families.
Individuals will be offered developmentally appropriate services and treatment segregated by age. Involvement of recovered persons in the delivery of services is an asset.
Transitional services will be provided to all individuals treated at Comprehensive Care Centers for Eating Disorders with the goal of eventual return to optimal functioning at home and in the community. These services will be incorporated into all levels of care and will focus on providing the individual with the necessary services and skills to adjust to changes in level of care and to prevent relapse. Transitional services will specifically address eating in a variety of settings and also include educational or vocational counseling, assistance in finding housing, meal preparation and grocery shopping skills, and other services as needed. If an individual chooses to use providers not affiliated with the Comprehensive Care Center for Eating Disorders, the Center will facilitate their transition to those providers and may continue to serve the individual if clinically indicated.
Comprehensive Care Centers for Eating Disorders must provide or arrange for residential care and services specifically oriented to the needs of persons with eating disorders in nursing homes, adult homes, or facilities licensed under Article 31 of the Mental Hygiene law.
Individuals with eating disorders who require the provision of 24-hour medical supervision or nursing services may reside in a nursing home with specialized programs for eating disorders. The specialized program shall mean discrete beds or a unit with a planned combination of services designed to serve individuals with eating disorders who cannot be served in a less restrictive setting. The program shall provide the medical services of the nursing home and also the services required under Guidelines 3 and 4, as indicated in the service plan. The specialized program for eating disorders shall be located in a separate nursing unit or group of beds that are specifically designated for individuals with eating disorders.
The facility shall develop written admissions criteria to be applied prospectively for individuals with eating disorders. The facility shall have a written agreement with an acute care hospital licensed under Article 28 of the Public Health Law and an inpatient psychiatric facility licensed under the Mental Hygiene Law to provide for inpatient admission and consultative services as needed. A proposed discharge plan shall be developed within 5 days of admission as part of the overall care plan and will include input from all professionals caring for the resident, as was as the resident and their family. When the interdisciplinary care team determines that discharge of the resident to another facility or community based program is appropriate, the discharge plan will be implemented. Program staff shall be available post-discharge to act as a continuing resource to the individual and their family. With regard to individuals with eating disorders under 18 years of age, the facility must assure that the child receives an appropriate education in compliance with state and federal mandates.
For individuals with eating disorders who do not require 24 hour medical supervision or nursing services, existing adult homes and enriched housing facilities under Section 416(b) of the Social Service Law will provide a dedicated unit or beds including residential care, room, board, housekeeping, personal care, activities and supervision to individuals under eighteen as well as over eighteen years of age. Such residential care programs will include monitoring of attendance and supervision of meals by licensed dietary personnel and medication management by licensed nursing professionals. Activities at a minimum of ten hours per week will be relevant for individuals with eating disorders and include monitoring of such activities. Applications for new adult care facilities must meet these requirements and will be considered by the Department. Any requests for waiver of regulations must be included in the application and are subject to the approval of the Commissioner.
All residences must maintain clinical relationships with the Comprehensive Care Center for Eating Disorders.
To ensure that each person is provided quality care, all providers, directly employed by or affiliated with the Comprehensive Care Center for Eating Disorders, must have appropriate licensure and be in good standing with the State of New York. Affiliations with the Academy for Eating Disorders and other professional affiliations are assets.
A Comprehensive Care Center for Eating Disorders must employ a full-time Director, either a physician or psychiatrist, with at least five years direct experience in treating individuals with eating disorders. Centers must employ or contract with sufficient medical professionals with demonstrated clinical experience and training in the treatment of eating disorders to provide appropriate care for the client load of the Center. Mental health professionals conducting therapy will be psychologists or master level certified social workers. Mental health professionals will have specialized training in treatment modalities, for example therapists should have training in cognitive behavioral therapy, family therapy and other psychotherapies used in the treatment of eating disorders. All professional staff will obtain a minimum of 24 continuing medical education or applicable professional education credits annually in the subject area of eating disorders or other significant co-morbidities.