Services for Patients and Clients with Eating Disorders

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Policy Number:

UW-2109

Responsible Office:

University Health Services

University Policy

Rationale/​Purpose:

To ensure students with eating disorders (ED) receive coordinated, specialized, multi-disciplinary care appropriate to their level of severity. To define the role of University Health Services (UHS) in providing care, coordinating referrals to community providers, and responding to students requiring inpatient and/or residential treatment for eating disorders. To describe the UHS levels of care and eating disorder service functions.

Policy:

1. A student may access care for eating concerns by self-referral. Alternatively, they may be referred for evaluation by Housing staff, advisors, faculty/staff members, athletic coaches, concerned family or friends, or by the Division of Student Life.
2. Students entering UHS for management of eating concerns, whether through Mental Health or Medical Services, will be offered a comprehensive eating disorders assessment. This assessment may include a psychological/psychiatric evaluation, physical examination, and/or nutritional assessment and will determine the appropriate level of care for the student. Services available at UHS include short-term therapy, psychiatric consultation, fitness/wellness counseling, and long-term medical and nutritional management. Alternatively, CM services may be offered in lieu of the psychological evaluation if the student has has a diagnosis of an ED and needs more long-term and frequent therapy than can be offered at UHS.
3. The eating disorder service is a multidisciplinary team of mental health therapists, psychiatrists, nutritionists, physicians, advanced practice clinicians, nurses, care managers, and clinical trainees which meet to review cases, discuss treatment plans, develop UHS policies, provide staff education, and plan outreach and educational efforts on campus. UHS staff members seeking additional consultation regarding students with eating disorders are encouraged to present challenging cases at the regularly scheduled eating disorder case consult meetings. If the student is referred out for psychological services, the eating disorder service team will be available for consultation with UHS staff both on an individual basis and/or via eating disorder case consultation.
4. The University strives to provide necessary resources for students with eating disorders; however, at times the severity of the disorder may not be compatible with registered student status. This includes:
   1. A condition that poses a threat to the health of the student unless treated;
   2. a condition requiring intensive treatment that would interfere with academic activities;
   3. a condition with physical or mental effects that interfere with academic progress; or
   4. a condition that results in disruption of the student community by the affected student.
5. If it is determined the severity of a student’s disorder is not compatible with a continued student status,  the eating disorder service team will assist UHS clinicians in referring a student to the appropriate level of care and other appropriate actions based on the level of risk.(see III F) 

Appendix A

1. Level 5 (Emergency Referral)
   1. Interventions to assist students with severe ED who are medically or psychiatrically unstable to provide crisis case management and obtain an urgent referral to an appropriate higher level of care.
   2. Assessment at UHS, may include:
      1. Psychological
      2. Psychiatric
      3. Medical
      4. Nutritional
2. Level 4 (Community Referral)
   1. Interventions are designed to assist students with moderate to severe ED and/or long standing/chronic symptoms.
   2. Medically stable patients with chronic anorexia or bulimia nervosa.
   3. Assessment at UHS may include:
      1. Psychological
      2. Psychiatric
      3. Medical
      4. Nutritional
   4. Referral and transition to community mental health providers
   5. Medical/Nutritional management at UHS
3. Level 3 (Comprehensive Intervention)
   1. Interventions are designed to address the needs of students in the early stages of mild to moderate ED who are medically stable.
   2. Assessment at UHS, may include:
      1. Psychological
      2. Psychiatric
      3. Medical
      4. Nutritional
   3. Individual and/or Group Therapy at C&CS
   4. Medical/Nutritional management at UHS
4. Level 2 (Early Intervention)
   1. Interventions are designed to address body image concerns, weight preoccupation and abnormal eating patterns prior to the onset of a formal ED.
   2. Routine C&CS intake
   3. Referral for further UHS services as needed:
      1. Psychological
      2. Psychiatric
      3. Medical
      4. Nutritional
      5. Psycho-educational teaching
      6. Body Image Group
5. Level 1 (Self-Help/Peer Help Intervention)
   1. Designed as a primary prevention strategy. Concerns can be addressed by educational interventions including:
   2. Creation of ED brochure
   3. Creation of ED webpage
   4. Prevention Services
      1. UHS
      2. Fitness assessments
      3. Peer program
      4. Campus training programs
      5. Women’s Center
      6. House Fellow training in public and private dorms

Procedure:

1. Access to comprehensive disordered eating consultation is bidirectional. Mental Health staff can refer a student for a medical evaluation by contacting the medical services designee. Conversely, medical staff can directly refer a student for an eating disorder assessment on the medical floor without first needing to go through a Mental Health  access appointment.
2. A student diagnosed with or suspected to have an eating disorder will be assigned to a treatment plan based on the level of care applicable to the severity of the student’s eating disorder (see Appendix A).
3. Students requiring long-term therapy will receive extensive assistance locating community providers who will collaborate with medical and nutrition personnel at UHS. UHS mental health care managers will provide on-going support for acutely ill students and students returning to campus from a medical leave of absence. The cost of treatment outside of UHS is the student’s responsibility.
4. UHS providers will follow guidelines developed by the American Psychiatric Association (APA) in determining if outpatient treatment is appropriate. Findings that may indicate the need for inpatient treatment include, but are not limited to:
   1. Severe malnutrition-Weight < 70-75% of IBW for sex, height and age
   2. BMI<15
   3. Medical complications including electrolyte disturbance or cardiovascular instability
   4. Psychiatric instability
5. In the event that a student receiving mental health services from a community provider is deemed to be medically inappropriate for outpatient treatment, the UHS medical provider may consult with the UHS eating disorder service team to develop a treatment and intervention plan.
6. A student who develops medical or psychiatric complications that pose an immediate threat to their well-being will be referred for an urgent case conference by the members of the eating disorder service team, including a Medical Services designee and Mental Health designee. These referrals may be from other UHS providers or from university staff or faculty. This evaluation will assess the student’s immediate risk and may result in immediate hospitalization, inpatient treatment, and/or medical leave. Any involuntary admission will be based on standards of care that include safety to self and others or inability to care for oneself. The decision to hospitalize a student or involve the student’s family or the Office of Student Assistance and Support is done on a case-by-case basis. All efforts will be made to respect the student’s wishes, while at the same time adhering to the legal and ethical standards established to protect the student’s health and well-being. Students that are hospitalized will be assisted in obtaining resources and accessing supports on campus including leave of absence when necessary by the eating disorder service. 

Under these circumstances, UHS, in conjunction with the University, will facilitate referral for more intensive treatment. The University may pursue involuntary leave procedures with the goal of the student’s eventual return to the University.

External References:

Practice guideline for the treatment of patients with eating disorders (revision). American Psychiatric Association Work Group on Eating Disorders, The American Journal of Psychiatry; 2000 vol: 157 iss: 1 Suppl pg: 1 -39

Policy Administration

Approval Authority:

Associate Vice Chancellor & Executive Director, University Health Services

Policy Manager:

Associate Vice Chancellor & Executive Director, University Health Services

Contact:

Executive Assistant, University Health Services -- Pam Miller, pamela.miller@wisc.edu

Effective Date:

06-18-2018

Revised Dates:

06-01-2018

Reviewed Dates:

06/2018

Retrieved:

01-22-2025 00:04:03