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When were you there: December 2009 – January 2010; about a month

Describe the average day: starts at 8am, free time while they do everyone’s vitals, breakfast, groups, snack, group, lunch, groups, leave at 3.

What were meals like? There’s a really small table that you sit at when you first get there, and the nutritionist sits with you and monitors your intake, etc. Once you’ve eaten 100% of meals and snacks for a day (or 2 meals and a snack in a row, so it could be like lunch one day and then breakfast and snack the next), you move to unsupervised starting the next meal after that. You drink 12oz of water per meal unless you have juice, which come in 4oz containers. (The most juice you can have is 2.) You can always ask for more water unless you’re obviously being disordered about it. Also, you get 2 “trade-ins” so if you choose something you don’t like or if you can’t eat something and don’t want to supplement you can trade out… but you’re basically stuck with whatever the nutritionist has lying around in the kitchen.

Don’t think the nutritionist isn’t still watching your behavior. She is. One day I was at the far end of the unsupervised table (away from the nutritionist) and I was having a hard day so I was cutting my pasta really small. The next day I was still unsupervised, but I was seated like right next to supervised. They watch.

What sorts of food were available or served? It was off the hospital menu, so it was basic. There were things that you can order every day: grilled cheese, hot dogs, pizza, pasta, grilled chicken, etc. and then there were daily specials. A lot of it wasn’t too bad. The juice is always frozen in the winter, though.
Snacks were mostly Nature Valley, fruit, granola, juice, yogurt, stuff like that.
Then there was “list day” on Tuesday… for snack you had to pick something off a list the nutritionist keeps. It was mostly “fear foods” like cookies, chips, etc.
Occasionally they did “surprise day” where you left a couple of exchanges off your menu and the nutritionist picked some “fear food” that was the same for everybody. They say it’s usually take-out or something, but it only happened once when I was there and it was this gross chocolate cake from the hospital menu. If you don’t remind them they usually forget all about it.

Did they supplement? How did that system work?
You could do Carnation instant breakfast as all or part of your breakfast. If you can’t finish a meal, they let you do Ensure and it’s only what you don’t finish… the nutritionist estimates it. I did it once and I’d say her estimation was pretty fair.

What privelages are allowed? It’s all PHP/IOP… they do walks outside in the spring, apparently, but I was there in winter. The only “privilege” I got was being able to go to blood labs (once a week) in the tunnels so we didn’t have to go outside. You can have phones, iPods or books, people also knit a lot, and unless you’re doing/reading something blatantly disordered, they generally don’t care. You’re technically not supposed to chew gum, but the girls and I passed it around blatantly and they didn’t say much.

Does it work on a level system? The levels are PHP vs. IOP which is more based on how sick you are… although I was normal weight and PHP so I have no idea what their criteria is.

What sort of groups do they have? They have “community meetings” on Thursdays where they basically tell us anything unusual going on (i.e. snow cancellations, not like illness stuff). Then there’s art therapy on Mondays, psychotherapy, nutrition, meditation, the regular stuff. And you meet individually with your “case manager” (one of the two RNs who handle all the cases) once a week, or more if needed. They also do family meetings sometimes.

What was your favorite group? I loved art therapy! Elaine, one of the RNs, runs it and she’s the coolest and the most understanding one there.

What did you like the most? I had a GREAT group of girls there with me, so that helped. I also liked that if you were struggling you could go meet with a case manager on down time, their doors were open a lot.
Also, at discharge you do a “rock ceremony” where Elaine, the RN, picks out a gemstone for you based on what the stone does, and you pass the stone around and give the person leaving advice/well wishes. It’s really sweet and supportive.

What did you like the least? There’s no therapist on staff at all. The group modality is nice, but individual therapy is so necessary for eating disorders, so if your insurance won’t pay for both (or won’t pay for your individual therapy while you’re there) you’re basically screwed in terms of having an OP therapist. Even my therapist had to make a case for why she should still be allowed to see me… IOL should really have a therapist on staff to avoid this problem. (They have a psychiatrist who’s really nice, but she doesn’t have the time or resources to do real talk therapy, and last I heard she was only on the unit part of the day three days a week.) Also, the RNs are really nice, but the nutritionist (Carrie) isn’t trained in psychology and she doesn’t seem to care whether patients can psychologically handle her meal plans or recovery in general. She’s not very sensitive, I went to my case manager a lot crying about things she said to me. She basically made me cry on my first day.
Also, a little thing: they have staff meetings at least once a week right after lunch (it might have been every day, I can’t remember) and that’s the hour the bathroom is locked… so if you can’t even use it on supervision during that time, which sucks because they make you drink so much water.
The other thing is you make all your menus on Wednesdays and give them to the nutritionist, and she has to send them over to the main hospital for the entire week. So you don’t really get the experience of practicing making immediate food choices, if that makes sense–except for snack, all your meals are predetermined by what you thought you wanted the previous week. I’m sure it’s like this at a lot of places though, if not most.

Would you recommend this program? Yes — BUT only for people who only need the PHP/IOP level. Do NOT do this program (or any PHP in general) if you really should be in residential or inpatient. I was there when my insurance was ready to pay for res (and they don’t just do that if they don’t have to)–I wasn’t technically AMA, but I really needed res at that point, and because of that I don’t think IOL was as effective as it could have been.

What level of activity or exercise was allowed? Technically none… it was on the honor system, but if you admitted to it (which the people who wanted to get better did) you were considered to be noncompliant.

What did people do on weekends? went home

Do you get to know your weight? I mean, again, people go home on nights and weekend so you can easily find out yourself, but they’d never tell you and they won’t confirm your guesses. They don’t try to deny that you’re gaining though–I asked if I was gaining and they were honest with me about it.

How fast is the weight gain process? It really depends on how compliant you are at home, but it’ll take them about a week to figure out if you’re not, even if you’re lying, and then you go up to res anyway. If you comply I’d say 1-2 pounds a week, but of course it’s faster in the beginning when your metabolism is kicking in.

What was the average length of stay? 4-6 weeks, I was there for 6. If you start at PHP level and drop to IOP it can be longer. (IOP there is a meal–snack doesn’t count–and 2 groups I think.)

What was the average age range? It’s pretty centered around teenagers, but when I was there the full range was pre-teen to older adults. It’s all women.

What kind of aftercare do they provide? Do they help you set up an OP treatment team?
They recommend therapists and nutritionists in your area, but if you already have one, they respect who you have. The IOL nutritionist will sometimes call whatever nutritionist you choose or the one you already have to discuss meal plans and make arrangements.

How many IP beds? How many patients in PHP or IOP? There’s no IP, I’ve heard PHP/IOP can go to 20, but when I was there, they were trying to keep it around 10-12.