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Program Outcomes

At Oliver-Pyatt Centers we believe the effectiveness of a program should not only be measured by how helpful and satisfied clients report their experience to be, but also by measurable and meaningful changes in clinical symptomatology and weight. To that point, we conducted a study that demonstrated statistically significant weight gain in our patients with Anorexia Nervosa treated in our residential level of care (LOC), with over 90% of them achieving weight restoration by discharge, defined by a body mass index (BMI) greater than 18.0.

While weight restoration is an essential measure of treatment outcome, effective treatments must also address the core psychological and behavioral symptoms of eating disorders and the impact they have on our patients’ lives. We conducted another study that examined symptom change in a subset of patients who participated in our residential and / or partial hospitalization program LOC. Importantly, this sample included patients with a diagnosis of Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and other / unspecified eating disorder. Our data analysis revealed clinically and statistically significant symptom reduction (depression and eating disorder symptoms) and improved quality of life from admission to discharge.

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Dr. Tim Brewerton is a Senior Advisor for Oliver-Pyatt Centers and a Co-Principal Investigator as approved by the Institutional Review Board, which ensures our research is conducted in accordance with all federal, institutional and ethical guidelines. Dr. Brewerton consults with our clinical leadership team on our research and outcome assessment protocols. A specialist and recognized expert on  trauma and substance abuse, Dr Brewerton also provides supervision to clinicians trained in Cognitive Processing Therapy and consults with us on developing and enriching our treatment programming for our clients with complex co-occurring presentations.

While weight restoration is an essential measure of treatment outcome, effective treatments must also address the core psychological and behavioral symptoms of eating disorders and the impact they have on our patients’ lives. We conducted another study that examined symptom change in a subset of patients who participated in our residential and / or partial hospitalization program LOC. Importantly, this sample included patients with a diagnosis of Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and other / unspecified eating disorder. Our data analysis revealed clinically and statistically significant symptom reduction (depression and eating disorder symptoms) and improved quality of life from admission to discharge.

In addition to sharing these preliminary findings below, we also discuss the state-of-the-art research program we are in the process of developing.

2018 Oliver-Pyatt Centers Research Findings

 

In 2018 Oliver-Pyatt Centers (OPC) began a comprehensive research study, approved by an Institutional Review Board, in order to assess treatment outcomes in our Residential, PHP and IOP levels of care. Specifically, patients who consent to participate in our research study complete a series of questionnaires upon admission, transfer to a new level of care (stepping up or down), as well as upon discharge from the program. Additionally, we obtain follow-up data for patients who consent at specified time-points after their discharge. The surveys administered represent the gold standard of assessments for eating disorder pathology as well as depression, anxiety and trauma. 

The purpose of these questionnaires is multifaceted. Primarily, it represents our commitment to personalized treatment planning. This data provides a snapshot of each patient’s distinctive symptom presentation on measures of eating disorder symptoms, depression, anxiety, functional impairment, and trauma reactivity. This information deepens our understanding of the clinical challenges specific to each patient and as a roadmap for exploration of the factors that may be maintaining the eating disorder. Data guides the clinical teams in developing a shared language for each patient’s experience, to build engagement and design more effective treatment plans.

In addition to guiding treatment planning, this data allows leadership at OPC to track program effectiveness and identify areas for program development. As a company, we are continually evaluating whether we are providing the most effective and evidence-based interventions to our patients. Last, this data is collected with the hope and expectation of contributing to a growing body of research and helping the field of eating disorders continue to move forward.

Sample

The patient sample for 2018 included data for 99 residential stays, 95 PHP stays and 46 IOP stays.

The average length of stay in residential was 41.32 days, 35.1 days for PHP and 22.78 days for IOP.

Our Residential sample included patients with the following Eating Disorder diagnoses: 29.3% Anorexia Nervosa, Restricting Type, 26.1% Anorexia Nervosa, Binge/Purge Type, 32.6% Bulimia Nervosa, 5.4% ARFID, 4.3% Binge Eating Disorder and 2.2% OSFED.

Our PHP sample included patients with the following Eating Disorder diagnoses: 33% Anorexia Nervosa, Restricting Type, 29.5% Bulimia Nervosa, 17.9% Anorexia Nervosa, Binge/Purge Type, 7.4% ARFID, 6.3 % OSFED and 5% Binge Eating Disorder.

Last, the IOP sample included patients with the following Eating Disorder diagnoses: 39.1% Anorexia Nervosa, Restricting Type, 23.9% Bulimia Nervosa, 21.7% Anorexia Nervosa, Binge/Purge Type, 4.3% ARFID, 8.7 % OSFED and 2.2% Binge Eating Disorder.

Importantly, this group of patients from all levels of care also presented with multiple co-morbidities. For example, across all levels of care approximately 85% were diagnosed with an anxiety disorder and over 75% were diagnosed with a mood disorder.

Weight Changes Data in Patients with Anorexia Nervosa at the Residential Level of Care

Overall, results demonstrate significant weight gain in our patients with Anorexia Nervosa at the residential level of care.

The average BMI of female adult patients with AN, restricting type admitting to residential care at Oliver-Pyatt Centers was 17.61. The average BMI at discharge was 20.24.

The average gain in weight at the Residential level of care was 13.44 pounds for clients admitting with a diagnosis of Anorexia Nervosa. This gain is a statistically significant change, t (47)= -8.774, p= .0000.

Ninety percent of our adult female patients with Anorexia Nervosa restored their weight to a BMI ≥ 18.5 by the time of discharge from our Residential level of care and 83% restored their weight to a BMI ≥ 19.

On average, all patients (regardless of diagnosis) experienced a BMI increase of 1.75 in OPC’s residential program. These results demonstrate a statistically significant increase in BMI for our patients from admission to discharge, t(85) = -9.58, p =0.000.

Last, patients diagnosed with Anorexia Nervosa, Restricting Type experienced an average BMI increase of 2.63 in residential care. This change represents a statistically significant increase in BMI from admission to discharge, t(25)=-7.727, p<0.000.

Eating Disorder Symptoms

Eating Disorder Symptoms were measured using the Eating Disorder Examination Questionnaire (EDE-Q), a 28-item, self-report measure assessing the core features of eating disorder psychopathology. It is the gold-standard self-report assessment that has demonstrated reliability, validity and correlation with the lengthier assessments of eating disorder symptomology. This assessment tool measures a range of symptoms including fear of weight gain, self-induced vomiting, and loss of control with food, thus capturing the complexity and unique features of each individual’s eating disorder. 

Results indicate that patients experienced clinically and statistically significant reductions in eating disorder symptoms over the course of treatment in the Residential, PHP and IOP levels of care on nearly all scales.

On average, patients presented at admission with severe eating disorder symptoms relative to female community norms. Upon discharge, average patient scores on the EDE-Q were consistent with community norms, suggesting clinically significant improvements. The graphs below provides mean admission and discharge scores at OPC in comparison with community norms.

Eating Disorder Inventory (EDI-2) – Adults and Adolescents

Eating disorder symptomology is also assessed using The Eating Disorder Inventory (EDI-2). The EDI-2 is a self-report measure of symptoms frequently related to anorexia nervosa or bulimia nervosa. This measure was designed to be an aid to forming a diagnosis and not as the exclusive basis for making a diagnosis. It is extremely valuable in guiding treatment planning and clinical work. The EDI-2 provides information regarding the psychological and behavioral dimensions of eating disorders. It has 91 items and 11 subscales. The subscales and a brief description of what they measure are as follows:

  1. Drive for thinness (DT): an excessive concern with dieting, preoccupation with weight, and fear of weight gain.
  2. Bulimia: episodes of binge eating and purging.
  3. Body dissatisfaction: not being satisfied with one’s physical appearance.
  4. Ineffectiveness: assesses feelings of inadequacy, insecurity, worthlessness and having no control over their lives.
  5. Perfectionism: not being satisfied with anything less than perfection.
  6. Interpersonal distrust: reluctance to form close relationships.
  7. Interoceptive awareness: the ability to discriminate between sensations and feelings, such as hunger and satiety.
  8. Maturity fears: the fear of facing the demands of adult life.
  9. Ascetism: reflects a tendency to find value in self-deprivation, as well as denial and control of feelings, wants, desires, and urges.
  10. Impulse Regulation: the ability to regulate impulsive behavior, especially binge behavior.
  11. Social Insecurity: estimates social fears and insecurity.

Results indicate that patients in Residential demonstrated statistically significant reductions at the p ≤ .01 level on all 11 subscales on the EDI-2. In PHP,  results indicate statistically significant reductions at the p ≤ .01  or p ≤ .05 level with the exception of ascetism.  In IOP, scores demonstrated statistically significant reductions in symptoms for the following domains: ascetism, bulimia, interoceptive awareness, ineffectiveness and perfectionism.

Below see graphs for the Residential and PHP levels of care comparing admission and transfer/discharge scores to those of female college students as well as sample of individuals diagnosed with an eating disorder. Of note, in order to most accurately compare our patients’ scores with the EDI-2 eating disorder norming sample, we did not include patients diagnosed with ARFID or BED in these specific analyses.

Below see graphs for the PHP level of care comparing admission and transfer/discharge scores to those of female college students as well as other a sample of individuals with eating disorders. Of note, in order to most accurately compare our patients’ scores with the EDI-2 eating disorder norming sample, we did not include patients diagnosed with ARFID or BED in these specific analyses.

Depression and Anxiety

Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9), a nine-item tool used for screening and measuring the severity of depression.

Overall, results show clinically and statistically significant depression symptom reduction across levels of care. On average, scores on the PHQ-9 indicated patients admitted to the Residential Level of Care with “moderately severe” symptoms of depression and reported “mild” symptoms upon discharge. At the PHP level of care, patients reported on average “moderate” symptoms of depression at the time of admission and reported “mild” symptoms of depression upon discharge. On average, patients admitted to IOP with self-reported “mild symptoms of depression and discharged with “mild” symptoms of depression. The graph below represents changes in depression scores at the Residential and PHP levels of care.

Symptoms of anxiety were measured using the State-Trait Anxiety Inventory (STAI), a 40 item self-report measure of anxiety. This tool assesses the temporary state of feeling anxious as well as anxiety as a more general and long-standing quality.  Scores indicated that patients in both the Residential and PHP levels of care demonstrated statistically significant reductions in both state and trait anxiety from admission to discharge. In IOP, scores demonstrated statistically significant reduction in state anxiety from admission to discharge.

Posttraumatic Stress Disorder (PTSD)

OPC has also been systematically assessing for the presence and severity of PTSD and its symptoms.  The presence of significant life events that either happened to an individual or was witnessed (Criterion A) was recorded after admission using the Life Events Checklist for DSM-5 (LEC-5), and in addition, other PTSD symptoms were assessed at admission and discharge using the PTSD Symptom Checklist for DSM-5 (PCL-5) (Criteria B-E). Data have been collected and are in the process of being analyzed. However, preliminary results indicate that 49% of individuals admitted to OPC Residential care met criteria for PTSD.

Treatment of PTSD and Complex PTSD

OPC has developed an integrated treatment program to properly assess and treat the high rates of severe trauma, PTSD, dissociation, and related comorbidity that often accompanies EDs, especially those who have not responded to outpatient care. Trauma and PTSD are known factors that can often lead to treatment dropout or failure. In concert with expert consultation, OPC has trained its psychotherapy staff to utilize and integrate Cognitive Processing Therapy (CPT) into the overall, individualized and integrated treatment plan for such patients.

Oliver-Pyatt Centers is grounded in mindfulness and the belief that each person has the capacity for a mindful relationship with food and their body. Present in every aspect of our program, this philosophy encompasses nutrition and eating, as well as movement, with an emphasis on becoming free from negative habits, behaviors and rigidity. We work from a place of empathy and wisdom, using a medically grounded, psychologically gentle approach.

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Oliver-Pyatt Centers

6100 SW 76th Street
Miami, Florida 33143

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