About 10 months ago, I was once giving a presentation to about 10 therapists, psychologists and doctors at Stanford’s Vaden Health Center. Vaden is the health center for Stanford’s students to use while at school. During a presentation about Bright Heart Health, a female in attendance said, “what evidence-based practices are you using?”
I felt confident this was an easy question. A softball question. My colleague chimed in,“CBT, DBT, and some other techniques.” Not satisfied, the individual asked another question “how are you measuring your outcomes and can you describe your quality program.” I thought “RED ALARM, RED ALARM.” I looked at my colleague with a look of “whatever you say, I don’t think it will meet her expectations.”
Thankfully, the conversation led to a deep discussion and partnership, as well as a study on outcomes. As we, Bright Heart Health, have began working on this study, I am surprised at the rigor and detail required. Then I reflected on my past and realized, after overseeing 160+ eating disorder and substance abuse programs across the United States, not one of them had the knowledge, focus, or perseverance to develop a truly quality program. This realization shocked me. After all, this is the most important criteria patients would consider when choosing a program.
With Stanford, our Quality Program is built on evidence-based practices, using the latest research and technology.Lois Zsarnay, Clinical Director
As I field calls from patients, doctors, therapists, and family members, the most frequently asked question is about the quality of the program. It’s asked in many different ways, sometimes directly and sometimes indirectly. However, it is always asked. I would argue this question is asked more often than “how much does it cost”. After all, who wants to go to a shabby program? Who wants a subpar healthcare experience? Moreover, who wants average? If you were to evaluate your doctor, would he or she be average? Would they even be just above average? No way. Not on your life, or you don’t go to them again.
The one universal truth in healthcare, held by all individuals, is that they want to be treated by the best. If not the top, at least highly competent and qualified. Not average. But, how to gauge quality is a bit of a mystery?
Ask yourself how you would gauge quality?
When we asked this question of ourselves, we agreed on one thing “do our patients get better compared to other treatment programs?” The goal is health. Health is the problem, and healthy is the goal of all patients. Therefore, we wanted to ensure patients of Bright Heart have the highest success of reaching a healthy outcome than other treatment options.
In treating eating disorders, we have more to consider than just the staff on our team. We follow a program over 10 weeks and use multiple treatments. Our measures of quality, therefore, need to account for staff and our treatments.
In addition, we had to find a way to evaluate success, and identify areas of improvement.
To lead the world in treatment quality, it begins and ends with technology.Dr. Vicki Berkus
Therefore, for us to develop a quality program, we focused on three (3) items.
1. Technology
2. Staff
3. Treatments
To create an exceptional program, the best in the world, we needed to track our patients, track the care provided, track the professionals providing the care, and analyze the results.
This efforts is visible to all patients once they begin our program. On a weekly basis, our clients are evaluating and assessing their behaviors, the staff, and treatments. Our team analyzes this data to measure progress and identify improvements. The information informs our team, identifies areas of intervention, and illustrates areas of progress. Information also incents clients as they can witness the progress.
Through technology, quality begins and ends.
Eating Disorder Treatments can vary by therapist, program and geographically. However, data shows CBT and DBT have the strongest evidence leading to lasting recovery. Often, we will hear programs mention CBT and DBT, however, interpretation of the treatments varies widely. Thus, the treatments are affected by the therapist providing the treatment as much as the understanding of the treatment. The tool and the hand using the tool are inseparable.
One caveat to this is the consistency of the tool. Just like different screwdrivers are used for different screws, one must be sure the same screwdriver is used for the same screw. Thus, a curriculum outlining the program, setting forth the goals, activities and measurable outcomes is required.
A simple way to measure the quality of a program is to ask to view the curriculum. If the curriculum is written, and specifies goals, activities and outcomes, you are assured they have spent time thoughtfully picking and choosing the treatments a patient should get in the program.
Just as the treatments should be well documented, staff should be well chosen. Experienced staff is a must. But a focus on skillsets of the staff is also a must. Unless first agreed to, I don’t think anyone wants to have an intern guide their care unless first disclosed and agreed. In addition, having a couples therapist may not be best suited to an eating disorder patient. Simple questions around what evidenced-based treatments has the therapist studied or been certified illuminates their experience or lack of in treating eating disorder.
As we work to create the best program, we encourage professionals to use these experiences to improve their programs. Further, we encourage individuals considering a eating disorder treatment to ask questions so they may gauge the quality of the program. Ask providers to explain their quality program, ask to see their curriculum, ask about staff qualifications specific to CBT, DBT, and years of experience working with eating disorders.
Better therapy, better treatment, and better outcomes require detailed data analysis, measurement, detailed programming, and qualified staff. Your health, your loved-ones health, or your client’s health depends on it.
Jonathan Ciampi
President
Bright Heart Health