Evidence-Based Treatment
Cost-Effective Care
Interdisciplinary Care
Individualized Services
Services across the Developmental Spectrum
Emphasis on Family Involvement

Evidence-Based Treatment.
Therapy is guided by a cognitive-behavioral model that integrates family and interpersonal therapy, applied in an individualized manner. The approach to treatment has been the subject of numerous scientific publications and presentations over the past 25 years. Many of these principles have been described in the Handbook for Treatments for Eating Disorders, edited by D.M. Garner & P.E. Garfinkel (1997), New York: Guilford Press. The RCC programs are grounded in evidence-based practice that involves improving clinical effectiveness by evaluating therapeutic outcomes using well-established measures of change (Margison, et al. 2000). Data are collected prospectively using standardized measures that can be used as a benchmark for progress and to determine outcomes. Patient evaluations of treatment are also part of routine assessment and are used to assess the effective components of treatment as well as evaluate therapists for the purpose of remedying deficits and adding new skills. Centre Syracuse is dedicated to studying therapy the way that it is delivered in clinical practice. This means that evidence-based treatments are routinely modified to meet the individual needs of each patient. Following the recommendations for practice-based evaluation (Margison et al., 2000), resources have been directed toward generating graphical measures of clinical change as a tool for clinicians and patients to evaluate progress. Finally, Centre Syracuse is developing a practice research network infrastructure that links with other centers using common data-collection procedures. This will result in the generation of a large multi-center database that ultimately should be able to allow much better predication outcomes at the level of the individual case.

Cost-Effective Care.
The Centre Syracuse Partial Hospitalization Treatment Program has been designed to be sufficiently economical that three months of highly specialized treatment can be provided for about the same overall costs as 10-14 days of inpatient treatment. This is because the Partial Program provides therapeutic services similar to inpatient programs; however, costly overnight stays are avoided or provided at minimal costs in an independent living setting. Moreover, treatment is 5 days a week rather than 7 days a week, and this translates into considerable savings during the course of treatment (a 20 day rather than a 30 day month). Figure 1 provides a cost comparison between one month of the RCC partial hospitalization program versus inpatient hospitalization at the typical rates of $1,000, $1,500 and $2,000 per day. Figure 2 provides the same cost comparison for 10 weeks of treatment.

Figure 1

Figure 2

The forgoing discussion is not meant to imply that hospitalization is not necessary for a small subgroup of those suffering from serious eating disorders. However, as has been shown over the past 10 years at the River Centre Clinic Program, in most cases, effective treatment does not require very costly and highly restrictive inpatient treatment.

Interdisciplinary care:
Eating Disorders are complex health problems. Optimal assessment and treatment requires an interdisciplinary team, whose members are specifically trained and highly skilled in the management of the full spectrum of these disorders. The staff at Centre Syracuse includes an experienced psychiatrist, family practice physicians, a registered nurse, psychologists, social workers, a registered dietitian, Master’s level therapists, and mental health workers. Consultants in the community include other areas of medicine such as cardiology, endocrinology and internal medicine.

Individualized services:
Centre Syracuse Partial Hospitalization program provides comprehensive, coordinated services provided by a highly-skilled professional team to ensure consistency in our approach to eating disorders. Specific treatment protocols are followed, but are adapted to meet the unique needs of individual patients. Therefore, an individualized treatment plan based on a comprehensive assessment, and grounded in evidence-based treatment protocols and principles, is developed for each patient. This plan is continually revised, based on changes that occur during treatment. It actively encourages the participation of patients as well as family members who also need individualized services, within the confines of our treatment protocols.

Services across the Developmental Spectrum.
Our program has not been in operation long enough to provide reliable data on age representation of patients seeking care. However, the River Centre Clinic is serving as a model for the Centre Syracuse treatment program and the RCC has collected data on more than 700 patients since 1997. Of these, 36.3% have been under 18 years of age, 38.2% have been 18-24 years old, 15.8% have been 25-34 years old, and 9.7% have been 35 or older. Approximately 12.2% have been 14-years old or younger. (Table 2) Thus, the RCC has adapted treatment to serve patients across the age spectrum.


Emphasis on Family Involvement.
There are ethical, financial and practical grounds for including parents in treatment of younger patients. The approach used at Centre Syracuse emphasizes family therapy as one of the cornerstones of treatment (Garner et al. 1997) and is required for almost all program participants who are under the age of 18 or who are living at home. From a strictly practical point of view, parents or guardians are legally responsible for the patient's well being. Moreover, parents have the potential to provide powerful directives in support of therapeutic goals. From a theoretical perspective, the interaction between the patient's thinking, feeling, and behavior and family members is usually so salient that it compels family involvement. We are committed to providing family services for patients who suffer from eating disorders.