Intensive Outpatient Program
Admission Criteria:
All of the following must be met:
- Must meet all Intensity of Service Criteria 1- 10.
- This service intensity is required to meet the essential health needs of the individual; and there is a reasonable expectation of reduction in behaviors/symptoms with treatment at this level of care.
- The individual has a documented primary diagnosis found in the Feeding and Eating Disorder section of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders which is the primary focus of active treatment each program day or has a diagnosis of Globus hystericus that has resulted in a documented micronutrient deficiency (e.g., scurvy) identified in labs or office visit, completed within the last six (6) weeks.
- Consistent in type, frequency, and duration of treatment with evidenced-based guidelines as determined by medical research.
- The individual is cognitively and emotionally capable of actively engaging in the treatment program. Cognitive and emotional symptoms are addressed throughout the program stay.
- The individual and/or guardian is expressing willingness to participate in treatment.
- The requested services do not duplicate other provided services.
- All of the following must be met:
A. A medical evaluation has been completed and includes assessment for neurological, metabolic and gastrointestinal disease, AND an evaluation performed to identify any structural or functional abnormalities (e.g., videofluorographic swallowing study).
B. Individual has a significant feeding disorder associated with a medical condition (e.g., failure to thrive, prematurity, neurological conditions, developmental disability, malabsorption or gastroesophageal reflux, gastrostomy tube, scurvy, globas hystericus).
C. Adequate treatment for any contributing underlying medical conditions, if present, has occurred without resolution of the feeding problem.
D. Individual has been unresponsive to initial outpatient treatment efforts by single discipline (e.g., occupational therapist, speech language therapist) over a 2-month period or deemed medically unstable to be treated in an outpatient program.
E. Meaningful improvement is expected from the therapy. The therapy is individualized, and there is documentation outlining quantifiable and attainable short and long-term treatment. The treatment plan includes targets of behavior modification for inappropriate feeding patterns, which will include supervised feedings and meals. Progress and barriers in gaining and utilizing skills is documented. The treatment includes a transition from one-to-one supervision to outpatient therapy on discharge.
F. Discharge planning is initiated on the day of admission. This should include coordination of care with individual's outpatient providers.
9. One of the following must be met:
A. Consumes less than 20% of nutritional needs by mouth.
B. Consumes less than 70% of nutritional needs with solid food by mouth and has high to moderate levels of inappropriate behavior during meals which interferes with the child obtaining sufficient calories, volume of fluids, and/or varieties of food to sustain the individual's growth and/or nutrition.
C. Weight for age is below the 5th percentile due to malnutrition.
D. Weight is < 80% of ideal weight for height-age.
E. Weight crosses more than two major percentiles downward, for example, going from the 90th percentile to the 25th (crossing the 75th and 50th).
F. Weight for height falls below the 10th percentile due to malnutrition.
G. Have been hospitalized in the last week to a pediatric hospital due to Globus symptom
H. Has a neurodevelopmental diagnosis and meets normal growth curve however demonstrates micronutrient deficiencies or unstable lab values (e.g. elevated lipids, elevated triglycerides, low iron, Vitamin D or C….)
10. The individual has documented symptoms and/or behaviors which create a significant functional impairment in at least two (2) of the following areas:
A. Primary support
B. Social/ interpersonal
C. Occupational / educational two
D. Health/medical complications.
