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Change in clinical model stirs controversy among Emily Program clients

This month, a number of long-term outpatient clients of The Emily Program, a St. Paul-based comprehensive eating disorder treatment program with locations in Minnesota, Ohio, Pennsylvania and Washington, were surprised to learn that their behavioral health treatment would be transferred to outside providers by Jan. 2, 2018.  

The decision, part of a new clinical model that will launch at The Emily Program in 2018, left many clients feeling abandoned and adrift. They took to social media, overwhelming the program’s Facebook page with their concerns that the change had to do more with financial priorities raised by Emily Program investor Triple Tree than with supporting the health of clients, many of whom could face serious health consequences if abruptly cut off from psychiatric care.

These Emily Program clients wanted to make sure that the public heard their concerns, so they reached out to the media. I spoke with one such client Monday night who asked that her name not be used, but expressed serious concerns about the impact that these changes could have on her own eating disorder treatment and on other clients in similar situations.

Because I wanted to hear what Emily Program officials had to say about the anxieties stirred by these changes to their clinical model and about their reasons for enacting them, I called Jillian Croll Lampert, Emily Program chief strategy officer.  Here’s what she had to say:

MinnPost: A lot of current and former Emily Program clients are expressing concern on social media that they are being abruptly cut from their treatment plans and forced to find new behavioral health providers. Many have speculated this program change — and your program’s partnership with Triple Tree — is financially based. Is this true?

Jillian Croll Lampert: These changes are not being driven at all by financial measures. That’s all rumor and speculation. This partnership is not new. We have worked with our financial partners at Triple Tree for years. The people at Triple Tree believe in the mission of The Emily Program and they support what we do. That’s why they got  involved with us in the first place.

There is a lot of speculation on social media sites. We understand that the changes people are experiencing feel frustrating and difficult — we absolutely do. But these changes are not being driven from financial need. They really are driven by the need to support the latest evidence-based research on eating disorder treatment while still providing the same quality of treatment that we’ve been providing since we opened in 1993. Our goal is to keep up with the latest science and practice. We want to provide the best and most effective services possible for our clients.

MP: So how do these changes at The Emily Program reflect the latest research on effective eating disorder treatment?

JCL: In a lot of ways what we are doing starting in January is very similar to what we‘ve always done. In some ways it is better. We’re incorporating the science around effective eating disorder treatment and recalibrating our treatment model to better reflect the science.

Jillian Croll Lampert
Jillian Croll Lampert

What we’re implementing is this concept of a strong, individualized assessment of each client’s needs. Our clinicians are conducting thoughtful reviews of their case lists, saying, “Of the clients I see now, who needs what? Who’s best served by more or less at The Emily Program? Who will be best served by something or someone else?” Some of our clients have primary non-eating-disorder behavioral health needs. We’re thinking about how those needs can be best served. In some cases that’s not by us. We’re really good at eating disorder treatment, but there are other conditions that aren’t our best expertise. We want to partner with community-based providers that are best qualified to treat those other concerns.

MP: How many of your patients will be impacted by this change?

JCL: A small percentage, or about 5 percent, of our population is people in long-term outpatient care. Some of those clients are people who have primary non-eating-disorder behavioral health needs. We want to do everything we can to facilitate a referral to the best provider that will meet their behavioral health needs. We realize that mental health treatment isn’t always linear. If an individual who has transferred to another provider relapses with their eating disorder, they can come in and out of The Emily Program for intensive treatment. This in no way shuts the doors. What it does is tailor the recommendations so that more people are getting access to the intensive eating disorder treatment they so desperately need. 

It might not feel like that to the people who are hearing, “We think you’d be best served by something else.” That’s difficult for people to hear, and I understand that we’re suggesting a change that could feel sudden or traumatic, particularly if someone has been with The Emily Program for a long time. We understand that that’s a big change, we really do. But we are simply trying to provide the best care for each person based on what they truly need. 

MP: It almost sounds like you are trying to encourage more of your clients in long-term treatment to discover a new level of independence. 

JCL: If you take the broad view of the last 25 years, The Emily Program grew up as an outpatient program with extra care wrapped around inpatient services. This new approach seamlessly wraps around the patient, providing a higher level of care and access to ease people through the process of moving on to the next level of independent behavioral health treatment. Our goal is to provide specialty intensive eating disorder treatment services that are more closely in tune with the needs of the individual. This approach will maximize our ability to serve the large population of people that need eating disorder treatment.

MP: How large of a population are you talking about?

JCL: Right now, The Emily Program treats a little over 5,000 people across the country. Some 30 million Americans are going to experience an eating disorder in their lifetime. In Minnesota alone, 180,000 people are struggling with an eating disorder right now. We are trying to maximize our ability to make a difference, to help as many individuals as possible heal from an eating disorder. That’s what drives our work every day. That’s why we get up in the morning. We want to serve families better, to increase access to care and defeat stigma around eating disorders that creates barriers to care. We think this approach will help with that.

I want to emphasize that this is not a cost-cutting measure. I understand that people go there right away in this health-care environment. There are so many factors influencing health care decisions. The news continues to be full of health care reform. We think about that all of the time and try to maximize our ability to work within that system. That’s always there. But this set of changes is really about stepping back and saying, “We really do provide a scarce resource.” There are about 300 programs that treat eating disorders in the whole country, outpatient to inpatient. We are one of the largest programs. If you compare that to an illness that has a similar prevalence rate, there would be 300 resources in a state rather than just 300 in a country.  We provide this scarce recourse. We want to get it to the most people. 

MP: The way you describe it, it sounds sort of like a cakewalk: When the music stops, everyone has to find a chair, but the reality is there aren’t enough chairs for everyone.

JCL: I think there’s a strong element of truth in that description. But maybe a better description is a cakewalk where some people are marching to a different song than everybody else is. We want to make sure those people are at the right cakewalk.

We don’t want people to be on a waiting list to access treatment when they are acutely ill. This change will help us to have more of a flow through the program to allow people with higher-acuity needs to get the care they need.

MP: What I’m hearing is a lot of serious concern that clients are going to be out on the streets without the mental health care they need to stay healthy and alive. How do you respond to that concern?

JCL: I understand the anxiety. Change is hard for everybody. But the concern I hear in social media that people are going to be out on the streets and instantly cut off from treatment is not true. That’s not going to happen. Our providers will work with clients to identify where the recommended services can be accessed within the client’s parameters of what they need. The transition to outside services is going to happen over a minimum of 30 days.

People with eating disorders tend to be a very thoughtful, very attentive, concerned group of people. There are so many people who work here that have had eating disorders. I’m one of them. We get it. We really do. We understand how it feels to face change, for whatever it’s worth. We really put that perspective into this evolution of our treatment model. We are working to provide the best model of eating disorder care for all of our clients. We believe that our treatments should be evolving with the science.  

MP: So you’re saying that these changes will make sure that The Emily Program’s treatment model is keeping up with the times?

JCL: That’s an important point. We expect treatment models to change with the times for other medical conditions: If we treated every medical condition today the same way that we did 10 years ago, the public wouldn’t be satisfied. We are keeping up with the times.

MP: Did your anticipate this kind of reaction when you planned on making these programmatic changes?

JCL: We expected a certain degree of anxiety when we decided to make these program changes.  But we do sincerely think that they will help people. A current staff person who works here who is public about the fact that she was once a client said to me yesterday, “I’ve been thinking about this response that we’ve been getting to our changes and I want to say that I think that if we would’ve had this model when I was sick, I would’ve gotten better faster. I 100 percent support this change.”

That side of the coin isn’t being heard much in the social media commentary. We expected people to be upset. But we also expect some people to be really happy. 

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