Treatment Overview
The Johns Hopkins Eating Disorders Program provides a full continuum of care for eating disorders. Levels of care include outpatient consultations, an outpatient clinic for ongoing care, and a fully integrated inpatient and day hospital (partial hospitalization) programs.
- If you are seeking an opinion regarding treatment, it is usually best to start with a full evaluation in our Outpatient and Consultation Clinic.
For Outpatient and Consultation services
Tracey Farrow, Outpatient Clinic Coordinator
Phone: 410-955-3863 Fax: 410-502-7907
E-mail: [email protected]
Directions - Prospective patients interested in our Inpatient Program or Partial Hospitalization Program can contact our admissions coordinator directly.
For Inpatient and Partial (Day) Hospital information
Lisa Smith, Admissions Coordinator|
Phone: 410-955-5114, Fax: 410-955-6155
E-mail: [email protected]
Eating Disorders Inpatient Intake Referral Form
The Johns Hopkins Eating Disorders Program
Department of Psychiatry and Behavioral Science
600 North Wolfe Street, Meyer 101
Baltimore, Maryland 21287
Inpatient Program
Director: Angela S. Guarda, M.D.
Assistant Director: Graham W. Redgrave M.D.
Nurse Manager: Devin Lowe, BSN, RN-BC
Clinical Nurse Specialist: Allisyn Pletch R.N.
Admissions Coordinator: Lisa Smith
The Inpatient Program is located on the fourth floor of the Meyer Building of the Johns Hopkins Hospital, which also houses the Adult and the Young Adult Mood Disorders Service. The Program draws on the multidisciplinary expertise of our dedicated Eating Disorders Treatment Team to provide comprehensive and individualized care. The team is staffed by physicians, nurses, social workers, occupational therapists, and nutritionists.
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Admission criteria vary depending on symptoms and degree of severity of an eating disorder. Some examples are:
- Severe eating disorder
- Unsuccessful outpatient treatment
- Medical or psychiatric complications or co-occurring conditions that require daily nursing, nutritional and medical assessment and support.
Learn more about the admissions process and contact information below.
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If you adhere to your individualized treatment program during and after hospitalization, you can expect restored physical and psychological health. The program will assist you in mastering tools and coping strategies necessary to avoid relapse once you return home. You may experience ambivalence about admission and about pursuing treatment; these feelings are normal. Although treatment can feel difficult initially, recovery has huge rewards and is always possible. As you progress through the program, your motivation to change your eating behavior is likely to increase -- even if you are ambivalent about changes at first. Most people report an increased sense of mastery and confidence in the possibility of a full recovery as they progress through the program. You will use the program best if you bring to it a willingness to work hard and an openness to learn new ways of dealing with your emotions, and apply principles learned in the program to your life at home. Read comments from patients and families treated in our program
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The expected length of stay on the inpatient unit is variable and depends both on your medical condition at admission and on how you progress with treatment. An average inpatient length of stay is two to four weeks but can be shorter or longer depending on individual factors. Once you are ready, you will transition to the Day Hospital (Partial Hospitalization), where the average length of stay is an additional two to three weeks but may be extended or reduced depending on your needs. We work together with you to formulate your treatment goals and to make your stay successful.
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Patient-Focused
If you have an eating disorder, you and possibly your loved ones are suffering as a result of your complicated relationship with food, weight, shape, and feelings. Our treatment goal is to assist you in normalizing your eating behavior, to help decrease your preoccupation with food and weight, and to aid you in restoring your weight if it is too low. We will also address any co-occurring medical or psychological conditions or complications of your eating disorder. An important strength of this program is that it is highly structured and will assist you in regaining control over your eating and your life.Nutrition
Our goal is to help patients learn principles of evidence-based, healthy balanced nutrition as both medicine and fuel for the body and mind. Consuming a wide variety of foods in appropriate portions at regular meals has been associated with improved outcomes in the treatment of eating disorders. All patients meet with our registered dietician during their admission, both in individual and group education sessions. We strive to help our patients develop healthy eating patterns to correct dysregulated hunger and fullness signals while learning to challenge and manage eating disorder related thoughts and feelings that have come to drive eating-related behaviors in unhealthy ways.Treatment of Depression and Anxiety
The treatment team is led by a faculty attending psychiatrist with experience in the treatment of eating disorders and related psychiatric conditions.Psychiatric symptoms such as depression and anxiety are often experienced by those with an eating disorder and their treatment is important for a full recovery. In some cases, psychiatric medication may be helpful to relieve these symptoms. All medications you are currently taking will be reviewed by the attending physician once you are admitted. We may recommend a trial of a new medication or a change in medications after discussion with you and with your parents if you are a teen. Standard psychological testing designed to help you understand your particular strengths and vulnerabilities when faced with the stresses of living may also be recommended.Restoration of Function
Eating disorders can consume much of an individual’s time and energy. This can lead to a decrease in social, academic, or occupational function. Patients often report feeling stuck or “derailed” by their eating disorder. You will have the opportunity to work with specially trained occupational therapists on creating appropriate goals, updating resumes, job-seeking, or re-entrance into school. We believe that full recovery from your eating disorder is possible and this includes not having your eating disorder permanently affect the trajectory of your life.Group Therapy
Daily group therapy sessions with patients on the unit provide a forum to explore the challenges of coping with an eating disorder and its toll on relationships, work, and emotional life. These meetings provide the opportunity to learn from other patients and decrease the loneliness and isolation that often come with these conditions. We also offer more structured cognitive-behavioral therapy, family relations, discharge planning, body-image, and stretch and relaxation groups. As you progress in treatment, you will participate in a weekly meal planning and preparation group with occupational therapy staff. In the Partial Hospitalization (Day) Program you will be involved in daily meal preparation and social eating skills groups with the goal of improving your comfort with common meal-related activities such as grocery shopping, cooking meals, eating family style, ordering carry-out meals, and eating in restaurants.Family Involvement
Whenever possible, we actively engage patients’ loved ones and include them in the treatment team to support recovery. With adolescents, we use a family-based treatment approach that includes parent training in how to support your child’s recovery. We help families assist their child to eat normally and to correct driven eating disorder behaviors. This family-based therapy was developed at the Maudsley Hospital in London, and has been found to be effective for adolescents with eating disorders. Family members participate in therapy sessions and receive nutritional guidance on supporting their child’s healthy eating after discharge. A social worker, nursing and other team members work with you and your family to assess the impact of your illness and to help your family support your recovery. Family meetings will be recommended as part of your treatment as needed for all patients regardless of age. We also provide a weekly family support group for parents/loved ones of hospitalized inpatients, led by one of our unit social workers.
Inpatient Admissions
Admissions Coordinator
Admissions Coordinator, Lisa Smith
Eating Disorders Treatment Program
Johns Hopkins Department of Psychiatry and Behavioral Science
600 North Wolfe Street, Meyer 143
Baltimore, Maryland 21287
Phone: 410-955-5114, Fax: 410-955-6155
Hours of Operation: Monday - Friday, 8:00 am - 4:30 pm
E-mail: [email protected]
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To arrange admission to one of our inpatient services, the clinician currently treating the patient, a member of the patient's family or the patient him/herself should contact The Johns Hopkins Hospital Admissions Office as soon as possible. There may be a waiting list for admission.
The Admissions Office will request that current clinical information about the patient's condition be faxed for review before admission arrangements are made. This information will help determine which service is most suitable for the patient. It is also essential for the Admissions Office to have clinical information in order to contact the patient's insurance company. The insurance company will then determine the extent to which the patient's policy covers the admission.
The patient and the patient's family are advised to discuss financial details with the Admissions Office in order to clarify the extent and nature of insurance coverage. Depending on the level of insurance coverage, a deposit may be required on the day of admission.
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Patients who are not being admitted through the Emergency Department should report to The Johns Hopkins Hospital Admissions Office in Meyer 143 at the arranged time. Planned admissions usually occur between 8:00 a.m. and 10:00 a.m.
The patient or parent (for adolescent patients) will sign admission papers and review other documents that will be explained by the admissions coordinator. The patient and family will then be escorted to the inpatient unit in the Meyer Building. There, a nurse will welcome them and provide a tour of the unit.
The attending psychiatrist and resident psychiatrist will take medical and psychiatric histories and examine the patient. It is important for the patient to tell the physicians about any medical problems, including allergies to medications. A nurse will do an assessment so that the nursing staff can plan for its part in the patient's care. A social worker may also meet with the patient's family to assess the patient's social supports.Note: This is a general description of what transpires on the day of a planned psychiatric admission; it may vary somewhat by service. Please contact the Admissions Office if more detailed information is required.
Frequently Asked Questions about Inpatient Program and Admissions
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If you think you have an eating disorder, if your symptoms have persisted or worsened despite attempts at outpatient treatment, or if you feel constantly preoccupied by thoughts of food and weight, a good place to start is with a comprehensive evaluation in our Consultation Clinic.
You will be seen by a psychiatrist who will perform a thorough review of your history and symptoms, medical tests and past treatment. We recommend you forward any past treatment records ahead of your appointment for the doctor to review. Whenever possible we ask that you attend the consultation with a close family member or significant other, since we believe family support and involvement is very important when you are struggling with an eating disorder. The doctor will also be interested in any medical or psychiatric problems you may have besides the eating disorder.
Common co-occuring psychiatric conditions include depression, anxiety, substance abuse and obsessive-compulsive disorder. Co-occurring medical conditions that may bring patients to treatment include gastrointestinal symptoms, infertility problems or menstrual irregularities, osteoporosis, or chronic pain conditions. At the end of your evaluation, the consulting physician will review his or her impression and diagnosis of your condition and will make suggestions regarding the best next steps for you in terms of treatment. These suggestions may include recommendations for medication, psychotherapy, further testing, or consultation with another medical specialist in the Johns Hopkins Health System.
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Most patients find the following helpful to bring:
- Photo ID, insurance card(s), list of current outpatient providers and their contact information, list of current medications.
- One week’s worth of clothing. We recommend casual, comfortable clothes. Laundry facilities are available on the unit.
- Hygiene products and a shower caddy.
- Electronics, including cell phones, tablets, headphones, and/or computers are permitted.
- Comfort items, e.g. blankets, pillows, photos.
- Leisure activities such as books, personal journals, crosswords/puzzles, crafting supplies (e.g. crocheting, drawing supplies).
- Your current medications. The hospital will provide any medications, however your physician will want to confirm what medicines you are currently taking.
On arrival, a nurse or technician will review all of your belongings to check that all items are permitted on the unit and meet hospital safety regulations. If you have specific questions about a particular item before admission, please reach out to our Admissions Coordinator, Lisa Smith (Phone: 410-955-5114; Email: [email protected]).
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The following items are not permitted for safety reasons or are discouraged:
- Sharp or glass items, belts and other long string-like items
- Smoking materials, including lighters, matches, cigarettes, e-cigarettes, Juuls, vape pens, vape cartridges, etc.
- Cannabis products
- Illegal drugs or alcohol
- Outside food or snacks (our program provides all meals and snacks)
- Valuables (e.g. large sums of cash, expensive jewelry)
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Yes. Patients are permitted to bring electronics with them, including phones, headphones, tablets, laptops, or other handheld devices. We do not allow gaming systems or other large devices. For privacy reasons, no photography or videotaping is allowed on the unit.
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Yes. During the weekdays, in-person visiting hours are from 6:00-8:00pm. On weekends, family and friends may visit from 12:00pm to 8:00pm. Additionally, patients are able to use electronic devices (e.g. facetime) on the unit, allowing for regular phone and/or video calls as long as no other patients are in view during their conversation with family. If you are under age 18, your parents will need to approve an allowed visitor list.
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Yes. Through the Home and Hospital program, we provide on-site tutoring with a dedicated education specialist to assist with homework completion for adolescent patients in grade/high school. We work closely with schools to prioritize inpatient treatment and to adjust school assignments or requirements appropriately to minimize effects on academic advancement.
For patients in college or other degree/training programs, our social workers will work with you and your program to determine appropriate arrangements. -
Depending on your employment benefits or your state, you may be protected through short-term disability, Family Medical Leave Act (FMLA), or other forms of leave. Our team will complete any necessary documentation to employers at your request and will advocate on your behalf.
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Yes, with supervision once cleared to do so by your treatment team. Part of the unit’s daily schedule includes an afternoon walk out of the unit, with time outside when weather permits. Additionally, some activities, such as meal preparations, take place off the unit. If you need to leave the unit for testing or other medical procedures, you will be accompanied by a nurse or technician.
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There is no required length of stay in our inpatient program. Length of stay is individualized and will be an ongoing conversation between you and your team, based on your unique needs and treatment recommendations. Depending on your individual medical condition, your hospital length of stay can vary greatly from days to several weeks. The average stay is 2-5 weeks.
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Our program treats a spectrum of eating disorders, and all patients work together in one therapeutic cohort. However, each person’s treatment is individualized by the treatment team in order to meet their unique needs. We treat all patients age 13 and older and typically have a range of ages on the unit at any one time. We strongly believe that combining diagnoses and treating adolescents with adults is a strength of the program, as both groups benefit from supporting each other and learning from each others’ experiences in working towards recovery from an eating disorder. We focus on the commonalities of struggling with interrupting behavior patterns that feel increasingly driven and automatic, anxiety about eating, as well as the common costs of an eating disorder on mental and physical health and on social function. These common features are shared by all eating disorders, although specific behaviors and thoughts that drive them may vary between individuals. All meals are shared and eaten together.
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Typically after your first week in the program, you will start selecting your meals based on a meal plan prescribed by your team. Before beginning menu selection, you will receive education on the ‘exchange system’ which focuses on overall nutritional needs, portions, and balanced nutrition rather than calories. Nursing and nutrition specialists are available for added support and guidance as you begin creating your own menus.
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Admissions are scheduled on a case-by-case basis based on bed availability, medical and/or psychiatric acuity, and past treatment history. All referrals are initially placed on a wait list. The admissions team will review records and determine appropriateness and staffing ability to accept a patient. If you are currently on the wait list and have questions about the estimated wait time, please reach out to our Admissions Coordinator, Lisa Smith (Phone: 410-955-5114; Email: [email protected]).
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If you are being admitted to one of our hospital-based programs, both Inpatient and Partial Hospitalization, our business office will verify your benefits beforehand, and the admissions coordinator will contact you with information about your coverage and any copay or coinsurance expected. Admission to our program in the Johns Hopkins Hospital Department of Psychiatry qualifies as a mental health hospitalization and will be authorized under the mental health benefits portion of your insurance coverage. Please see the Admissions page for more information. For outpatient consultation, please contact Tracey Farrow 410-955-3863 for information on insurance coverage.
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Please click here to review our team's published papers.
Partial Hospitalization (Day Hospital) Program
During your inpatient stay, the team may recommend and plan for your transition to the Eating Disorder Day Hospital. The partial hospitalization program is a step-down service from the inpatient program with a focus on relapse-prevention and successful transition to home and outpatient follow-up care. The Day Hospital is fully integrated with the Inpatient Program and is located on the same unit and staffed by the inpatient treatment team.
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The Day Hospital runs from 8am to 8pm, seven days a week. As you progress through the program, you will start to have days off to practice independent eating in a less supervised setting. You will learn relapse-prevention skills and develop a discharge plan for your return to home life, and will work closely with medical, nursing, occupational therapy and dietician staff providing meal support. You will gradually spend increasing time outside the hospital living at home and/or with your family and will have daily opportunities to practice your new healthy eating skills and to troubleshoot problems before leaving the structured hospital environment to return home and to outpatient care.
For patients who live a far distance from the hospital, you and your treatment team will work to arrange the most appropriate step-down plan to prevent relapse. This may include staying in the area (staff can assist with locating low-cost accommodations in Baltimore) while you participate in the Partial (Day) Hospital program, or arranging follow-up care in your local area in another step-down treatment program (e.g. a local partial hospital, intensive outpatient or with your outpatient treatment providers). -
By discharge from the Johns Hopkins Partial Hospitalization Program, most patients are attending the program two to three days a week; and have practiced planning and cooking meals, ordering carry-out meals; and eating in social settings including at restaurants and in the hospital cafeteria. Participation in the Day Hospital helps shorten the length of your inpatient stay, gets you ready to leave the structure and support of the treatment program, and helps you independently practice the new skills you have learned in a real world environment.
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- increase patients' functional ability to the highest possible level
- decrease the length of inpatient hospitalization
- provide a smooth transition from inpatient to outpatient treatment
- facilitate reestablishing relationships with family, work and community
- provide additional education and support for patients and families
- provide practice in daily activities that improve and normalize social eating skills and nutritional intake. These activities include eating family-style and cafeteria meals, preparing and cooking meals, grocery shopping, and restaurant outings.
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While in the Partial Hospital, adolescent patients (under 18 years of age) stay with their families. If adolescent or adult patients are from out of town, staff will assist families in obtaining low-cost accommodation in the Baltimore area.
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8:00-9:00am
Breakfast – Breakfast at a local restaurant or cafeteria (with occupational therapist)9:00-10:00am
Activity group and individual rounds meeting with the psychiatrist-led team
School for adolescent patients (9:30-11:00a)10:00-11:00am
Coping skills group (led by social worker) or cognitive-behavior therapy group (led by nurse)11:00am-1:00pm
Lunch - meal planning, preparation and performance group – this includes either selecting foods in the cafeteria, eating in a restaurant, having a family-style meal on the unit or cooking a meal (led by nursing or occupational therapy staff).1:30-2:30pm
Psychotherapy Group (led by psychiatrist or social worker)3:00-4:00pm
Psychotherapy Group (led by social worker)4:00-4:30pm
Daily walk with staff5:00-6:00pm
Dinner
Depending on individual progress in the Day Hospital program, patients may leave the Day Hospital before or after dinner to return home for the evening.
Outpatient and Consultation Clinic
The Outpatient and Consultation Clinic provides comprehensive evaluations for patients referred by their physicians, families, or themselves.
Consults are performed by a psychiatrist and include review of outside medical records and a comprehensive psychiatric and medical history to clarify the diagnosis. Laboratory studies are often ordered, including blood work, cardiac testing (EKGs), or imaging studies among others if indicated. At the end of the consult, the psychiatrist will provide their thoughts on diagnosis and comprehensive recommendations for treatment, including appropriate level of care, psychotherapy modalities, and medication management if indicated. The psychiatrist may recommend ongoing outpatient treatment, or at times, may recommend a more intensive level of care, such as hospital-based treatment in the Inpatient or Partial Hospitalization programs for medical or psychiatric stabilization and treatment.
Our outpatient clinic treats patients with anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder (ARFID), as well as other specified feeding and eating disorders (such as atypical anorexia nervosa). We see patients with a single diagnosis of an eating disorder as well as those with co-occurring psychiatric disorders. For adolescents, family-based treatment is strongly encouraged. We work closely with patients’ other outpatient providers and are able to utilize a multi-disciplinary referral approach that includes our Nutrition and Speech and Language Pathology departments as indicated.
To provide the most thorough evaluation and opinion we request that you forward us any medical records or pediatric growth charts (for adolescent patients) ahead of time so the doctor can review these before meeting with you and your family.
We currently provide remote telemedicine video visits - for patients residing in Maryland only - which allow patients to connect face-to-face in real time with a clinician without leaving their home. Patients can use a smartphone, tablet or computer. Virtual connections are secure and HIPAA compliant. In most cases however we will want an initial evaluation to be completed in person. We also offer second opinion consultations.
For more information or to schedule a consultation, contact Tracey Farrow at 410-955-3863, fax 410-502-7907 or email [email protected]