TABLE 3.
Items with no consensus
| Initial recommendations | ||||
|---|---|---|---|---|
| Item | Mean rating |
SD | %Agreement | |
| Including a dietitian in the outpatient treatment team | 5.68 | 1.55 | 72 | |
| Inpatient level of care when the adolescent's BMI is less than 70% of ideal body weight | 5.00 | 1.41 | 68 | |
| Duration of illness is not a deciding factor | 4.92 | 1.66 | 64 | |
| Inpatient treatment for a medically stable adolescent who has already tried multiple other treatments, including FBT, structured outpatient, and other outpatient | 4.36 | 1.60 | 52 | |
| Structured outpatient when parents refuse to participate in treatment and the patient's home or family environment are not conducive to treatment | 4.64 | 1.11 | 64 | |
| Inpatient level of care when an adolescent's BMI is less than 75% median BMI for age and sex | 4.16 | 1.37 | 28 | |
| Structured outpatient when FBT was not sufficient and the family needs additional guidance or support around meal times | 4.00 | 1.73 | 44 | |
| Other outpatient treatments for a medically stable adolescent | 4.00 | 1.61 | 52 | |
| Inpatient level of care when an adolescent has a substance use disorder in need of treatment | 3.84 | 0.94 | 36 | |
| Inpatient level of care when an adolescent has a history of multiple failed outpatient treatment attempts | 3.28 | 1.57 | 52 | |
| Inpatient level of care when an adolescent's parents request it | 2.96 | 1.17 | 60 | |
| Structured outpatient when the adolescent is below the 10th percentile in BMI | 2.84 | 1.37 | 60 | |
| Inpatient level of care when an adolescent is purging daily (and is otherwise medically stable) | 2.68 | 1.14 | 68 | |
| Inpatient level of care when there is nonsuicidal self-injury | 2.44 | 1.04 | 72 | |
| Transitions between levels of care | ||||
| Type of transition | Item | Mean rating |
SD | % agreement |
| Increase | Different outpatient treatment before structured outpatient program, when FBT is not succeeding | 4.72 | 1.40 | 68 |
| Increase | Different type of family therapy when FBT has not been successful | 4.56 | 1.36 | 52 |
| Increase | Structured outpatient when FBT has failed* | 4.52 | 1.42 | 56 |
| Decrease | Structured outpatient treatment following inpatient treatment | 4.24 | 1.88 | 48 |
| Decrease | Transition from a higher level of care to outpatient treatment when an adolescent is gaining weight consistently | 4.16 | 1.68 | 40 |
| Decrease | Discharge from the hospital as soon as adolescent is medically stable and non-suicidal, even if still substantially underweight | 4.16 | 2.06 | 48 |
| Decrease | Transition to outpatient treatment as soon as regular eating established | 4.04 | 1.67 | 40 |
| Increase | Structured outpatient level of treatment when FBT has stalled* | 4.04 | 1.34 | 44 |
| Increase | Transition from structured outpatient to inpatient when an adolescent is refusing meals in the program for several days in a row | 4.00 | 1.26 | 50 |
| Decrease | Transition to outpatient treatment when the adolescent is at full or close to full weight restoration | 3.52 | 2.12 | 52 |
| Increase | Transition from outpatient to a higher level of care when the adolescent has failed to gain weight at the rate of 0.5lbs/week over 6–8 weeks | 3.36 | 1.50 | 60 |
| Increase | Transition from FBT or other outpatient to higher level of care when adolescent has failed to gain weight at the rate of 1 lb/week over 4 weeks | 3.28 | 1.54 | 60 |
| Decrease | Transition to structured outpatient program after about 2 weeks of inpatient treatment | 3.20 | 1.32 | 44 |
| Increase | Inpatient hospitalization when FBT has failed | 2.92 | 1.35 | 64 |
| Increase | Transition adolescent from FBT to inpatient care when the family needs a break from the work of refeeding | 2.84 | 1.49 | 68 |
Note: Mean rating of less than 4 and %agreement >50 indicates that the majority of panelists disagreed with the item.
Abbreviations: BMI, body mass index; FBT, family-based treatment.
*
Overlapping statements with differing responses.