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Podcast Transcript

Episode 29: All About the Levels of Care: Part 1

[Bouncy theme music plays.] 

Sam: Hey, I’m Sam!

Ashley: Hi, I’m Ashley and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome, we would love for you to join us on this journey. Let’s learn together.

Ashley: Hey, everybody. Welcome back to another episode of All Bodies. All Foods. Ashley and Sam are here today. And actually, it’s just Ashley and Sam. It’s just us.

Sam: Just us!

Ashley: Just us. We really wanted to talk with you all today about higher levels of care, and maybe even explain some of the stuff that we do at Renfrew, at the Renfrew Center. But essentially, you know, we have our email, we would love for you all to get in touch with us, [email protected]. And some of the things that have come through in the email— Sam and I do a lot of speaking out in the community, and like one of the biggest questions that we get is, “How do I know when to refer a client? When is it time for an intervention,” essentially. “When is it time for the client to receive more support than their outpatient team? When do they need to have, you know, multiple days of treatment,” and things like that. So, our entire episode is gonna be talking about higher levels of care today. We really just wanted to bring this to you as an educational piece and hopefully help you all understand even some of the work that we do at a higher level of care. Does that sound, Sam?

Sam: That sounds great. And I think there are probably lots of folks listening out in the community who might be thinking about going to treatment. And it’s like a whole alphabet soup, where it’s like “PHP, IOP,” and it’s really confusing, especially because there are, like, multiple names for the same thing. So, we’re gonna break all that down, really simplify it, so everyone out there really knows, you know, what their options are and what each program offers. See which one sort of would probably fit best.

Ashley: Right. And we promise we will, if we say an acronym for something, we will try to break it down for you.

Sam: Yes.

Ashley: So that everyone can kind of understand this. So, well, let’s kick it off. One of the, I think the place that we can start, Sam, is Residential. What does it mean when somebody goes to Residential, what are the services, what we provide— all the things Residential. Sam, I’m gonna let you take it, all things residential.

Sam: Well, thank you. Yeah, thank you for letting me take this one because I worked for nearly a decade in Residential and in our residential treatment center in Philadelphia as not only a therapist, but a Team Leader and Assistant Clinical Director. So, I’ve helped out probably in every department at some point in my career. So, I can talk in detail about Residential. But, you know, Residential, also known as “Res,” you might hear people talk about it that way, “Res,” R-E-S— residential programming is, it is a place where you can go to get treatment where you really do have 24/7 structure, supervision, and support. And the length of stay at residential really varies depending on a lot of different factors. You know, for some folks who may be use using insurance, you know, certain insurance companies might sort of have their own criteria for, you know, what they need to see in order for a person to stay in residential. So, the length of stay varies based on the treatment goals, based on a lot of different factors. So it could be anywhere, you know, for some folks, they might stay for about a month, some folks will stay for 2, 3, 4 months, it totally depends. And for other folks, they might only have maybe 2-3 weeks where they might go to just sort of get medically stable and then step down somewhere else. So Residential, the residential setting, there are a lot of things that happen on a therapeutic level. So, there’s group therapy. So, when you go there you’re probably going to be going to, you know, multiple groups a day, including meal time. So, your meal times are all done together as a community, with support, with counselors there. Sometimes the dieticians are right there in the dining room as well. But when you go to Residential, it’s not only group therapy, you have individual appointments with your treatment team. And we talk about this in other episodes where, how important it is with an eating disorder, ideally, to have an interdisciplinary team supporting you.

Ashley: Right.

Sam: And I just want to acknowledge that accessibility in mental health care is a major issue and not everyone is fortunate and privileged enough to have that interdisciplinary team. I’m going to talk in sort of idealized terms, you know. Ideally, what we believe can be very effective is to have an interdisciplinary team because eating disorders not only affect folks psychologically but medically as well. It’s a mind-body issue. And so you need a team that can treat all of those things.

Ashley: Right.

Sam: You know, it’s about. So, it’s about your psychological well-being, it’s about your medical stability, it’s also about the food that you’re eating. So, so when you go into residential, on your very first day, you meet your team. You meet your therapist who is meeting with you multiple times a week individually to work on your treatment goals. There’s a registered dietician on the team that helps you figure out the meal plan that meets your body and brain’s needs. So everything is really individualized. You have a psychiatrist on the team to manage any medication, if need be. And then there is a medical team, so nurses, nurse practitioners, things like that, they are there monitoring 24/7, making sure that everyone is safe from a medical perspective. And then there’s counselors who, you know, sort of are walking around in the dining room, on the floor, making sure everyone feels supported and safe. And so, those counselors are available for check ins and just to sort of make sure that everyone feels safe, and seen, and has someone to talk to essentially, you know, when they’re programming there. But not only that, I think one of the most helpful things about residential would be that you’re finally meeting a community of other people who are dealing with the same exact issue.

Ashley: Yes.

Sam: An eating disorder. And of course, you know, as we know eating disorders, so rarely travel alone. Not only are you, you know, getting treatment for an eating disorder but for the comorbid diagnoses. So, all of those diagnoses that we see so frequently travel alongside an eating disorder. So, you’re meeting other people who are, you know, trying to heal from their eating disorder, but also trying to heal from other things. And it can be such a relief to finally be in a space where people get it.

Ashley: Yes.

Sam: And you realize, you know, sitting in groups and hearing other people share these things that maybe they’ve never even told anyone before— it’s like the thoughts that they’re having and the feelings they’re experiencing— and to be able to hear that and to say to yourself, “I experienced that too, that happens to me too. I’m not alone.” And it can be so healing to know that, you know, eating disorders can affect anyone, any shape, any size, you know, any race, ethnicity, gender, the list goes on and on. And to finally meet these other folks who are in it with you and want to get better with you, I mean, so powerful. I can’t even tell you how many times I hear alum say that the power of the community was one of the most helpful things in their recovery.

Ashley: Right, yeah.

Sam: So that’s one really cool thing about residential, is that you’re living with these folks, you know, you’re living with these folks. You have— at Renfrew, we separate things by team, and each team is separated by age. So, you might be on a team that is younger folks in programming, you might be on a team where it’s sort of 30-something and beyond. And ideally, I think whenever there’s a really big community, no matter where you’re programming, it’s important that there are communities within the community. So, you know, different— so, maybe certain groups are separated by age, and maybe certain groups are separated by the different things that you might be struggling with, you know, trauma substance use, you know, those sort of, like, specialized programming, I think, is really important when you’re in sort of a bigger facility. So, you know, finding community within community and essentially making lifelong friends and support systems for you to, you know, carry on. So, that’s just a little bit about Residential. I could probably talk for hours and hours about it.

Ashley: Well, let me ask you some questions specifically about that, if that’s OK.

Sam: Yeah, yeah.

Ashley: So, you mentioned initially, like, comorbidities, or we also call them co-occurring diagnoses. We know that 98% of those diagnosed with eating disorders are also diagnosed with a co-occurring disorder.

Sam: Right.

Ashley: And so, for those of you listening, that might mean depression, that might mean anxiety, that might mean PTSD, substance use disorder, OCD, the list could go on. Could you briefly speak to that a little bit, Sam? Like, when someone comes to Residential, how are they working on both the eating disorder and their co-occurring disorder, or co-occurring mental health disorder, as well?

Sam: Yeah. So, that’s a great question. You know, we really believe that you can’t just treat one thing. You know, if you have multiple things happening, you know, let’s say you have eating disorder and trauma. If you try to treat only one, you can expect to see the symptoms of the other diagnosis heighten up.

Ashley: Ramp up.

Sam: Absolutely, absolutely. Or the urges, you know, ramp up. And so, it’s really important that wherever you’re programming— I mean, there’s so many roads to recovery but whatever road you choose, to be sure that, you know, your team or your therapist is addressing all of the issues. Because they’re all connected, they’re all connected. And so, what we’ve sort of discovered in the search for what we feel like is the perfect treatment modality for an eating disorder is— Okay, like, you know, the question is, what’s the common denominator of all of this stuff? And the common denominator, what we so frequently see, is emotional avoidance. And so, the work becomes learning how to get better at feeling, and learning how to experience your emotions and allow them to rise and fall and learn the skills, take that pause, really learn how to navigate your emotional world without turning to eating disorder symptoms. And a lot of people are just, it blows their mind when they hear that, you know, eating disorders are emotional disorders. But a lot of the work, that emotional work ends up actually addressing the depression, the anxiety, PTSD, it’s sort of that thread that we see across diagnoses. That’s why we call it a Transdiagnostic Treatment Modality. So, what we’re really doing is we’re trying to build up that emotional efficacy. And what we mean by that is the ability to feel your emotions and allow them to exist, allow them to guide you as necessary. But also knowing when it’s best to just sit with an emotion and wait for it to sort of ride out. So, a lot of the groups at residential are rooted in our treatment model, which is all about emotional avoidance. But in addition to that, we have different groups that really sort of target very specific issues. So, we call these “tracks.” So, you might go into residential, and you’ll be in sort of like the general programming, but then also you might be recommended to join the Trauma Track.

Ashley: Right.

Sam: And so, the Trauma Track is this whole separate track with other folks who have also experienced trauma, where you gradually sort of move through these stages and essentially work on healing your trauma, and getting the tools that you need to continue doing so even after you leave treatment. And that’s really the key for sustainable change, is is your program gonna give you tools that you can actually use when you leave, so that six months down the road, a year down the road, five years down the road, you’re still using those tools and you’re still healing. So, you know, so there’s the Trauma Track, and then we also have a Substance Use Track for folks who are struggling with not only an eating disorder but substance use issues, and/or might even be someone who wants to sort of explore their relationship with substances and have a healthier relationship with substances. So, there might, you know, you might be recommended for that track as well. So, these tracks can be really helpful because again, you’re meeting other folks in these tracks who are dealing with the same exact thing.

Ashley: Right.

Sam: Yeah, yeah.

Ashley: Well, and I just wanted to add, too, as you were talking a little bit about the model and the emotional avoidance— just as a reminder, you all, if you haven’t listened to an episode in Season 2 already, we talked with Melanie Smith in Season 2 about our specific model and about this emotional avoidance and kind of the type of work that we’re doing. So, if you wanna, you know, put a pin in this episode and then go back to that episode just to kind of help refresh your memory or understand it a little bit better, that is a great educational episode as well, so.

Sam: Thanks for that reminder.

Ashley: Yeah, and thanks for letting us know about the tracks, which I find massively important. I mean, again, we can’t really pick apart and just treat one or the other. I mean, this is what you’re saying, Sam, is that there’s a common thread, and there’s things that are often buried so deep and like, you know, looking at that, working on that stuff as well as working on some of the eating disorder behaviors. It just can be the best of both worlds. Well, and also very, very hard. But beautiful work, right?

Sam: Yeah, yeah. Absolutely.

Ashley: So, what about what about, like, the medical piece? What would put somebody at the residential level medically?

Sam: Yeah so, again, good question. I think, you know, when you’re working with a client, there are certain things that you’re definitely going to want to be monitoring. And again, I talk about how important it is to have an interdisciplinary team. And so a PCP could be someone who is monitoring certain things as your client is recovering from their eating disorder. So if there’s medical instability, that’s really a sign that, you know, this person is probably needing a higher level of care. A level of care where they are being monitored around the clock. You know, where lab work is being routinely taken where, you know, vitals are being taken in the morning, just a way to really be sure that this person is medically safe, but also that they’re medically improving. So, you know, having a medical team that’s monitoring that on a daily basis, you can really start to see how the body is healing over time, and it can be sort of a sign that the person is on the right track on in their recovery. So, you know, also there might be folks who are struggling with dehydration, you know, struggling to stay hydrated and being somewhere where you can be monitored for that. You know, we monitor for orthostasis, we monitor for all different types of things, heart rate. And so, having that care around the clock can be so helpful for someone who is not medically stable essentially. So, that’s a piece of residential that you won’t really find in other levels of care. And the other thing about, you know, the whole process of when you start to reintroduce food after, you know, eating disorder symptoms— so, whether it’s restricting, binging, purging, when you start to reintroduce an individualized meal plan, there are a lot of uncomfortable and sometimes scary things that can happen physically, and they may or may not be medically dangerous, but when they’re happening, it’s easy to sort of feel anxious about it. You know, if you’re feeling really full, or feeling really bloated, or maybe you’re constipated, and there’s all kinds of things that can happen. And to have a team there that can say to you, “This is totally normal. Here’s what your body is doing. You know, here’s what, you know, you’re on the right track, just continue doing what you’re doing.” To have that support and that reassurance from a medical professional can be so helpful rather than trying to figure out what’s going on at home.

Ashley: Right, right.

Sam: And wondering if you’re doing the right thing, wondering if it’s normal, and sort of panicking and having these urges to go back to your eating disorder. You know, it’s like, you know, feeling, you know, super constipated, for example, which can be really common, especially in recovery for bulimia or sometimes with other restrictive eating disorders. But to hear from a professional, like, “You’re ok, like, this is normal and it will pass, and here’s what is actually happening in your body.” So, we actually even have a group where a medical professional would explain sort of what happens to your body when you have an eating disorder, but also, you know, normalize some of the physical experiences when you start eating again. So that, that can be really a helpful thing, or maybe even going to your medical team if you are feeling nauseous or you’re feeling uncomfortable, there are certain over the counter medications and treatments that the medical team can offer you in the moment just to help make life a little easier when you’re doing the hard work of recovery. So, that’s another benefit of having a team there around the clock.

Ashley: Yeah. Right. That can support you.

Sam: Yeah.

Ashley: One more question about residential, can you talk to us about safety concerns? You know, if we’re working with somebody that might come in with some suicidal ideation or things like that, what, how can we support them at residential?

Sam: Yeah. So, you know, at the outpatient level, for folks who have eating disorders, they are at elevated risk of suicidality. That, you know, that’s the sad truth of it. And so sometimes, I would even say oftentimes, especially, you know, when you have a malnourished brain, it’s not uncommon to have those sort of thoughts. And I can’t emphasize enough, if you have a client who has an eating disorder, to make sure you’re asking those questions, and to make sure that your client is safe and is willing to keep working with you on healing. Because a lot of it, you know, with eating disorders, what we see is when the brain is nourished and that sort of physical healing starts to take place, we see some of that resolve. So, suicidal ideation is really a common part of the territory, unfortunately, with eating disorders. But it is important to assess for it. But Residential can be a safe space where, you know, there’s again, there’s that 24/7 support. There’s that 24/7 supervision, where even if you woke up in the middle of the night, there’s someone that’s there and you can check in with them and, you know, make sure you’re safe. There can be safety checks put in place, you know, every hour, even every half hour, every 15 minutes, you know, whatever, you know, is maybe needed, whatever is, you know, we try to individualize everything for each client. But whatever would be most helpful and would increase the chances of that person staying safe. So, and then of course, the community, I can’t stress that enough. I mean, just being around other folks who are encouraging you, who are, you know, rooting for you can really just help mentally and help someone get to a better space mentally.

Ashley: Yeah, the community aspect is so, so wonderful and can really be healing.

Sam: Yeah, absolutely.

Ashley: So, Sam, next steps— somebody’s completed residential, what do they do? Oh, and I guess, let me say this too. With the providers that are maybe working with us that are in outpatient, what are we doing with them while their client is in the residential setting?

Sam: Well, yeah, so the outpatient therapist is really part of the team. And they— so we aim to call that therapist the day the patient lands there, and to introduce ourselves and to let, you know, to let the therapist know that we really want to collaborate and hopefully just get the therapist perspective on what’s happening and how we can best sort of pick up where the therapist left off. But really, what we want to be doing is updating the therapist on progress throughout treatment, maybe even having them involved as part of the discharge. So, we might invite them to maybe do, like, a bridge call, where we invite them to come in and sort of, over the phone, give the patient a chance to let the therapist know what they were working on and how they’re doing. And if the patient is stepping back down to them, that bridge call can be really helpful. But yeah, so we really do aim to collaborate as much as possible with the outpatient therapist and the outpatient team in general, because eventually the client’s gonna be going back there. And so, we want to be sure that we’re all on the same team working towards the same goals. patient centered goals, where, you know, the client is really getting all of their needs met. So, yes, so that’s part of part of the process as well.

Ashley: OK. Thank you for that. And I guess I also thought of another question!

Sam: Oh, good!

Ashley: I’m just asking you all the things today. Talk to me about family involvement and family support at a residential level.

Sam: Yeah. So, family involvement is, it can be very powerful, and when we say family, we use that term pretty loosely.

Ashley: Loosely, yeah.

Sam: Yeah, because family can be your partner, family can be your roommate, family can be your best friend, family can be your rabbi or, you know, someone from the spiritual community. So, the client tells us who their family is and we want to help the client build out their support system and get practice opening up to the people they trust.

Ashley: Yeah.

Sam: Getting comfortable asking for support, getting comfortable talking openly about the eating disorder, so that when they leave, it’s easier to do that. And so we might have a family session once a week, or the therapist will schedule that, and we sort of decide together who to include in that family session. And we also have family day where the families, support people, really any kind of supportive person can join. And it’s an all-day educational event where those folks are learning about eating disorders. We’re busting myths about eating disorders, we’re teaching support people how to emotionally validate, how to not be the food police. You know, all the Dos and Don’ts basically, and that sort of Eating Disorder 101 type education and support that’s really needed. I think there are a lot of times, you know, there are people who really want to be supportive and they end up just saying triggering things, or they might have beliefs about eating disorders that just aren’t true. And so, we want to be sure that those folks have accurate information so that they can support their loved one differently. Yeah, so family work, and again, “family,” I put that in quotes, family is, you know, we use that term in many different ways. But getting support people involved can be so powerful. If you have people who really understand what you’re going through, or at least try to understand what you’re going through, and then learn how to support you emotionally rather than focusing so much on food or, you know, or other aspects that just really aren’t really valuable to focus on.

Ashley: Yeah, yeah. Ok. That’s, helpful. Thank you, Sam.

Sam: Yeah!

Ashley: And then all right back to my OG question a few minutes ago. Next steps— what is somebody to when they’re ready to leave Residential?

Sam: Yeah, so when someone is ready to leave, it’s sort of like a collaborative process with the treatment team and the client. And hopefully the client was able to achieve the goals on their treatment plan and get to a place where they’re medically stable and all that good stuff. And so ideally, you know, I think of the levels of care like a staircase, you know, and Residential would be at the top of the staircase. So, besides Inpatient care. So, I just want to point that out that you might hear the word “Inpatient” sometimes and Inpatient is really being in a hospital. Usually if there’s some kind of acute medical issue that needs immediate attention someone might be in that level of care. But besides like a hospital bed, there’s Residential at the top of the steps, and then when you take one step down, that would be PHP. So that stands for “Partial Hospitalization Program,” but it’s also known as “Day Treatment,” right? This is where it gets kind of tricky.

Ashley: Right.

Sam: So, PHP and day treatment are the same thing,

Ashley: Right

Sam: And so that would be the very next step, and that’s five days a week. And then when you step down from Day Treatment, then ideally you’re stepping down to IOP, which is Intensive Outpatient Programming, which is three days a week, sometimes three nights a week, depending on your schedule, depending on the program. And then after IOP, then moving back down to your outpatient team. I want to point out that not everyone has the resources, has the accessibility to do it that way.

Ashley: Right, right.

Sam: And, again, there’s more than one road to recovery. However, ideally to gradually go down those steps rather than, I mean, imagine standing at the top of the staircase and then jumping down to the first floor, going from 24/7 support structure and supervision to going home and, like, seeing your therapist and dietician, like, once a week, that’s a big jump.

Ashley: It’s a huge jump, yeah.

Sam: And oftentimes, it’s just, I think a lot of clients find that jump to be quite overwhelming. And so hopefully, at every step along the way, the client is gradually sort of feeling like they’re mastering that program. It’s like, “I got it, I can do this, and I’m ready for more challenges.”

Ashley: Right, right.

Sam: So, I often have said to my clients in the past where we’re sort of, like, getting towards the end of Residential, and I’ll say to them, “I’m running out of ways to challenge you,” you know. And they’ll say, “Yeah, I know, me too. Like, I wanna go out to more restaurants, or I wanna try to make dinner at home, and I wanna try to do this stuff,” and, I’ll agree with them. I’m like, “Yeah, you know, that you’re ready.” So, that’s how we know. It’s sort of like when you sort of feel like, “OK, I’m ready for the next challenge. I’m ready for more freedom. I’m ready for less structured time because I have the confidence that I can manage it and I have the tools I need. So, ideally going down those steps gradually can really be empowering. It’s like, you’re really feeling like you’re mastering each level. And then if you’re at a level, say you’re in the middle of the staircase, you’re like at IOP and you’re just really struggling, and you’re kind of, you’re having these slips and you’re feeling like things are kind of spiraling, you have the option to step up.

Ashley: Right. And I want to say to that right there specifically, like I— so where Sam has worked at the Residential level for so many years, I’ve worked at the PHP and IOP level with Renfrew for so many years. And it is not a shameful thing if you need additional support. Sometimes we might see somebody start at the IOP level, which as Sam was saying, that’s just three days, three nights a week, it’s three hours each of those days. You’re gonna get a couple of groups and a meal. And the thing with that is, if it is helping, what you will start to see is that you can challenge yourself. Like, what Sam was saying, you can challenge yourself and be able to work through and with those challenges. You can lean into the distress of what’s coming up, you can practice leaning into those emotions instead of avoiding them. If somebody finds themselves having a hard time leaning into those emotions, still using avoidant type behaviors, you know, daily even. Maybe even still using, you know, some of the eating disorder behaviors, what we might suggest is that step back up. So, a step up to PHP so that they can have more support, so that they can see somebody five days a week instead of three days a week. So that we can really keep working with somebody to build that kind of internal ego strength and help them to really feel, you know, like they can tolerate whatever challenge is coming up. And then just to add on to that, we have different groups as people move through these levels of care, through IOP, PHP, and Residential, we even have these different groups that, you know, where we do more challenges. We do some interoceptive, so where people get in touch with their internal feeling and kind of what’s going on for them. So, we might spin in a chair and create that kind of dizzy feeling and learn what that emotionally and physically feels like, and learn that we can experience that and we can tolerate that. So, I just wanted to highlight, like, there’s nothing wrong if you found yourself stepping down and you might need a bit more support, and you might need that moment to step back up. That’s ok. Yeah.

Sam: Thanks for pointing that, I think, pointing that out. That’s such an important reminder that, you know, we say this all the time, that, you know, recovery isn’t linear.

Ashley: Right.

Sam: And it’s not really until you’re in it that you’re like, “Oh, this is what my therapist meant.” It’s that, you know, sometimes you might be at a level of care and life happens and you’re like, “Wow, I didn’t expect these stressors and, you know, these major events in my life,” and that eating disorder might really get activated again. And it’s ok, you know, we can’t, we don’t know what life is gonna throw at us and we know that eating disorders sort of love a good transition. They love loss and grief and that’s when an eating disorder really thrives. And sometimes life is hard and the eating disorder really wants to come back to try to protect us, and having additional support and structure can make all the difference during those times. So, yeah, recovery is not linear and it’s totally ok to go up and down that staircase if you need to.

Ashley: And I also wanted to say that about the staircase too, but based on what someone’s symptoms are, based on what somebody’s experiences are, they— we’re not saying that, you know, the first place to start is residential, even. Someone may start at the IOP level, someone may start at the PHP level.

Sam: Yes.

Ashley: And then as we work with them, work with the goals of the treatment team and we figure out what their needs are, you know, we can make moves as we need to. But you can really enter into that staircase at any level. And it doesn’t, you know, we don’t have to go just straight to the top.

Sam: No, of course not. We really— so I think the important point to make here is that whatever level of care is recommended, it really should be the least restrictive environment to meet your needs.

Ashley: Yeah.

Sam: So, we don’t want to put someone in a setting that they don’t necessarily need to be in if they can start at a lower level. And so that’s why it’s really important to get a thorough assessment from an eating disorder specialist, from a reputable program that can do that really thorough assessment and will be able to really identify what level of care meets your needs. Because there are multiple needs, there’s the needs with, you know, the support that you have, there’s medical needs, there’s needs with getting support around your meal plan, there’s psychological needs and comorbid diagnoses. So, there’s so many factors at play, but a skilled assessor will be able to tell you, “Ok, based on research and experience, this seems to be the level of care that is probably going to fit best for you, given what’s going on with your eating disorder and in your life in general.” Because it’s not just about the eating disorder, it’s about, you know, what’s your home environment like? Is that a place where you can really safely recover? Is it a place where, you know, you can really focus on recovery or maybe you need more structure and supervision to break the cycle. Which is very common, you know, it’s eating disorders, it’s like, if it were easy to break the cycle, everyone would just be doing it at home. But, you know, some folks just need a little more support than that and that’s totally OK.

Ashley: Yeah. Yeah.

Sam: Yeah.

Ashley: So, we hope this has been helpful. Again, I think I mentioned this at the beginning, but please reach out to us. Our email is [email protected]. And if you have any other questions or you want us to do any episodes, you know, focused on other information that you would like to learn more about or know more about, let us know. We want to be a resource. Sam and I, we’ve been so honored to sit across from so many people on this show and be able to ask the experts about stuff. And we’ve been honored to even connect with you all and kind of share what we know with you all. So let us know what you would like to hear.

Sam: Thank you for listening to All Bodies, All Foods. We hope you enjoyed this episode with Ashley and Sam on levels of care. If you enjoy this episode, you can support us by subscribing, rating, leaving a review, or sharing with others. And if you want more, follow us on Facebook, Instagram, Twitter and TikTok, our handle is @RenfrewCenter. For free education, events, trainings, webinars, resources, and blogs, head over to our website, And if you have any comments or questions you’d like us to answer in a future episode, you can email them at [email protected]. I hope you join us next time on All Bodies All Foods.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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services and to schedule an assessment. Or, fill out the information below and we will contact you.

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