The day patient program currently offers 12 places which may be shared between more than 12 patients. It functions flexibly and offers an intermediate intensity of care as either a step up from outpatient care when greater intensity of treatment is required to achieve progress, or as a step down from in-patient care when a lower intensity of care is sufficient to maintain progress.
Multidisciplinary care provides nutritional, medical, psychological, occupational and social components of care through a combination of individual, group and family work with an emphasis upon community care and rehabilitation. Intensity of treatment varies from 1-5 days a week according to clinical need.
Care plans and length of stay in in-patient and day patient care is guided by individual need and not by fixed programs of treatment. The day and in-patient programs combine meals and nutritional support with more intensive medical, psychological and social care than can be provided by out-patient attendance. Care is delivered through a combination of group work, individual sessions, specialist psychotherapies and occupational therapy interventions within a framework of motivational enhancement. Many of the components of the day-program are accessible to both in-patients and day patients, in order to facilitate flexible and graduated movement between these two levels of care.
This is particularly important in facilitating early discharge from hospital to ongoing day patient care. Transitions between services (or components within a service), are associated with high risk of disengagement and relapse. Continuity of relationships with staff and peer group, structure of the program and familiarity of the environment help to reduce the risk of disengagement or relapse at the time of transition from in-patient to day patient care.
Transitions are graded, with periods of increasing home leave in preparation for discharge to day patient care. Timing of transition is determined by progress with weight gain during periods of home leave and not by fixed length of stay or Body Mass Index (BMI) criteria. Thus, if a patient is able to continue to make progress with weight gain on leave, she is able to continue care as a day patient, even if BMI remains low. Where geography precludes the use of day patient care, in-patient care is extended until there is evidence from periods of extended leave that progress is likely to continue with local out-patient care.