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Management of Discharge From Full Hospitalization

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Programs vary on how to manage the transition between living in the hospital and living outside the hospital. This partly depends on models for funding treatment and the availability of inpatient and day hospital treatment. Ideally, patients should be allowed to experience the maximum number of opportunities to practice their eating outside the hospital before being discharged. This may include passes away from the hospital on weekends or weekday evenings, where this is possible for the patient. If the home environment is stable and supportive, passes to home should be part of any inpatient program. If the home situation is not stable or if the patient lives at a long distance from the hospital, alternative arrangements need to be considered. There is limited empirical research comparing the effectiveness of "strict," or externally contained, and "lenient," or less externally contained, treatment approaches. Touyz et al. (1984) compared "strict" and "lenient" operant conditioning programs in the inpatient treatment of 65 consecutive patients with AN. There was no difference between the two programs in rate of weight gain (approximately 1 kg/week), and a similar proportion of patients in each group reached their target weight. No follow-up data were reported. Current practice is more consistent with a lenient approach, with a significant emphasis on patients taking responsibility for behavior change and challenging themselves with practice opportunities outside the hospital.

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