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Gradual Decreases in Containment in Inpatient Programs | Timing of Discharge From Inpatient Treatment
Excerpt
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.