Treatment Outcomes Demonstrating the Effectiveness and Scalability of our Adaptive Care Model - Alsana
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®
2019-2020
Treatment Outcomes
Demonstrating the Effectiveness and Scalability
of our Adaptive Care Model®
M ED I CA L
THERAPEUTIC
N U T R IT IO N
R ELATI O N A L
M OV EM EN T
alsana.com 866-651-7129 linkedin.com/company/alsana/
1
Contents Introduction Efficacy of the Adaptive Care Model..............................................................................................................1 Effect Sizes and Demographics......................................................................................................................2 2019-2020 Data and Analysis Eating Disorder Symptoms and EDE-Q Score..............................................................................................3 Quality of Life....................................................................................................................................................4 Anxiety Symptoms............................................................................................................................................5 Depression Symptoms.....................................................................................................................................6 Trauma-Related Symptoms..............................................................................................................................7 Exercise..............................................................................................................................................................8 Self-Compassion.............................................................................................................................................10 Perception of Care Results PoC Overview..................................................................................................................................................11 PoC: LGBTQ+ Clients.....................................................................................................................................12 PoC: Virtual Programs Clients........................................................................................................................13 Featured Content: How COVID Impacted Eating Disorders Treatment Trauma: the COVID Coefficient.....................................................................................................................14
Efficacy of the Adaptive Care Model®
E D E-Q G LO BA L SCO R E Admission
Discharge
4.1 4
2.7
2.23
1.4
2015 – Using a traditional 2019 – Using the Community Norm
ED treatment Model Adaptive Care Model (Fairburn and Beglin, 1994)
NOTES: EDEQ = Eating Disorder Examination Questionnaire, Fairburn, C. G., & Beglin, S. J. (1994).
International Journal of Eating Disorders, 16, 363-370.
Gold line indicates EDE-Q global score cut off value (see Rø et al., (2015). Eur Eat Disord Rev., 23(5), 408-12.)
We utilize the Eating Disorder Exam Questionnaire (EDE-Q) to evaluate improvement in eating disorder
symptoms from admission to discharge. The EDE-Q Global Score provides a psychometrically sound and
empirically-validated overall measure of eating disorder behavior change.
The Adaptive Care Model outperforms traditional eating disorders treatment models in reducing the severity
of eating disorders symptoms. Analyses show that eating disorders symptoms, assessed with the Eating
Disorder Examination Questionnaire, were significantly lower at discharge in 2019 than in 2015 (p
Effect Sizes
In 2019 and 2020, our clients had statistically significant improvements during their treatment. A statistically
significant improvement indicates that the improvements were not due to random chance but does not
show the improvement size. The figure below shows the effect sizes and improvement for the change from
admission to discharge for each outcome.
EFFECT SIZ ES
0.542 0.544
LARGE
0.406
0.361
0.339
MEDIUM
0.306
0.275 0.271
0.228
SMALL
EDE-Q EDEQL State Trait Depression Trauma Compulsive Self- Emotion
Anxiety Anxiety Exercise Compassion Regulation
Effect sizes are used to quantify exactly how much our clients are improving in each domain. Reporting effect
sizes are a way to show how much our clients are improving. Alsana’s outcomes are stronger.
DE M O G R A P H ICS O F CL IENT SA MP L E
S A M PL E SIZE LE N GTH O F STAY
602 80 1-557
Clients Days (Average) Range in Days
TIM E PE R IO D E ATI N G D I S O R D E R D I AG N O S E S *
Jan 2019 65.1% 12.6% 4.2% 2.3% 13.9%
through AN BN BED ARFID OSFED
December 2020
GE N DE R IDE N T ITY LE V E LS O F CA R E
87% 8% 5% 73% of these Alsana clients were admitted to the RTC level of care, while
Female Male Nonbinary/
Genderqueer
67% of clients from the same group discharged from the PHP/IOP levels of care.
These are demographic data for 2019 and 2020 combined.
* Anorexia Nervosa – Restricting type; Anorexia Nervosa – Binge-eating/purging type; Bulimia Nervosa; Binge Eating Disorder; Avoidant/Restrictive Food
Intake Disorder; and Other Specified Feeding or Eating Disorder
2
Eating Disorder Symptoms
E AT ING DISO R DER EXA M Admission
Q U E STIO NNA IR E G LO BA L SCO R E Discharge
4.06
2.57
1.4
2019 and 2020 combined Norm
NOTES: EDEQ = Eating Disorder Examination Questionnaire, Fairburn, C. G., & Beglin, S. J. (1994).
International Journal of Eating Disorders, 16, 363-370.
Gold line indicates EDE-Q global score cut off value (see Rø et al., (2015). Eur Eat Disord Rev., 23(5), 408-12.)
At Alsana, we utilize the Eating Disorder Exam Questionnaire (EDE-Q)
to evaluate improvement in eating disorder symptoms from admission
to discharge. The EDE-Q is a psychometrically sound and empirically-
validated instrument that assesses eating disorder symptoms.
Example questions include:
• “Have you had a definite fear of losing control over overeating?”
• “Trouble concentrating on other activities like work?”
• “How many days have you eaten in secret?”
• “How often do you feel guilty after eating?”
• “Do you have a desire for a totally flat stomach?”
The EDE-Q Global Score provides an overall measure of eating disorder
behaviors. Clients at Alsana in 2019 and 2020 demonstrated statistically
significant improvement in eating disorder symptoms on the EDE-Q from
admission to discharge (p
Quality of Life
EAT ING DISO R DER Admission
QUA L ITY O F L IFE SCA L E Discharge
145
126.41
97.06
2019 and 2020 combined Norm
NOTES: Eating Disorders Quality of Life Instrument, Adair, C.E., Marcoux, G.C., Cram, B., Ewashen, C.J., Chafe, J., Cassin, S.E., et al.
(2007). Development and multi-site validation of a new condition-specific quality of life measure for eating disorders. Health and
Quality of Life Outcomes, 5, 23.
The Eating Disorder Quality of Life Questionnaire (EDQLS) is utilized to measure improvement in quality of life
symptoms related to eating disorder recovery. The EDQLS is a valid and reliable measure of quality of life for
clients in eating disorder recovery.
Sample questions from the EDQLS include:
• “I feel like I don’t have a life”
• “My life is full of worry right now”
• “I have lots of rules about food”
• “I feel connected to others’’
• “I see positive things in my appearance.”
Clients discharging from Alsana from January 2019
to December 2020 demonstrated statistically
significant improvement in quality of life (p
Anxiety Symptoms
STATE /T R A IT A NXIETY INV ENTO RY Admission
STAT E Discharge
62.57
53.45
36
2019 and 2020 combined Norm
NOTES: State Trait Anxiety Inventory, Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Palo Alto, CA:
Consulting Psychologists Press.
STATE /T R A IT A NXIETY INV ENTO RY Admission
T R A IT Discharge
62.78
54.30
36
2019 and 2020 combined Norm
NOTES: State Trait Anxiety Inventory, Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Palo Alto, CA:
Consulting Psychologists Press.
The State Trait Anxiety Inventory (STAI) was utilized to measure anxiety symptoms. Example questions include:
STAT E E X A M PL E S T R A IT EXA MP L ES
• “I feel strained.” • “I wish I could be as happy as others seem to be.”
• “I am presently worrying over possible • “I feel pleasant.”
misfortunes.” • “I feel like a failure.”
• “I am relaxed.” • “I have disturbing thoughts.”
• “I feel happy.”
There was a statistically significant improvement from admission to discharge in Trait Anxiety scores and
State Anxiety Scores (p
DI F F I CU LT I ES IN EMOT IO N R EG UL AT IO N
Admission Discharge Norm
3.16
2.9
2.69
2019 and 2020 combined Norm
NOTES: Difficulties in Emotion Regulation Scale, Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation
and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of
Psychopathology and Behavioral Assessment, 26, 41–54.
Depression Symptoms
The Patient Health Questionnaire allows us to assess the level of severity of depression more quickly. The
PHQ-9 differentiates minimal symptoms of depression from minor depression, major depression, and mild,
moderately severe, or severe major depression.
Items ask about critical aspects of depression and how often they occurred over the past two weeks.
Responses are on a four-point scale ranging from “not at all” to “nearly every day.” Items include “little interest
or pleasure in doing things,” “trouble falling asleep, staying asleep, or sleeping too much,” “moving or
speaking so slowly that other people could have noticed. Or, the opposite – being so fidgety or restless that
you have been moving around a lot more than usual” and, “thoughts that you would be better off dead or
hurting yourself in some way.”
PATI E NT H E A LT H QUEST IO NNA IR E ( P H Q-9)
Admission Discharge Minimal Mild Moderate Moderately Severe Severe
25
20
15 16.64
10 11.08
5
0
Admission Discharge Reference
NOTES: Depression assessed by the PHQ9. Measure development and severity reference groups available at Kroenke et al., (2001). Journal of General
Internal Medicine, 16, 606-616.
6
Trauma-Related Symptoms
PATI ENT CH ECKL IST FO R PT SD
Admission Discharge Normative Range Clinically Significant Range
50 90
45 80
47.51
40 70
35
37.59 60
30
50
25
40
20
15 30
10 20
5 10
0 0
2019 and 2020 combined Norm
NOTES: The Posttraumatic Stress Disorder Checklist for DSM5, Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015).
The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic
Stress, 28, 489-498.
The PTSD Checklist (PCL-5) was utilized to measure symptoms of posttraumatic stress disorder.
The PCL-5 is a validated and reliable measure of symptoms associated with PTSD.
Examples:
Over the month, how much were you bothered by:
• “Avoiding memories or thoughts of stressful events?”
• “Having strong physical reactions when reminded of stressful events?”
• “Trouble remembering important parts of the stressful event?”
• “Blame yourself for the stressful event after it happened?”
• “Irritable behavior, angry outburst, or acting aggressively?”
There was a statistically significant improvement in PTSD symptoms from
admission to discharge (p
Exercise The Compulsive Exercise Test (CET) assesses the core features of excessive exercise in eating disorders: Compulsivity (e.g., continuing to exercise despite illness or injury, lack of exercise enjoyment, the experience of extreme guilt when unable to exercise, making up for missed exercise sessions), emotion regulation, weight, and shape driven exercise (e.g., exercising solely to burn calories), and exercise rigidity (e.g., rigid adherence to a strict and repetitive exercise routine). General Compulsivity Global scores above 15 denote clinical significance. Example items include: • “I exercise to improve my appearance.” • “If I feel I have overeaten, I will exercise more.” • “I feel guilty if I miss an exercise session.” • “I feel less stressed/tense after I work out.” • “If I cannot exercise, I feel anxious.” There was a statistically significant improvement from admission to discharge on the General Compulsivity Global Score (p
Exercise (continued) Specific analyses were conducted for clients with a history of compulsive exercise who received treatment at Alsana from January 2019-December 2020. These clients (n = 175) scored above the cut-off score of 15 on the CET Global Scale of the CET (M=17.99) (SD=2.02). Listed below are specific subscale analyses from admission to discharge on the CET for these 175 clients with a history of compulsive exercise. All subscales demonstrated statistically significant improvement from admission to discharge (p
Self-Compassion
S E L F-CO MPA SSIO N SCA L E Admission
Discharge
2.62
2.5
2.24
2019 and 2020 combined Norm
The Self Compassion Scale-Short Form (SCS-SF) is an empirically validated measure of self-compassion,
assessing Self-Kindness (e.g. ‘When I’m going through a very hard time, I give myself the caring and
tenderness I need’), Self-Judgment (e.g. ‘I’m disapproving and judgmental about my own flaws and
inadequacies’), Common Humanity (e.g. ‘I try to see my failings as part of the human condition’), Isolation
(e.g. ‘When I fail at something that’s important to me, I tend to feel alone in my failure’), Mindfulness (e.g.
‘When something upsets me I try to keep my emotions in balance’) and Over-Identification (e.g. ‘When I’m
feeling down I tend to obsess and fixate on everything that’s wrong’). There was a statistically significant
improvement from admission to discharge on the Self-Compassion Scale with a moderate effect size (.228).
Our adaptive approach to therapy works
synergistically with our other four dimensions
of care, supporting one another to effectively
treat the whole person and ensure a full and
sustainable recovery beyond treatment. We
know the importance of relationships in recovery.
Our staff is encouraged to be authentic and
compassionate, nurturing a sense of openness
and kindness. This acceptance of self is vital to
healing the whole person.
– NICOLE SIEGFRIED, PHD, CEDS, Chief Clinical Officer
10Perception of Care
Perception of Care (PoC) Surveys are administered to all clients discharging or stepping down from each level
of care at Alsana, regardless of discharge type.
CLI E NT S W H O WO U L D R ECO MMEND A L SA NA TO SO MEO NE EL SE
W I T H A N E ATI NG DISO R DER (JA N 2019–DEC 2020)
100
90
n=1813
80
70
60
50
40
30
20
10
0
Would Recommend Would Not Recommend
11PoC: LGBTQ+ Clients
Statistics show that eating disorders are much more prevalent in the LGBTQ+
32% of Alsana clients
community than in the general population.
identify as LGBTQ+
For a space to be truly suitable for healing, it must be more than physically safe and generally respectful.
It must be affirming, intentional, and compassionate— taking safety and respect to a new level so that those
who are most vulnerable get the care and support they need in an environment that is built to meet each
unique client where they are in recovery.
At Alsana, all of our in-person and virtual programs are inclusive, welcoming all genders and sexual orientations.
Clients who identify as LGBTQ+ are never segregated. Every client is embraced and appreciated as an integral
part of our eating recovery community.
Clients in this group were asked if they agreed with the following LGBTQ+-specific PoC statements:
• “I would describe Alsana
as an accepting and LG BTQ* P ER CEPT IO N O F CA R E JA N 2020–DEC 202 0
affirming environment.” Agree Do Not Agree
• “I was able to show up 120%
n=316
authentically and be
100%
respected.”
• “My gender identity was 80%
respected and affirmed
at Alsana.” 60%
• “My sexual identity was 40%
respected and affirmed
at Alsana.” 20%
• “I would recommend this 0%
facility to other individuals Recommend Accepting Authentic and Gender Identity Sexual Identity
to Others and Affirming Respected Respected Respected
seeking treatment for an and Affirmed and Affirmed
eating disorder.” *32% of Alsana clients identify as LGBTQ+.
At Alsana, we are committed to nurturing a
treatment environment that’s not only accepting but
affirming and healing for people of all genders and
sexual identities. Many members of the LGBTQ+
community- a community that experiences eating
disorders at a rate significantly higher than that of
the general population- face stigma, discrimination,
and other access-to-care barriers before finally
finding the life-saving care they need. We design our programs to be inclusive,
supportive, and safe for all clients, including LGBTQ+ individuals whom we
embrace as valued members of our eating recovery community.”
– ALLISON BURNETT, LICSW, CEDS, National Director of Alumni and Advocacy
12PoC: Virtual Programs Clients
In 2020, social distancing and quarantines created an abundance of circumstances in which virtual services
made the most sense for many clients with the appropriate medical acuity to receive care remotely. Alsana is
proud to offer flexible, virtual IOP and PHP services to clients across the United States. These programs are
designed in alignment with our Adaptive Care Model, offering meal support, yoga, group and one-on-one
therapy, and more — all within the safety and comfort of the home environment.
Virtual clients receive the same high level of personalized care in virtual treatment as our in-person care.
These virtual options have not replaced our in-person treatment offerings but provide much-needed flexibility
to help us meet our clients’ diverse schedules and needs. Virtual programs also created additional space in our
in-person programs for growing amount of clients needing that level of care.
V I RTUA L P H P /I O P * P E RCEPT IO N O F CA R E A P R IL 2020–DEC 2020
Agree Do Not Agree
120%
n=60
100%
80%
60%
40%
20%
0%
Recommend Engaged in Virtual fit my Virtual deliverd Virtual offered Virtual services
to Others virtual services needs better adaptive care unique were more or
experience just as helpful
*Virtual PHP/IOP opened in April 2020. Virtual Services were offered as an additional option for clients. Brick and mortar PHP/IOP
remained open throughout the pandemic.
Clients in this group were asked if they agreed
with the following Virtual-specific PoC statements:
• “I felt engaged in treatment delivered virtually.”
• “Virtual services fit my schedule and needs better
than in-person services.”
• “Virtual services were able to deliver comprehensive
and adaptive care.”
• “Virtual services offered a unique experience by
allowing me to be at home and continue to work on
my eating disorder in that environment.”
• “Virtual services were just as helpful or more helpful
Chef Christine Gonzales teaches a
than in-person services.” Virtual PHP client about jackfruit and
how to use it in a recipe.
13Featured Content – How COVID Impacted Eating
Disorders Treatment: The COVID Coefficient
E ATI NG DI S O RDE R E XA MINAT IO N QUEST IO NNA IR E SCO R ES:
A P R IL-DECEMBER
— 2019 - no trauma — 2019 - trauma -- 2020 - no trauma -- 2020 - trauma
4.5
4
3.5
3
2.5
2
Admission Discharge
The figure shows that clients without trauma fared almost precisely as they did in 2019. However, the clients
with an existing history of trauma responded very differently to treatment. Specifically, their EDEQ scores were
a bit higher at discharge. This provides valuable context for the slight bump in our outcome scores.
Trauma: The COVID Coefficient Stabilization of trauma symptoms may need to be a
first-line intervention for clients during the COVID-19
Understanding the impact of COVID on eating pandemic. Emotion regulation skills, resource
disorder symptoms and interventions for installation, somatic-based interventions, and distress
treatment. *These findings were featured at tolerance techniques may be beneficial for these
clients early in treatment. Additionally, an exploration
IAEDP’s 2021 Virtual Symposium
of how COVID intensifies long-standing negative
trauma-related core beliefs is recommended.
The COVID-19 pandemic has had a psychological
impact resulting in an escalation of mental health Eating disorder and trauma symptoms were higher at
symptoms. Although all mental health disorders admission in 2020 than in 2019. Although the rate of
have been negatively impacted by COVID-19, eating improvement in symptoms was the same during the
disorders are significantly affected. Specifically, emergence of the COVID pandemic and in 2019,
COVID-19 has exacerbated eating disorder eating disorder symptom scores at discharge were
symptoms, impacted the delivery of treatment, elevated in 2020 compared to 2019, which appears
and may interfere with treatment effectiveness. to be a function of trauma symptoms. We coined this
the COVID Coefficient and suggested that individuals
with a history of trauma have an escalation of
The COVID Coefficient was revealed through
trauma-related symptoms in the wake of COVID,
data analysis of 2020 compared to 2019 and which may exacerbate their eating disorder
demonstrated that eating disorder symptom symptoms. This may slow recovery, ostensibly
exacerbation is a function of an escalation in because clients need their eating disorder to cope
trauma symptoms. with their trauma-related symptoms.
14®
We are grateful to be part
of your eating recovery community.
alsana.com 866-651-7129 linkedin.com/company/alsana/
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