The level system at Clementine was created to demonstrate clear markers of progress along multidimensional domains of treatment. Each level is structured with certain privileges and ways to challenge the eating disorder through activities, assignments and collaboration. Designed for adolescents to gradually take increased responsibility with food, thoughts and feelings as they progresses in treatment, the Level System supports development of personal responsibility while allowing the treatment team, family, outpatient providers to “speak the same language”.
Each week, adolescents will receive and fill out “contracts” during pre-contract group. These contracts contain accomplishments as well as mood and cognitive, family and relationship, nutritional and educational goals for the upcoming week. These contracts will reflect the level the adolescents is at, and will provide clarity for the adolescents and treatment team, as well as the family and outpatient providers.
The first level in the Clementine Level system is Entry Level. During this time adolescents are getting acquainted with, and oriented to, our program. While on this level, they will have initial meetings with our treatment professionals for medical, psychiatric, nutritional and psychosocial assessments. Entry Level gives us time to get to know an adolescents and what her individual needs will be as well as the family and what their familial needs are.
This level is about stabilization and engaging in treatment. Nutritionally, staff will continue portioning for the adolescents, according to their meal plan and options. Adolescents are asked to follow the rule of 100% meal and snack completion; otherwise a supplement will be given. Exercise at this level is usually limited to short walks and yoga for stretching, as approved by the team.
On Level 2, our adolescent girls are likely to more engaged in the treatment process although they may still struggle with motivation at times. They are encouraged to show flexibility with their snack choices at this level and are also encouraged to experiment with under and over-portioning challenges when deemed appropriate by their dietitian to do so. The criteria for participating in certain activities, such as passes, will depend on current functioning and engagement in treatment as evaluated by the treatment team.
Level 3 adolescents demonstrate a feeling of mutual trust with the treatment team and share an understanding of what is needed and desired as they move toward living a more satisfying life. They will gradually move towards self-portioning all of their meals and snacks. Exercise for Level 3 will include walks, yoga for stretching and strengthening and potentially adjunctive additional exercise as determined appropriate by the treatment team.
They should have gained psychological insight and understanding of their eating disorder and its underlying causes. Adolescents at this level should have a range of appropriate coping skills they can use and should be able to know when to ask for help from the staff or family. On Level 4, adolescents will be demonstrating the ability to prepare and portion their meals and snacks appropriately. Adolescents may have on and off-site meal challenges and passes to prepare them for a lower level of care. Exercise on Level 4 may include exposures or passes not otherwise included in the previous levels; this may include a type of movement that an adolescent may return to upon leaving treatment or family exercise passes when appropriate.