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At Clementine, we believe it is of utmost importance to demonstrate the effectiveness of our programs through data collection and research. Beyond asking clients to report on how helpful and satisfied they were with their treatment experience, we have conducted a study examining measurable and meaningful changes in weight and clinical symptoms.
We also believe it is important to demonstrate treatment outcomes beyond weight restoration. Effective treatments must also address the core psychological and behavioral symptoms of the eating disorder, which have an extensive impact on the lives of our patients and their loved ones. We conducted another study that examined symptom change in a subset of patients who participated in our residential and/or partial hospitalization program LOC. Importantly, the sample included patients with a diagnosis of Anorexia Nervosa and Bulimia Nervosa. Our data analysis also revealed clinically and statistically significant symptom reduction (depression and eating disorder symptoms) and improved quality of life from admission to discharge. Please see additional findings below.
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Dr. Tim Brewerton is a Senior Advisor for Clementine Programs and a Co-Principal Investigator as approved by the Institutional Review Board, which ensures our research is conducted in accordance with all federal, institutional and ethical guidelines. Dr. Brewerton consults with our clinical leadership team on our research and outcome assessment protocols. A specialist and recognized expert on trauma and substance abuse, Dr Brewerton also provides supervision to clinicians trained in Cognitive Processing Therapy and consults with us on developing and enriching our treatment programming for our clients with complex co-occurring presentations.
In 2018 Monte Nido and Affiliates began a comprehensive research study, approved by an Institutional Review Board, in order to assess treatment outcomes in our programs. Specifically, our Clementine patients who consent to participate in our research study complete a series of questionnaires upon admission, transfer to a new level of care (stepping up or down), as well as upon discharge from the program. Additionally, we obtain follow-up data for patients who consent at specified time-points after their discharge.
The purpose of these questionnaires is multifaceted. Primarily, it represents our commitment to personalized treatment planning. This data provides a snapshot of each patient’s distinctive symptom presentation on measures of eating disorder symptoms, depression, anxiety, functional impairment, and trauma reactivity. This information deepens our understanding of the clinical challenges specific to each patient and as a roadmap for exploration of the factors that may be maintaining the eating disorder.
Eating Disorder Symptoms
Eating Disorder Symptoms were measured using the Eating Disorder Examination Questionnaire (EDE-Q). Results indicate that on average, Clementine patients experienced clinically and statistically significant reductions in eating disorder symptoms from admission to discharge.
On average, patients presented at admission with severe eating disorder symptoms relative to adolescent female community norms. Upon discharge, average patient scores on the EDE-Q were significantly reduced on all scales, suggesting clinically meaningful improvements. The graph below provides mean admission and discharge scores at Clementine in comparison with community norms.
Eating disorder symptomology was also assessed using The Eating Disorder Inventory (EDI-2).
Results indicate that Clementine patients demonstrated statistically significant reductions at the p < 0.01 level on scales assessing Body Dissatisfaction, Bulimia, Drive for Thinness, Interoceptive Awareness, Ineffectiveness, Interpersonal Distrust, Maturity Fears and Social Insecurity. Additionally, scores demonstrated statistically significant reductions at the p < 0.05 level for the scale measuring Ascetism.
Below see graphs comparing admission and step-down/discharge scores to those of female college students without an eating disorder diagnosis as well as sample of adults diagnosed with an eating disorder. Of note, in order to most accurately compare our patients’ scores with the EDI-2 eating disorder norming sample, we did not include patients diagnosed with ARFID or BED in these specific analyses.
Depression and Anxiety
Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9), a nine-item, validated tool used for screening and measuring the severity of depression. Overall, results show clinically and statistically significant depression symptom reduction for our Clementine patients.
Symptoms of anxiety are measured using the Screen for Child Anxiety Related Disorders (SCARED), a 41-item, validated self-report instrument used to screen for childhood anxiety disorders. This tool generates a Total Score and 5 Factor scores: Panic Disorder or Significant Somatic Symptoms, Generalized Anxiety Disorder, Separation Anxiety, Social Anxiety Disorder, and Significant School Avoidance. Scores indicated that Clementine patients experienced statistically significant reductions in overall anxiety from admission to discharge (as measured by the total score), as well as on factors of generalized anxiety and separation anxiety.
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Find out more about our unique approach to eating disorder treatment and recovery.