ABSTRACT

Clinical guidelines for the treatment of anorexia nervosa (AN) converge in recommending treatment in the least restrictive environment (i.e. outpatient or day patient care), reserving hospital admission for those at risk of medical and/or psychological compromise (American Psychiatric Association, 2006; Beumont, Hay, & Beumont, 2003; Hay et  al., 2014; National Institute for Clinical Excellence, 2004). According to these guidelines, a higher level of care (HLC) such as inpatient treatment is warranted when specific medical, psychiatric, and social situations arise, such as acute medical instability relating to the complications of malnutrition, suicidality, severe family environment or social problems, and a decline in weight despite maximally intensive outpatient care. As described elsewhere in this volume (Kirby, Runfola, Fischer, Baucom, & Bulik, 2016), UCAN (Uniting Couples in the treatment of Anorexia Nervosa; Bulik, Baucom, Kirby, & Pisetsky, 2011) is a 22-session treatment for patients with AN and their partners that integrates cognitive-behavioral couple therapy and cognitive-behavioral therapy for AN. UCAN is provided in conjunction with individual therapy, nutritional counseling, and medication management to ensure treatment appropriately addresses all elements of the disorder. UCAN reflects the clinical guidelines mentioned above by delivering multidisciplinary care and is an example of maximally intensive outpatient treatment. Even during the course of such intensive intervention, the need for HLC can emerge. In the following sections, we discuss the strategies used in UCAN focal to HLC decisions. Specifically, we present techniques used to orient couples to the concept of HLC, prevent HLC, address when HLC is imminent, and facilitate the transition to and from HLC. (For additional detail on the UCAN program, see Bulik et al., 2011; Fisher, Kirby, Raney, Baucom, & Bulik, 2015).