By: Keesha Amezcua, LMFT, CEDS-C, and Jordan Watson

Outpatient Providers: Clients’ NorthStar in Eating Disorder Recovery

Outpatient providers are crucial characters in their clients’ recovery stories. They notice early signs of eating disorder symptoms, initiate care and family involvement, and walk alongside clients as they begin the difficult work of recovery.

For individuals recovering from eating disorders, outpatient providers often serve as trusted guides: helping to build safety, introducing new coping strategies, and offering support through moments of ambivalence and change.

Studies show that strong therapeutic alliances are associated with better engagement, and greater treatment satisfaction in eating disorder care (Graves et al., 2017). These alliances, most often established in outpatient settings, can become the foundation for long-term healing.

Because outpatient providers offer essential continuity and connection, their therapeutic relationship with clients should be preserved—even when a higher level of care is needed.

Referring Clients to Higher Levels of Care: Common Provider Concerns

Continuity of care is widely recognized as a critical factor in behavioral health outcomes—and eating disorders are no exception. Unfortunately, admission to a treatment program is often viewed as a hand-off, with outpatient providers sidelined until their client is ready for discharge.

Outpatient providers may have a range of concerns when referring clients to higher levels of care, including:

• Losing contact with their client during treatment
• Being excluded from treatment planning or team communication
• Not receiving timely updates on client progress
• Uncertainty about how and when to reintegrate into the care team
• Concern that their established therapeutic relationship may be disrupted or devalued
• Worry that the client will feel abandoned or confused by the transition
• Lack of clarity around how their clinical insights will be incorporated
• Fear that inconsistent care may undermine recovery progress

Key Areas of Collaboration Between ED Clients’ HLOC and Outpatient Teams

Clinical Alignment at Admission

Clinical alignment between outpatient providers and higher levels of care is essential for promoting treatment continuity, reinforcing therapeutic progress, and reducing the risk of fragmentation—a known barrier to recovery.

When clinical alignment is prioritized, it extends beyond general coordination—it means outpatient providers are actively informing key aspects of treatment. At the time of referral, they are the clinical authority on the client’s presentation, context, and progress to date. Outpatient provider level of care recommendations are not merely suggestions. They reflect a nuanced understanding of risk, readiness, and therapeutic needs and should be respected as such. 

Similarly, outpatient provider involvement in shaping treatment goals helps ensure that care at higher levels builds on existing progress rather than replacing it. When outpatient insight is integrated from the start, clients are more likely to experience treatment as a continuation of their recovery—not a disruption.

Ongoing Coordination, Treatment Through Discharge

Research shows that disjointed transitions are associated with poorer outcomes, lower treatment adherence, and increased dropout rates in eating disorder treatment (Austin et al., 2022; Kazdin & Rabbitt, 2013).

When outpatient and HLOC teams collaborate effectively, clients are more likely to experience their care as cohesive and individualized, which enhances trust, supports engagement, and increases the likelihood of long-term recovery. It also ensures that treatment at higher levels builds on prior work rather than duplicating efforts or unintentionally undermining progress already made.

Because of this, outpatient provider involvement shouldn’t end once clients have been admitted. Ongoing collaboration is essential for continuity, therapeutic cohesion, and successful transitions across care settings.

Bridge sessions are one way this collaboration takes shape. These sessions give clients the opportunity to remain connected to their outpatient provider throughout treatment, while also reinforcing alignment between teams. When used intentionally, bridge sessions support treatment goals, reduce fragmentation, and help prepare clients for step-down by maintaining a sense of relational consistency.

This level of coordination is especially critical during discharge planning. Preparing for a seamless reintegration should begin on day one of treatment and requires meaningful collaboration with the outpatient provider, who will ultimately carry the work forward. 

When discharge is approached as a shared clinical effort, it leads to more cohesive transitions, clearer recommendations, and a smoother return to outpatient care.

Sustained Collaboration Beyond Discharge

Post-discharge care coordination is strongly associated with better outcomes across mental health settings. Studies have shown that early and sustained follow-up after discharge reduces rehospitalization, supports treatment adherence, and improves engagement in ongoing care. In the eating disorder field specifically, delayed or poorly coordinated transitions are associated with increased risk of relapse and dropout (Austin et al., 2022).

Structured post-discharge follow-up creates opportunities for share updates, identify emerging needs, and ensure that recovery continues to be supported across settings. It’s a simple but impactful way to help clients feel held, not dropped, as they move forward in their recovery journey.

Ongoing collaboration after discharge reinforces clinical continuity and helps protect the progress made during treatment. When HLOC teams stay engaged post-discharge—sharing updates, checking in with outpatient providers, and remaining available for coordination—it signals that recovery is a shared, long-term effort, not a handoff. That kind of consistency builds trust, strengthens outcomes, and helps clients stay connected to the recovery process through inevitable ups and downs.

Alsana Would Like to Partner With You in Supporting Your Client’s Eating Disorder Recovery

At Alsana, we believe eating disorder treatment at higher levels of care is most effective when it’s collaborative, continuous, grounded in the relationships clients value most, and deeply respectful of the work they’ve already done.  We aim to build on the foundation you’ve established in outpatient care—not replace it.

• our partnership with you begins at referral and continues beyond discharge
• your clinical insight will be valued
• your level of care recommendations will be honored
• you’ll be included in treatment planning and goal setting
• open communication and collaboration will be maintained throughout treatment
• we’ll work with you to coordinate smooth transitions at every stage of care
• you’ll be actively involved in discharge planning
• we’ll continue to follow up post-discharge to stay aligned and support your client’s ongoing recovery

If you’re ready to make a referral or have questions for our admissions team, call 866-376-0888.

References

Graves, T. A., et al. (2017). A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders. International Journal of Eating Disorders, 50(4), 323–340. https://doi.org/10.1002/eat.22672

Austin, A., Flynn, M., Shearer, J., Allen, K., & Richards, K. (2022). Delays and disruptions in eating disorder treatment: A rapid review of the evidence and recommendations for action. Journal of Eating Disorders, 10(1), 1–12. https://doi.org/10.1186/s40337-022-00671-1

Kazdin, A. E., & Rabbitt, S. M. (2013). Novel models for delivering mental health services and reducing the burdens of mental illness. Clinical Psychological Science, 1(2), 170–191. https://doi.org/10.1177/2167702612463566