November 19, 2011 Jeanne Rust

Mirasol is Light Years Ahead of Any Other Program

Enthusiastic CARF surveyors said July 23, 2010, "Mirasol is light years ahead of any other program in the country." Continuing they said, that in all of their years working in the mental health field, they had never seen a program as excellent as what we do at Mirasol.

CARF, a national accrediting agency that examines and awards accreditation to more behavioral health facilities than any other agency, examines Mirasol every three years. A CARF endorsement means that a program's policies and standards meet the highest possible criteria of excellence. An accreditation by CARF is proof of excellence in all areas of a facility.

Last Thursday and Friday two CARF surveyors arrived. Both of them were long-time inspectors. One member of the team was an RN with 30 years of experience in the mental health arena. The other was a man with behavioral health experience as a social worker but also an experienced surveyor having done surveys for CARF for over 25 years.

When the survey was over, our management team and the surveyors gather round for "the" report. The entire staff had worked for months making sure that we had everything ready. After the CARF people gave their report, I was stunned. I knew that we had an excellent program. I knew we were really good, but I didn't imagine in my wildest dreams how good we are!

Basing their comments on our outcome data and after viewing our treatment at the units they said our treatment was like magic.

I have never wanted to play the game of outcomes. "Mine is better than yours. " "No, mine is much better........ " Statistics can be manipulated and when I hear someone claiming a success rate of 92% at a year, I know it's not true.

The CARF team made me promise that I would share some of our numbers with our stakeholders which are all of you!

When someone enters treatment, we do quite a lot of psychological testing. Two of the most important psychological instruments we administer are the Eating Disorder Inventory-III and the Beck Depression Inventory.

I'm going to give you all of this information just as we gave it to the surveyors. It's rather complicated but you can read the numbers – I'll help.

The Eating Disorder Inventory 3 (EDI-III) is the third edition of a test that reports in multiple scales. The test consists of 91 questions answered in terms of frequency of behaviors from always to never.

Reports consist of 21 separate scales; three are validity scales, four are eating disorder risk and composite scales, nine are psychological scales, and five are psychological composite scales. Results are presented as percentiles for all, anorexia, bulimia, and EDNOS diagnoses.

For simplicity of reporting percentiles of two risk scales/composite scores are used, each chosen for broad-based relevancy to Mirasol's program, the Eating Disorder Risk Composite (ERDC) and the Global Psychological Maladjustment Composite (GPMC).

In addition, the 9 psychological scales, including Low Self-Esteem (LSE), Personal Alienation (PA), Interpersonal Insecurity (II), Interpersonal Alienation (IA), Interoceptive Deficits (ID), Emotional Dysregulation (ED), Perfectionism (P), Ascetism (A), and Maturity Fears (MF).

These will all be compared for pre and post scores for the total, anorexic, bulimic, and EDNOS populations.

B Results: The information presented in the following chart is based on residents who completed the program during the years of 2007, 2008, 2009, and through June 2010.
You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You'll see that the scores progressively get lower – meaning that our patients are getting a lot better!
Now do the same for the GPMC.

You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You'll see that the scores progressively get lower – meaning that our treatment is more and more effective and our patients are getting a lot better!
Now do the same for the GPMC.

Risk Scales and Composite Scores

2007 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 22) 53.27 28.00 56.55 31.45
Anorexia (N = 9) 64.89 47.67 63.89 45.78
Bulimia (N = 13) 45.23 14.38 51.46 21.54
2008 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 34) 54.06 21.50 54.44 25.21
Anorexia (N = 11) 62.18 37.18 56.64 28.18
Bulimia (N = 20) 44.70 9.40 50.35 19.85
EDNOS (N = 3) 86.67 44.67 73.67 50.00
2009 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 20) 49.35 13.60 49.35 18.15
Anorexia (N = 3) 61.67 40.67 52.00 36.00
Bulimia (N = 13) 41.85 3.46 52.08 13.54
EDNOS (N = 4) 64.50 26.25 38.50 19.75
2010 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 11) 46.10 11.82 44.00 10.27
Anorexia (N = 6) 42.33 17.5 31.83 14.17
Bulimia (N = 5) 50.60 5.00 58.60 5.60

Here are the results for the individual scales as named above. Take a look at the self-esteem scores – pre and post 2007, 2008, 2009, 2010. The improvement is substantial with lower scores each consecutive year.

Psychological Scale Scores
2007
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 22) 56.5 30.6 53.6 31.0 51.2 32.8 62.6 50.5 58.3 29.1 62.8 48.5 57.0 42.3 57.2 39.1 56.0 44.6
Anorexia
(N = 9) 60.7 45.1 59.9 45.6 50.2 38.6 69.9 53.1 59.2 39.8 66.2 58.0 67.7 53.2 63.6 49.6 66.2 56.3
Bulimia
(N = 13) 53.7 20.6 49.2 20.8 51.9 28.8 57.5 48.7 57.6 21.8 60.4 41.8 49.5 34.7 52.8 31.9 49.0 36.5

2008
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N =34) 59.2 26.6 54.7 23.6 54.0 34.4 60.1 43.2 56.3 25.7 51.6 43.4 56.5 45.2 45.8 24.0 55.1 34.2
Anorexia
(N = 11) 68.1 30.8 62.3 26.0 58.9 42.1 59.5 44.5 55.8 26.2 45.3 34.8 59.5 54.3 41.3 21.0 59.5 45.8

Bulimia
(N = 20)
52.2
21.4
47.7
19.5
50.5
26.1
57.8
39.3
54.1
21.0
53.6
44.4
50.7
38.6
45.9
23.5
54.5
27.5
EDNOS
(N = 3) 73.7 46.3 74.0 42.0 59.0 62.0 77.3 64.7 73.3 55.7 61.7 68.3 84.3 56.7 62.3 38.7 43.3 36.0

2009
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 20) 47.8 17.7 53.1 18.9 46.5 27.8 53.9 34.7 58.5 22.8 50.9 35.5 52.7 39.0 50.5 18.3 43.9 35.7
Anorexia
(N = 3) 44.0 41.0 52.7 37.7 61.7 62.0 42.7 39.3 81.0 45.0 38.0 41.7 41.3 27.3 51.3 28.0 58.3 67.7
Bulimia
(N = 13) 52.8 13.2 59.0 15.4 46.5 19.9 61.3 38.1 55.5 18.6 54.9 33.2 52.1 35.4 45.6 14.3 46.5 31.5
EDNOS
(N = 4) 34.3 14.5 34.3 16.0 35.0 27.8 38.0 20.0 51.3 19.5 47.5 38.3 63.0 59.5 65.5 24.0 24.3 25.3
2010
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 11) 47.4 15.2 47.6 14.4 40.8 14.6 55 24.9 50.6 16.2 47.2 22.8 52.5 31.8 38.8 14.2 45.5 21.3
Anorexia
(N = 6) 32 19 32.7 19.3 34.5 17.3 56.3 34.7 49.3 16.5 38 19.5 43 25.8 30.5 21 37.8 21.5
Bulimia
(N = 5) 65.8 10.6 65.6 8.4 48.4 11.4 53.4 13.2 52.2 15.8 58.2 26.8 63.8 39 48.8 6 54.8 21

Last but certainly not the least is one of my favorite tests, the Beck Depression Test. It's short, only 21 questions, and highly accurate. The client answers the questions on a scale of 0 to 3, with three indicating the strongest symptoms and the 0 indicating few symptoms. Most of the clients who admit to Mirasol are severely depressed when they come in.

Look at these scores, pre-treatment and post-treatment from 2007, 2008, 2009, 2010. The post treatment scores show that there is very few, if any, depressive symptoms existing. All of the patients have greatly improved feelings of well-being.
2007 Results Pre BDI Post BDI
ALL (N = 23) 34.26 18.13
Anorexia
(N = 9) 41.00 26.33
Bulimia
(N = 14) 29.93 12.86
2008 Results Pre BDI Post BDI
ALL (N = 34) 31.50 13.03
Anorexia
(N = 11) 35.45 16.00
Bulimia
(N = 20) 27.85 10.00
EDNOS
(N = 3) 41.33 22.33
2009 Results Pre BDI Post BDI
ALL (N = 19) 30.42 7.89
Anorexia
(N = 3) 28.67 17.00
Bulimia
(N = 12) 31.42 7.25
EDNOS
(N = 4) 28.75 3.00
2010 Results Pre BDI Post BDI
ALL (N = 12) 29.83 10.5
Anorexia
(N = 6) 25.67 12.17
Bulimia
(N = 6) 34 8.83

I hope to keep reporting outcome information quarterly as well as reporting long-term outcomes. We have found that our treatment results are long lasting – at one year, 70% of our clients are still in recovery. This does not mean that they have not slipped a time or two, but because of our Focused Continuing Care, the slips have been very short lived.