boillingvegsmallCarrie had never been in residential treatment before. She had a long history of treatment in the inpatient and partial levels of care, but found herself missing crucial life skills, including meal preparation, primarily taught in the residential level of care. When her insurance changed and she finally had the benefit, she decided to give residential a try.

At Walden, the residential level of care (or resi, for short) is housed in apartments, a setting that allows clients to practice life skills necessary for success once they leave the 24-hr level of care. Walden’s adult resi is very unique, in that it requires all clients to prepare their own meals and snacks throughout the day. Learning to plan and cook for oneself is crucial for life post-treatment, and resi provides the opportunity for clients to prepare meals in a supportive environment. Resi meals are different than other levels of care. In the inpatient level of care, meals are placed on the tables in the dining room so when clients walk in, their food is right there and ready to be eaten. In the partial and intensive outpatient levels of care, clients must prepare their own meals while keeping portability in mind as they need to bring food to prep from home. But in resi, clients can truly cook.

Teaching

Carrie and her dietitian sat together for their first meeting. Carrie explained that she really does not know how to cook food, and was hoping she could learn to make some simple meals while in resi. Together, Carrie and her dietitian planned out a meal, a stir fry, which she could make with the help of a mental health counselor.

The task of teaching a client to meal plan and cook are the responsibility of the client’s dietitian and the mental health counselors (MHCs). If a client is struggling to prepare meals, their dietitian will help plan some simple meals to try first. The dietitian works with the client to brainstorm meals that are reasonable for the client’s level of comfort with meal prep, and also takes into account safe and challenge foods. Dietitians love recipes, so the resi recipe binder is another resource clients can pull from for meal ideas.

Preparation and Challenges

Meal prep in resi is typically under the supervision of MHCs. Clients can ask MHCs for assistance with meal ideas and how to prepare certain food items before or during prep time. Two of the greatest challenges during meal prep in resi are time and space. One hour is allotted for each meal, which includes roughly 30 minutes of preparation and 30 minutes to eat. Not all foods, especially for dinner, can be prepared in 30 minutes, so when the dietitian and the client plan meals together, they always take timing into account. Also, although the resi apartment kitchens are very lovely, sometimes it can be hard for everyone to cook at the same time. When clients are further along in treatment and feel ready to try a meal on their own, they can have passes to cook in a kitchen alone, which then allows them to make other, more elaborate meals, if they so choose.

In the milieu, clients can also learn from one another. Often times, there are 2-3 clients who feel very comfortable in the kitchen and love to bake or cook for others. These clients have the opportunity to pair up with others and prepare shared meals for the community. In resi, shared meals are recipes chosen by the community, one each for breakfast, lunch, dinner, and dessert, which clients prepare for everyone throughout the week. These meals provide the opportunity for clients to try new foods, which may also be challenging for them, but to do so and tackle the challenge together.

Why it’s better

There are certainly arguments for and against having clients, who are working to recover from their eating disorders like anorexia, prepare their own food. Some residential treatment programs have chefs who prepare all the meals and serve food cafeteria style, while other programs have level systems where a client starts by having chef-prepared meals and slowly progress to having clients cook for themselves. Walden’s residential program model stresses the fact that our clients will ultimately leave the 24-hr level of care and need to be prepared to return to their own kitchens, and feel comfortable and confident enough to make their own meals.

With the one-on-one help of a MHC, Carrie learned how to stir fry tofu and vegetables, and cook rice to complete the meal. Throughout the remainder of her time in residential, she practiced this recipe twice more, and was open to trying other new simple meal preparations. Carrie left residential feeling more confident about her abilities to prepare food for herself at home.

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About the author

KG RD PhotoKatie Gustamachio received her BS in Nutrition from the University of Massachusetts – Amherst, and completed her dietetic internship at Saint Louis University, in St. Louis, Missouri. After her internship, she worked at several acute care hospitals, including Beth Israel Deaconess Hospital – Plymouth, and St. Vincent’s Hospital in Worcester. Katie has been a dietitian at Walden Behavioral Care since December 2013, working primarily with the adults in Waltham’s residential and partial programs. More recently, Katie has transitioned out of residential and will be working with both adults and adolescents in Waltham’s partial program. In her free time, Katie enjoys baking, spending time with friends, and traveling.