local.
if you don't address all of the issues and strive for overall stability, it will be hard to achieve nutritional stability. while clearly eating/drinking are the immediate problem at hand, everything needs to be addressed to solve it.
an NG tube can be done anywhere--it doesnt necessitate going across the country. (a parent can be taught to do even), and although you didnt ask, *i* think thats a pretty tramatic and invasive option for someone with anxiety to begin with, quite frankly, it actually *does* irritate your nose/throat, and it can be a notorious pathway for a variety of infections (i'm envisioning a ramping of of anxiety, which actually might have a legitimate component, and a girl who cried wolf too many times, and the mess that could follow, if that makes sense). CLEARLY, it is a necessary evil if someone is in need of nutrition, so don't misunderstand--it would be a medical decision, one of which that actually *is* the lesser of all evils for the short term. it can be one of the most important nutritional techniques used, in conjunction with intensive therapy, in the nutritionally unstable. but its still only one tool.
but i would focus on the big picture. it would seem to me that any place, medical or psychiatric based, would assess for full nutritional needs and determine if medical hospitalization/Nasogastric feeding is in order--that would probably be the very first question i'd have for local. i'd personally be leary of someone who takes an absolute approach without ever having seen your difficult child....one size does not fit all.
i know you tried to call the psychiatrist, but maybe try again and see if he has any other suggestions on the east coast for inpatient services. while phobia might be rare, anorexia/bulima issues arent, and theoretically, a good program would have the medical/psychiatric services available, and theoretically, would tailor services to the need of the patient. thats a big theoretical, but it cant hurt to make a few more calls.
when i think of feeding (admittedly, more for mechanical issues, but even mechanical based prog's have a psychiatric component) i think immediately of CHOP and Cleveland Rainbows and babies. what their psychiatric/eating progs look like, I don't know. i do know CHOP has some sort of anorexia impatient deal....i would guess if you called for info and it was appropriate for your difficult child, your pediatrician could expedite getting you in. i'm sure you have zero strength to make yet another dead end phone call but it can't hurt at this point.
would beat flying 7 hours away. and i'm also going to say this....i dont know anything about ore, but if any program is promising you a fix in X amount of time, i'd be very leary. no one has a crystal ball...i'd just hate to see you plan on a ~month stay and it end up being much longer than expected.
thinking of you.
