Regence BlueCross BlueShield of Oregon Clinical Practice Guidelines - Mental Health and Chemical Dependency Treatment

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Clinical Practice Guideline - Mental Health and Chemical Dependency Treatment

Topic: Mental Health and Chemical Dependency Treatment	Date of Origin: January 2007
Revised/Effective Date: June 2009	Next Review Date: June 2010

Recommendation Summary:

Regence supports the use of practice guidelines to assist in determinations of the clinical appropriateness of treatment services provided for the mental health and chemical dependency disorders and conditions listed below. The practice guidelines describe generally accepted practices and were developed by nationally recognized organizations.

ADULTS:	CHILDREN/ADOLESCENTS:
Alzheimer's Disease and Other Dementias of Late Life (PDF)	Attention-Deficient Hyperactivity Disorder (ADHD) (PDF)
Bipolar Disorder (PDF)	Anxiety Disorders (PDF)
Borderline Personality Disorder (PDF)	Autism/Other Development Disorders
Eating Disorders (PDF)	Bipolar Disorder (PDF)
Major Depressive Disorder (PDF)	Conduct Disorder
Obsessive Compulsive Disorder (PDF)	Depressive Disorders (PDF)
Panic Disorder (PDF)	Obsessive Compulsive Disorder
Post Traumatic Stress Disorder (PTSD) (PDF)	Substance Use Disorders (PDF)
Schizophrenia (PDF)	Suicidal Behaviors
Substance Use Disorders (PDF)
Suicidal Behaviors (PDF)

Key Points:

Regence endeavors to ensure that treatments provided to members are evidence-based and offer the greatest probability of a favorable outcome
The following practice guidelines addresses 20 specific disorders or conditions that have considerable impact on the psychiatric practice. These guidelines provide suggested practice guidance and reflect the most current standards of practice for the management and treatment of various behavior and mental health conditions.

Assessment
The guidelines reflect current practice standards for management and treatment for the specific conditions by nationally recognized medical associations. Scientific evidence and references are provided to base recommendations, but methods that were used to systematically review and critically appraise the literature are not readily transparent. Some the listed guidelines are not updated annually. Therefore a crucial aspect in applying the guidelines is to ensure there is consideration of new or evolving research regarding established treatments/management.
Guideline	Sponsoring Organization	Revised Date	Well defined literature search ^a	Critical Appraisal Methods^b	Strength of evidence for recommendations clearly stated? ^c	Sources of Funding ^d
Alzheimer's Disease and Other Dementias of Late Life	American Psychiatric Association	10/2007	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest disclosed. No other funding source provided.
Bipolar Disorder	American Psychiatric Association	04/2002 (update in 11/2005)	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Borderline Personality Disorder	American Psychiatric Association	10/2001 (update in 03/2005)	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Eating Disorders	American Psychiatric Association	June 2006	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Major Depressive Disorder	American Psychiatric Association	April 2000 (update in 09/2005)	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Obsessive Compulsive Disorder	American Psychiatric Association	July 2007	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest disclosed. No other funding source provided.
PTSD	American Psychiatric Association	November 2004	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Schizophrenia	American Psychiatric Association	February 2004	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Substance Use Disorders	American Psychiatric Association	August 2006 (Update in 04/2007)	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Suicidal Behaviors	American Psychiatric Association	November 2003	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
ADHD	American Academy of Child and Adolescent Psychiatry	July 2007	Criteria for literature search vague or not reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest disclosed. No other funding source provided.
Anxiety Disorders	American Academy of Child and Adolescent Psychiatry	February 2007	Criteria for literature search vague or not reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest disclosed. No other funding source provided.
Autism/Other Development Disorders	American Academy of Child and Adolescent Psychiatry	December 1999	Criteria for literature search vague or not reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Bipolar Disorder	American Academy of Child and Adolescent Psychiatry	January 2007	Criteria for literature search vague or not reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest disclosed. No other funding source provided.
Conduct Disorder	American Academy of Child and Adolescent Psychiatry	October 1997	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Depressive Disorders	American Academy of Child and Adolescent Psychiatry	2007 (in press)	Criteria for literature search vague or not reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest disclosed. No other funding source provided.
Obsessive Compulsive Disorder	American Academy of Child and Adolescent Psychiatry	October 1998	Criteria for literature search well defined and reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Substance Use Disorders	American Academy of Child and Adolescent Psychiatry	June 2005	Criteria for literature search vague or not reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
Suicidal Behaviors	American Academy of Child and Adolescent Psychiatry	July 2001	Criteria for literature search vague or not reproducible	Appraisal methods were not described.	Unclear when recommendation is based on clinical study evidence or on consensus opinion.	Conflicts of interest and/or funding sources were NOT provided
^aRecommendations are based on a well-defined scientific literature search. ^bWhat methods were used to critically appraise the evidence supporting guideline recommendations and how transparent were they. ^cDo the guidelines clearly state the strength of the evidence for which recommendations are based. ^dAre the sources of funding listed? ^eRecommendations are given one of three grades: [I] Recommended with substantial clinical confidence, [II] Recommended with moderate clinical confidence, or [III] May be recommended on the basis of individual circumstances. The criteria for assigning these grades is not transparent.

Guideline Adoption and Recommended Use:

These guidelines have been adopted based on nationally recognized sources. This guideline is based on the most recent medical evidence or a consensus on clinical treatment patterns by physicians in the selected field of practice. Regence adopts guidelines to help practitioners and members make decisions about appropriate health care for specific conditions. Guidelines are not a substitute for professional medical advice.

Benefit Determination:

Benefit determinations should be based in all cases on the applicable contract language. To the extent that there are any conflicts between these guidelines and the contract language, the contract language will control.

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