Behavioral Health Clinical Practice Guidelines

Blue Cross and Blue Shield of Montana
Behavioral Health Care Management
Clinical Practice Guidelines 2022-2023

Clinical Practice Guidelines (CPGs) adopted by Blue Cross and Blue Shield are the foundation for the Behavioral Health Care Management Programs. Updates to CPGs are reviewed and adopted at least every two years.

If you have questions about the CPGs adopted by the health plan, contact us via email.

Select from the links listed below to view CPGs for behavioral health conditions:

Acute Stress Disorder and Posttraumatic Stress Disorder (PTSD)

•  Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder (2004) American Psychiatric Association
•  Guideline Watch (March 2009):Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder (2009) American Psychiatric Association
•  VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder (2017) Department of Veterans Affairs/Department of Defense
•  Post-traumatic Stress Disorder (2018) National Institute for Health and Care Excellence

Alzheimer's and Other Dementias

•  Treatment of Patients with Alzheimer's Disease and Other Dementias Second Edition (2007) American Psychiatric Association
•  Guideline Watch: Practice Guideline for the Treatment of Patients with Alzheimer’s Disease and Other Dementias  (2014)*
•  The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia  (2016) American Psychiatric Association
• Practice Guideline Update Summary: Mild Cognitive Impairment (2018) American Academy of Neurology
• Dementia: assessment, management and support for people living with dementia and their carers (2018) National Institute for Health and Care Excellence
• Neuropsychological Evaluation in Adults (2019) American Family Physician
• APA Guidelines for the Evaluation of Dementia and Age Related Cognitive Change (2021) American Psychological Association
• Objective subtle cognitive difficulties predict future amyloid accumulation and neurodegeneration (2020) Neurology

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) American Academy of Pediatrics
• Attention Deficit Hyperactivity Disorder: Diagnosis and Management (2018) National Institute for Health and Care Excellence
• Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder (2020) Journal of Developmental & Behavioral Pediatrics

Autism

• Practice Parameter for the Assessment and Treatment of Children and Adolescents with Autism Spectrum Disorder  (2014) American Academy of Child and Adolescent Psychiatry
• Autism Spectrum Disorder in Adults: Diagnosis and Management (2012) National Institute for Health and Care Excellence
• Practice Parameter: Screening and Diagnosis of Autism (2000) American Academy of Neurology
• Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research (2015) American Academy of Pediatrics
• Targeting Sensory Challenges in Children with Autism Spectrum Disorder-An Update (2017) Agency for Healthcare Research and Quality
• Identification, Evaluation, and Management of Children with Autism Spectrum Disorder (2020) American Academy of Pediatrics

Bipolar

• Practice Guideline for the Treatment of Patients with Bipolar Disorder Second Edition (2002) American Psychiatric Association
• Guideline Watch: Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2nd Edition (2005) American Psychiatric Association
• Evidence-Based Guidelines for Treating Bipolar Disorder: Revised Third Edition Recommendations from the British Association for Psychopharmacology (2016) Journal of Psychopharmacology

Depression

• Practice Guideline for the Treatment of Patients with Major Depressive Disorder Third Edition (2010) American Psychiatric Association
• Practice Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders (2007) American Academy of Child and Adolescent Psychiatry
• VA/DoD Clinical Practice Guideline for The Management of Major Depressive Disorder (2016) Department of Veterans Affairs/Department of Defense
• Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline from the American College of Physicians (March 2016) American College of Physicians
• Depression in Adults: Recognition and Management (first published 2009, updated April 2018) National Institute for Health and Care Excellence
• Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts (2019) American Psychological Association
• Depression in Children and Young People: Identification and Management (2019) National Institute for Health and Care Excellence
• Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management (2018) American Academy of Pediatrics
• Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management (2018) American Academy of Pediatrics

Eating Disorders

• Practice Guideline for the Treatment of Patients with Eating Disorders Third Edition (2006) American Psychiatric Association
• Guideline Watch (August 2012): Practice Guideline for the Treatment of Patients with Eating Disorders, 3rd Edition (2012) American Psychiatric Association
• Practice Parameter for the Assessment and Treatment of Children and Adolescents with Eating Disorders (2015) American Academy of Child and Adolescent Psychiatry
• Eating Disorders: Recognition and Treatment (May 2017) National Institute for Health and Care Excellence
• Identification and Management of Eating Disorders in Children and Adolescents (2021) American Academy of Pediatrics

General

• Practice Guidelines for the Psychiatric Evaluation of Adults (2015) American Psychiatric Association
• APA Guidelines on Evidence-Based Psychological Practice in Health Care (2021) American Psychological Association
• Practice Parameters for the Psychiatric Assessment of Children and Adolescents (1997) American Academy of Child and Adolescent Psychiatry

Generalized Anxiety and Panic Disorders

• Practice Guideline for the Treatment of Patients with Panic Disorder 2nd Edition (2009) American Psychiatric Association
• Clinical Practice Review for GAD (2015) Anxiety and Depression Association of America
• Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults (2015) American Family Physician
• Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders (2020) American Academy of Child & Adolescent Psychiatry

Obsessive Compulsive Disorder

• Practice Guideline for the Treatment of Patients with Obsessive-Compulsive Disorder (2007) American Psychiatric Association
• Guideline Watch (March 2013): Practice Guideline for the Treatment of Patients with Obsessive-Compulsive Disorder (2013) American Psychiatric Association
• Clinical Practice Review for OCD (2015) Anxiety and Depression Association of America
• Obsessive-Compulsive Disorder: Diagnosis and Management (2015) American Family Physician (2015)
• Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder (2012) American Academy of Child and Adolescent Psychiatry 
• Deep brain stimulation for chronic, severe, treatment resistant obsessive-compulsive disorder in adults (2021) National Institute for Health and Care Excellence (NICE)
• Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology (2014)

Schizophrenia

• Practice Guideline for the Treatment of Patients with Schizophrenia 3rd Edition (2021) American Psychiatric Association
• Practice Parameter for the Assessment and Treatment of Children and Adolescents with Schizophrenia (2013) American Academy of Child and Adolescent Psychiatry
• Psychosis and Schizophrenia in Adults: Prevention and Management (2014) National Institute for Health and Care Excellence
• Evidence-based guidelines for the pharmacological treatment of schizophrenia: Update recommendations from the British Association for Psychopharmacology (2019) Journal of Psychopharmacology
• Psychosis and schizophrenia in children and young people; recognition and management (updated 2016) National Institute for Health and Care Excellence

Substance Abuse Disorders

General

• Practice Guideline for the Treatment of Patients with Substance Use Disorders Second Edition (2006) American Psychiatric Association
• Guideline Watch (April 2007): Practice Guideline for the Treatment of Patients with Substance Use Disorders 2nd Edition (2007) American Psychiatric Association
• VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders (2015) Department of Veterans Affairs/Department of Defense
• Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide (2014) National Institute on Drug Abuse
• TIP 31 Screening and Assessing Adolescents for Substance Use Disorders (2012) Substance Abuse and Mental Health Services Administration
• TIP 42 Substance Abuse Treatment for Persons with Co-occurring Disorders (2013,revised 2020) Substance Abuse and Mental Health Services Administration
• Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) (2018) National Institute on Drug Abuse
• Treatment of Stimulant Use Disorders (2020) SAMHSA

Opioid

• The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder 2020 Focused Update (2020) American Society of Addiction Medicine
• Medications for Opioid Use Disorder TIP 63 (2018, revised 2020) Substance Abuse and Mental Health Services Administration
• Pain Management Best Practices Inter-Agency Task Force Report (2019) U.S. Department Health & Human Services

Alcohol

• Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder (2018) American Psychiatric Association
• Medication for the Treatment of Alcohol Use Disorder: A Brief Guide (2015) Substance Abuse and Mental Health Services Administration
• Alcohol Screening and Brief Intervention for Youth, A Practitioner's Guide-produced in collaboration with the American Academy of Pediatrics (Revised 2015, Reprinted 2019) National Institute on Alcohol Abuse and Alcoholism
• The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (2020) American Society of Addiction Medicine

Suicidal Behaviors

• VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide (version 2.0, 2019) Department of Veterans Affairs/Department of Defense

Telehealth

• Best Practices in Videoconferencing-Based Telemental Health (2018) American Psychiatric Association and American Telemedicine Association
  
• General Provider Telehealth and Telemedicine Tool Kit (2020) Centers for Medicare and Medicaid Services
• Telepsychiatry Toolkit (2020) American Psychiatric Association
• Practice Guidelines for Telemental Health with Children and Adolescents (2017) American Telemedicine Association
• Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders (2021) SAMHSA

Transgender

• Guidelines for Psychological Practice with Transgender and Gender Nonconforming People (2015) American Psychological Association
• Ensuring Comprehensive Care and Support for Transgender and Gender Diverse Children and Adolescents (2018) American Academy of Pediatrics

Diversity

• Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality (2017) American Psychological Association
• The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults: Guideline V. Assessment of Cultural Factors (2016) American Psychiatric Association
• Cultural Diversity and Mental Health: Considerations for Policy and Practice (2018) Frontiers Public Health

Electroconvulsive Therapy

• Royal Australian and New Zealand College of Psychiatrists Professional Practice Guidelines for the Administration of Electroconvulsive Therapy (2019) Australian and New Zealand Journal of Psychiatry
• American Psychiatric Association: Practice Guideline for the Treatment of Patients With Major Depressive Disorder (2010) American Psychiatric Association pages 44-46

Infertility

• Resource Document on Psychiatric Aspects of Infertility (2019) American Psychiatric Association
• Guidance on Qualifications for fertility counselors: a committee opinion (2021) Fertility & Sterility, Practice Committee and Mental Health Professionals Groups of the American Society for Reproductive Medicine
• Creating a collaborative model of mental health counseling for the future (2015) Fertility & Sterility American Society for Reproductive Medicine
• Recommendations for practices using gestational carriers: a committee opinion (2022) Fertility & Sterility Practice Committee of the American Society for Reproductive Medicine

Trauma-Informed Care

• TIP 57: A Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services (2014) SAMHSA
• SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach (2014) SAMHSA
• Key Ingredients for Successful Trauma-Informed Care Implementation (2016) SAMSHA
• Stress & Trauma Toolkit for Treating Historically Marginalized Populations in a Changing Political and Social Environment American Psychiatric Association

The Behavioral Health Care Management Programs offered by BCBS serve members suffering from Depression, Alcohol/Substance Abuse Disorders, Anxiety/Panic Disorders, Attention Deficit/Hyperactivity Disorder, Bipolar Disorder, Eating Disorders, Schizophrenia and other Psychotic Disorders. If a professional provider has a patient who may benefit from participating in one of the above-mentioned programs, please call Behavioral Health Member Services using the number on the back of the Member’s ID card to have the patient screened and considered for enrollment in a Case Management Program.

The Behavioral Health Clinical Practice Guidelines are applicable to all HCSC BH product lines including Illinois (MMAI, BCCHP, and MLTSS), Montana, New Mexico, Oklahoma and Texas Government Programs. These guidelines are designed to assist clinicians by providing a framework for evaluation and treatment of patients and is not intended to either replace a clinician’s judgment or establish a protocol for all patients with a particular condition. Guidelines for the use of Psychotropic Medication Management are included within each Behavioral Health Clinical Practice Guideline.

* This guideline is more than 5 years old and under consideration by American Psychiatric Association for revision.