Clinical Practice Guidelines
2020-2021

Behavioral Health Guidelines

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

If you have any questions about the CPGs adopted by BCBSTX, contact us via: Email BHQualityImprovement@bcbstx.com

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 BCBSTX Behavioral Health (BH) product lines including 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.

Clinical Practice Guidelines for Behavioral Health Conditions

Select from the links listed below to view CPG’s for Behavioral health conditions:

Acute Stress Disorder and Post Traumatic Stress Disorder (PTSD)

• Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder
  American Psychiatric Association, 2004
• Guideline Watch: Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder
  American Psychiatric Association, 2009
• VA/DOD Clinical Practice Guideline for the Management of Post Traumatic 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 2nd edition
  American Psychiatric Association, 2007
• 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: Asessment, 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 

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 

Autism

• Practice Parameter for the Assessment and Treatment of Children and Adolescents with Autism Spectrum Disorder (2014) American Academy of Child and Adolescent Psychiatry
  American Psychiatric Association, 2007
• 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
  American Psychiatric Association, 2002
• Guideline Watch: Practice Guideline for the Treatment of Patients with Bipolar Disorder, Second Edition
  American Psychiatric Association, 2005
• Bipolar Disorder: Assessment and Management Clinical Guideline (2014) National Institute for Health and Care Excellence 
• 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
  American Psychiatric Association, 2010
• Practice Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders 
  American Academy of Child and Adolescent Psychiatry, 2007
• Clinical Practice Review for Major Depressive Disorder (2016) Anxiety and Depression Association of America 
• 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 

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 

Eating Disorders

• Practice Guideline for the Treatment of Patients with Eating Disorders, Third Edition
  American Psychiatric Association, 2006
• Guideline Watch: Practice Guideline for the Treatment of Patients with Eating Disorders, Third Edition
  American Psychiatric Association, 2012
• 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 

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 

General

• Practice Guidelines for the Psychiatric Evaluation of Adults" (2015) American Psychiatric Association 
• Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents (2019) 

Generalized Anxiety and Panic Disorder

• Practice Guideline for the Treatment of Patients with Panic Disorder, Second Edition
  American Psychiatric Association, 2009
• Generalised Anxiety Disorder and Panic Disorder in Adults: Management Clinical Guideline (2011) National Institute for Health and Care Excellence 
• 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 

Obsessive Compulsive Disorder

• Practice Guideline for the Treatment of Patients with Obsessive-Compulsive Disorder
  American Psychiatric Association, 2007
• Guideline Watch: 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) 

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 

Substance Use Disorders

- General:

• Practice Guideline for the Treatment of Patients with Substance Use Disorders, Second Edition
  American Psychiatric Association, 2006
• Guideline Watch (April 2007): Practice Guideline for the Treatment of Patients with Substance Use Disorders, Second Edition
  American Psychiatric Association, 2007
• 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) Substance Abuse and Mental Health Services Administration
• Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) (2018) National Institute on Drug Abuse 

- Opiod:

• 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

- 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

• Practice Guidelines for Video-Based Online Mental Health Services (companion document) (2013) American Telemedicine Association
• Core Operational Guidelines for Telehealth Services Involving Provider-Patient Interaction (2014) American Telemedicine Association
• Guidelines for the Practice of Telepsychology (2013) American Psychological Association
• Clinical Update: Telepsychiatry with Children and Adolescents (2017) American Academy of Child and Adolescent Psychiatry
• 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 

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