Outpatient Therapy

​​​​​​​​Click here to view full service definition information in the Clinical Coverage Policy

Psychotherapy is a generic term that describes a variety of treatments used by licensed mental health professionals for a wide range of emotional, behavioral and substance use conditions. It is a collaborative process between the professional and individual(s) to achieve improved life skills and quality of life, as well as the reduction of symptoms and/or problematic behaviors. Along with medication management, clinic-based psychotherapy services provide the backbone for the basic service array. Psychotherapy can take many forms and can be effective in many contexts. Individual, group, and family therapies all have various indications, and specialized therapies can be helpful for specific conditions. Frequency and intensity of psychotherapeutic visits will vary according to diagnosis, symptom severity, member motivation and availability of other supportive resources.

Intended Population

  • Psychotherapeutic techniques may be used throughout the entire mental health and substance use disorder service system array for individuals with any diagnosis. The techniques should be specifically tailored for each individual's needs and preferences and informed by adopted Clinical Guidelines when available.

Recommended Best Practices

  • Core Best Practices

  • Outpatient therapists can choose from a wide range of therapy approaches based on their knowledge and skills acquired from training in the selected treatment model(s).  Cardinal Innovations expects providers to use goal-specific interventions related to a rehabilitative best practice or evidence-based treatment model consistent with community practice standards for meeting the needs of youth and their families.

  • The interventions should result in reduced symptoms and improvement in areas identified as the focus of treatment. See the following brief descriptions of some common research-supported practices Cardinal Innovations encourages providers to use.
     
    • Cognitive Behavioral Therapy: CBT is effective for treating a wide range of disorders including but not limited to mood, anxiety, personality, eating, substance use disorders.
       
    • Dialectical Behavior Therapy: DBT is an evidence-based form of cognitive-behavioral treatment for treating borderline personality disorder/traits. Individuals in DBT for borderline personality disorder receive three primary modes of treatment: individual therapy, skills group, and phone coaching. There also is research to support that DBT-informed therapy is an effective treatment for eating disorders, substance abuse disorders, PTSD, depression in older adults and other personality disorders. SAMHSA's National Registry of Evidence Based Programs and Practices.
       
    • Seeking Safety: For individuals with a history of trauma and/or substance use disorders designed to be flexible for use, group or individual format, in a variety of settings. Principles include safety as the overarching goal and integrated treatment. Content areas include cognitive, behavioral, interpersonal and case management. www.seekingsafety.org
       
    • Interpersonal Psychotherapy: Time limited treatment that seeks to help the individual regain control of mood and functioning typically lasting 12-16 weeks. Focus is on interpersonal issues which are affecting psychological distress. http://interpersonalpsychotherapy.org
       
    • Eye-Movement Desensitization and Reprocessing (EMDR): Designed to reduce trauma related stress, anxiety and depression symptoms associated with PTSD. www.EMDR.com
       
    • American Society of Addiction Medicine (ASAM): ASAM provides an exhaustive list of guidelines for assessment and treatment standards for substance use disorders. www.asam.org.
       
    • Motivational Enhancement Therapy (MET): A variation of motivational interviewing includes normative feedback presented in a non-confrontational manner that is designed to help individuals resolve ambivalence across a range of problematic behaviors.
       
  • This list is not exhaustive and there are numerous other evidence best practices. This list includes some of the major best practices currently emphasized in North Carolina. See additional best practices.

Desired Outcomes

  • Core Expected Outcomes

  • By using the appropriate research-supported treatment modality, the therapist has achieved goal(s) identified in the youth's treatment plan (e.g., increased coping skills, fewer symptoms of psychiatric disorder, reduced behavioral symptoms, improved functioning in familial, social, and educational life domains).  ​

Management Approach

  • A review of medical necessity is conducted under the following circumstances: (a) provider is requesting additional sessions after exhausting the unmanaged sessions (see authorization guidelines); (b) therapy is being requested while youth is receiving an enhanced service which has therapy already included in the service; (c) highly-specialized therapy is being requested while the youth is receiving residential treatment.

  • Conduct focused UR of Outpatient providers based upon over/under-utilization, negative outcomes (e.g., lack of progress due to lack of using EBP, decline in functioning in spite of high use of services), concerning incidents and/or grievances, and other data suggesting a clinician's practices are an outlier compared to the community standard of care.