Child/Adolescent Outpatient Therapy

​​Click here for full service definition information in the Clinical Coverage Policy.

Psychotherapy is a generic term used for a variety of treatment approaches 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 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 

  • Children and adolescents presenting with behavioral and/or psychological functioning impairments which have exceeded the individual/family's ability to manage without professional support/services. Youth should be capable of developing the needed skills to manage symptoms/behaviors via therapeutic interventions which do not require a higher level of care. In addition, outpatient therapy may be used as a step-down service or to augment higher level services such as residential treatment when the consumer needs highly specialized therapy to meet his/her treatment needs.

Recommended Best Practices 

  • Core Best Practices

  • American Academy of Child and Adolescent Psychiatry Practice Parameters

  • 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 utilize 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.

  • System of Care Principles

  • The intervention(s) selected should result in reduced symptoms and improvements in areas identified as the focus of treatment. See the following brief descriptions of some common research-supported practices which 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.

SAMHSA's National Registry of Evidence Based Programs and Practices ​

  • Trauma-Focused Cognitive Behavioral Therapy: TF-CBT is an evidence-based practice that uses psychoeducation, skills training, and therapy to address the unique needs of youth with PTSD, depression, behavior problems, or other difficulties related to the traumatic experience.

    SAMHSA's National Registry of Evidence Based Programs and Practices

     
  • Parent-Child Interaction Therapy: PCIT is a family therapy approach using play skills for youth ages 2-12 with step-by-step, live coaching sessions in order for the parent/caregiver to learn skills to improve the parent-child relationship, decrease child behavior problems and increase parenting skills.

    SAMHSA's National Registry of Evidence Based Programs and Practices

     
  • Triple P (Positive Parenting Program): Triple P is a parenting intervention with the primary goal of increasing the knowledge, skills and confidence of parents to reduce the prevalence of mental health, emotional and behavioral problems in children and adolescents.

​Triple P Home

  • Dialectical Behavior Therapy: DBT is an evidence-based form of cognitive-behavioral treatment for treating borderline personality disorder/traits. Consumers in DBT for borderline personality disorder receive three primary modes of treatment: individual therapy, skills group, and phone coaching. There is also 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

     
  • Seven Challenges:  Seven Challenges is a group treatment approach designed for adolescents with alcohol/drug problems and co-occurring problems to motivate their decision to change, commitment to change, and support success in implementing the desired changes.

    SAMHSA's National Registry of Evidence Based Programs and Practices

  • SPARCS: Structured Psychotherapy for Adolescents Responding to Chronic Stress: SPARCS is a group intervention designed to address the needs of chronically traumatized adolescents living with ongoing stress and who may be experiencing problems in multiple areas of functioning including affect regulation, impulsivity, self-perception, relationships, somatization, dissociation, numbing and avoidance, etc.

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 that has therapy already included in the service; (c) highly-specialized therapy is being requested while the youth is receiving residential treatment.

  • Conduct focused Utilization Review (UR) of Outpatient providers based upon over/under-utilization, negative outcomes (e.g., lack of progress due to lack of using evidence based practices, 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.