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Clinical Practice Guidelines

Community Care utilizes Clinical Practice Guidelines to help providers and members make decisions about appropriate health care for specific clinical circumstances.  These evidence-based guidelines are reviewed at least every two years, updated when appropriate and approved by the Board Quality Improvement Committee.  Community Care uses the American Psychiatric Association (APA) Guideline for Major Depressive Disorder (Second Edition) and the National Institute on Drug Abuse (NIDA) Principles of Drug Addiction Treatment: A Research-Based Guide for Substance Use Disorders (Second Edition).  In addition to these to Clinical Practice Guidelines, Community Care adopted the APA Practice Guideline for the Treatment of Patients with Schizophrenia (Second Edition – April 2004) as well as the APA’s Treating Schizophrenia – A Quick Reference Guide. 

Community Care measures compliance to the guidelines within the network through adherence measures.

The two adherence measures for depression are:

• Patients in treatment for depression with more than one behavioral health clinician where there is evidence of communication between clinicians during the treatment episode, which is based on record review results.
• Patients being treated with psychotherapy for a new episode of Major Depressive Disorder who have weekly visits during the first four weeks of treatment, which is based on claims data.

There are three adherence measures for substance abuse:

• Members with substance use disorders who receive an adequate length of treatment defined as three months, which is based on claims data.
• Members who initiate follow up chemical dependency treatment after detoxification, which is also based on claims data.
• Members in treatment for substance abuse who are assessed for the co-occurrence of a mental disorder and, if identified, receive integrated treatment for both conditions, which is based on record review results.

Community Care continues to encourage providers in our network to consider utilizing these guidelines when treating patients with Major Depressive Disorders or Substance Use Disorders.

To obtain copies of the APA guidelines, contact the American Psychiatric Association, 1400 K Street NW, Washington, D.C.  20005.  The guidelines may also be obtained via the APA website at by clicking here.

To obtain copies of the NIDA guideline, contact the National Institute of Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892.  The guideline may also be obtained via the NIDA website by clicking here.

For more information about our Clinical Practice Guidelines or adherence measures, please contact Community Care at 1-888-251-2224 and ask to speak to a Quality Representative. 

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