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for such programs may not be supported by the benefit plan (AACAP, 2007). • School-based interventions may include preventive programs that focus on the development of socio-emotional skills, selfcontrol and problem solving (AACAP, 2007). o Individual approaches should be behaviorally based and geared toward the development of problem-solving skills. Behavioral interventions can aim to control aggression, modify behavior, and enhance communication and self-awareness (AACAP, 2007). o Structured group therapy may be most helpful for adolescents focusing on communication, problem-solving and behavior management (AACAP, 2007). o Alternative family approaches include Functional Family Therapy (FFT) and Multisystemic Therapy shown to be most effective for members with ODD and Substance Use Disorders (AACAP, 2007). o Inoculation approaches (e.g., boot camps, shock incarceration) have been considered ineffective and even harmful especially when used in isolation from evidence-based approaches (AACAP, 2007). o Interventions should be delivered as long as clinically indicated, usually for several months with periodic “booster” sessions, reinforcing learned skills for both the member and family/guardians (AACAP, 2007). Pharmacotherapy Pharmacotherapy is generally not indicated to treat ODD as a sole intervention but may be helpful as an adjunct to psychotherapy to treat aggressive symptoms and/or comorbid conditions (AACAP, 2007). Medication intervention is best introduced after a strong alliance with the member and family has been established and only after psychosocial interventions have been implemented (AACAP, 2007). If comorbid conditions are present, medications specifically targeting those conditions should be chosen however, atypical antipsychotics, mood stabilizers (e.g., divalproex and lithium), and stimulants are often prescribed in treating acute aggression in a time limited manner (AACAP, 2007). Medications should only be started after a symptom baseline can be established as to not attribute positive outcomes to medications rather than a stabilizing environment (AACAP, 2007). If medication use is chosen, the child in addition to the parents should agree and it should be clearly assessed whether adherence and monitoring are issues of concern (AACAP, 2007). Intensive Outpatient Treatment of Oppositional Defiant Disorder (ODD) Page 8 of 14 Coverage Determination Guideline Confidential and Proprietary, © Optum 2012 Optum is a brand used by United Behavioral Health and its affiliates
Nonresponsiveness to a specific agent should lead to a trial of another class of medication rather than the addition of other medications (AACAP, 2007). Pharmacological treatments are typically short-term and/or time-limited however, prolonged treatment may be required due to usually severe and persistent ODD or ODD that co-occurs with other behavioral health conditions (AACAP, 2007). Discharge Planning and Referral Management Members in IOP may be discharged by either stepping up to a more intensive level of care when his/her condition has not improved or has worsened; or stepping down to a less intensive level of outpatient care when the member’s clinical condition improves or he/she no longer requires structured, intensive, multimodal treatment. (CMS Manual System, 2004). The discharge plan must include the anticipated discharge date and the following (LOCGs, 2012): o The next level of care, its location, and the name(s) of the provider(s) who will deliver treatment; o The rationale for the referral; o The date and time of the first appointment for treatment as well as the first follow-up psychiatric assessment within 7 days of discharge; o The recommended modalities of care and the frequency of each modality; o The names, dosages and frequencies of each medication, and a schedule for appropriate lab tests if pharmacotherapy is a modality of post-discharge care o Linkages with peer services and other community resources. o The plan to communicate all pertinent clinical information to the provider(s) responsible for post-discharge care, as well as to the member’s primary care provider as appropriate. o The plan to coordinate discharge with agencies and programs the member has been involved, when appropriate and with the member’s documented consent. o A prescription for a supply of medication sufficient to bridge the time between discharge and the scheduled follow-up psychiatric assessment. o Confirmation that the member or authorized representative understands the discharge plan. Intensive Outpatient Treatment of Oppositional Defiant Disorder (ODD) Page 9 of 14 Coverage Determination Guideline Confidential and Proprietary, © Optum 2012 Optum is a brand used by United Behavioral Health and its affiliates
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