Clinical Practice Guidelines

Community Care utilizes Clinical Practice Guidelines (CPGs) to support practitioners and members in making informed, consistent, and appropriate clinical decisions across a range of diagnoses and treatment settings. CPGs promote the delivery of safe, effective, and high‑quality care by outlining best practices for assessment, treatment planning, and ongoing management based on current clinical evidence, nationally recognized standards, and professional consensus. Community Care’s Chief Medical Officer reviews our recommended guidelines for updates and relevance to ensure the CPGs align with current research and address common diagnoses for the HealthChoices membership. The Quality and Care Management Committees and Board Quality Improvement Committee review and approve the guidelines annually.

In 2026, Community Care approved maintaining the following guidelines for continued use:

  • The American Society of Addiction Medicine (ASAM) National Practice Guideline for the Treatment of Opioid Use Disorder (OUD) - 2020 Focused Update 
  • The American Psychiatric Association (APA) Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder (AUD) The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (January 2018)
  • The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (January 2020)
  • The American Thoracic Society’s (ATS) guideline for Initiating Pharmacologic Treatment in Tobacco-Dependent Adults: An Official American Thoracic Society Clinical Practice Guideline (May 2020)
  • The American Academy of Pediatrics (AAP) Guideline for Attention-Deficit/Hyperactivity Disorder (ADHD) (October 2019) and its supplements 
  • The APA Practice Guideline for The Treatment of Patients with Schizophrenia (Third Edition – 2021) 
  • The Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline for the Management of Major Depressive Disorder (Version 4.0 – 2022)
  • The American Academy of Child & Adolescent Psychiatry (AACAP) Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders (October 2020)

In 2026, Community Care approved the addition of the following report:

  • The American Academy of Pediatrics’ Clinical Report, Suicide and Suicide Risk in Adolescents (2024)

Community Care measures compliance within our provider network for three of the CPGs; two adherence measures are selected for each guideline. All adherence measures are aggregated via service and/or pharmacy claims.

The two adherence measures related to the ADHD guideline are:

  • Children who had at least one behavioral health follow-up visit within 30 days of being prescribed ADHD medication (Initiation Phase or start of treatment).
  • Children who met the criteria for the Initiation Phase and had at least two additional behavioral health follow-up services within 270 days (Continuation and Maintenance Phase of treatment) after the Initiation Phase.

The two adherence measures for the Schizophrenia guideline are:

  • The percentage of adult members diagnosed with schizophrenia, who were dispensed and remained on an antipsychotic medication for at least 80% of the treatment period (SAA).
  • The percentage of adult members who had two or more antipsychotic prescription fills and had metabolic testing, including blood glucose and cholesterol levels.

The two adherence measures for Major Depressive Disorder (AMM) are:

  • Members newly diagnosed with depression and treated with an antidepressant who filled a sufficient number of prescriptions to allow for 84 days (12 weeks) of continuous therapy (Effective Acute Phase at the start of treatment).
  • Members newly diagnosed with depression and treated with an antidepressant who filled a sufficient number of prescriptions to allow for 180 days (6 months) of continuous therapy (Effective Continuation Phase for ongoing treatment).

Community Care also monitors the number of members taking Medication Assisted Treatment (MAT) for Tobacco Use to assess adherence to the ATS CPG.

Additional data related to race, ethnicity, gender, and age for these measures were examined to identify any disparities amongst these groups. The analysis of the segmentation data identified disparities within some of the measures, most notably:

  • For AMM, non-White, Hispanic, and male members have significantly lower rates of AMM for both phases; these disparities have been consistently noted for the past three years.

Further analysis of the AMM disparities reveals that, while Community Care’s data aligns with broader statistics and trends found within several national studies, increases were observed across nearly all population groups. To promote culturally competent care and support adherence, Community Care’s Customer Service Representatives can identify practitioners of the same race or providers with expertise serving diverse communities. This information can be shared when members contact Community Care’s member line to request services.

  • For the SAA measure, a longitudinal and consistent statistical difference was found with White members more likely to adhere to antipsychotics than Black members.

Related to the SAA disparities, further analysis found that Black individuals are at risk for being misdiagnosed with a psychotic disorder and underdiagnosed with a mood disorder. Community Care’s membership analysis showed that Black members were three times more likely to be diagnosed with schizophrenia when compared to White members. To address this concern, Community Care published an article within the Spring 2024 provider newsletter that outlined recommendations related to these diagnostic disparities; this article was updated and republished in the Spring 2025 newsletter. In addition, Community Care conducted a provider training focused on diagnostic disparities, highlighting the potential of over diagnosing Black members with schizophrenia.

Copies of the CPGs are available online:

Community Care continues to encourage providers in our network to use these guidelines when treating individuals diagnosed with substance use disorders, tobacco dependence, ADHD, schizophrenia, Major Depressive Disorder, and Anxiety Disorders in children and adolescents.

In addition to the ASAM CPG for Alcohol Withdrawal Management, Community Care offers The Alcohol Withdrawal Management Pocket Guide as an additional resource. This guide provides a brief overview of recommendations as well as pharmacotherapy flowcharts and tables for alcohol withdrawal severity and scales (ASAM Alcohol Withdrawal Management Guideline Pocket Guide).

For more information about the CPGs or adherence measures, please contact us at 1-888-251-2224 and ask to speak to a Quality Representative.