Approved by Council, October 1997
To be reviewed

The participation of family members in the assessment and treatment of infants, children, and adolescents is integral to positive clinical outcomes. The Practice Parameters for the Psychiatric Assessment of Children and Adolescents (AACAP, 1995) state "the child's functioning and psychological well-being are highly dependent on the family and school setting in which he or she lives and studies. The child cannot be assessed in isolation. Obtaining a full and accurate diagnostic picture of the child requires gathering information from diverse sources, including the family, school, and other agencies involved with the child."

In the care of young children, work with parents is always necessary. The Practice Parameters for the Psychiatric Assessment of Infants and Toddlers state "It is axiomatic that the infant or toddler must be understood, evaluated, and treated within the context of the family" (AACAP, 1997). Extended family members, foster parents, or guardians also should participate in assessment and treatment when they are the primary caregivers or figure prominently in the child's life.

When clinically indicated and at the discretion of the clinician, the parents and family of the patient should participate directly in treatment by being present during assessment and treatment sessions with the patient. A Clinical Procedures Terminology (CPT) code [90847] has been developed and certified for family medical psychotherapy (conjoint psycho-therapy) (AMA, 1996).

A number of clinical situations may require that the child not be present during a therapy session on his or her behalf. For example, the clinician may need to address harmful parental behavior or teach parents to make complex interventions with the child at home and in other settings.

A Clinical Procedures Terminology (CPT) code [90846] has been developed and certified for family medical psychotherapy (without the patient present) (AMA, 1996). When the patient is not present in a therapy session convened on his or her behalf, the CPT code used by the clinician in reporting the session should be linked to the child's diagnosis. It is not ethical or appropriate to substitute another clinical procedure, such as individual therapy with the child, to code as if the parent was the primary patient and the focus of the therapy session, or to obtain reimbursement for a therapy session with parent(s) or other family members who were seen on behalf of the child.

Denial by third party payers of the appropriate procedure code for parent and family treatment, with or without the patient present, is an arbitrary practice that runs against the best interests of children and adolescents in treatment.

References

American Academy of Child and Adolescent Psychiatry (1997). Practice Parameters for the Psychiatric Assessment of Infants and Toddlers. Journal of the American Academy of Child and Adolescent Psychiatry (36): XXXX-XXXX

American Academy of Child and Adolescent Psychiatry (1995). Practice Parameters for the Psychiatric Assessment of Children and Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry (34): 1386-1402.

American Medical Association (1996). Physicians' Current Procedural Terminology, Fourth Edition (CPT). Chicago: AMA.