Implementing Caregiver Behavior Management Training CPT® Codes

Additional cost reductions examples

Reduced pharmacy costs for ADHD

Empirical literature recommends starting with behavioral treatment before initiating medication for ADHD (Coles et al., 2020). This research supports prior recommendations (e.g., Pelham et al., 2016) showing the benefits on treatment outcomes and financial costs of starting group-based behavioral treatment before prescribing medication for ADHD. For those with prescriptions for ADHD medication, lower doses of medication can achieve comparable benefits. As pharmacy costs are one of the major expenses of ADHD, behavioral treatment could save on average $700 per case (Page et al., 2016). Behavioral treatment is thus an effective treatment and a good cost containment strategy.

Mitigating obesity costs

Empirical literature recommends starting with behavioral treatment before initiating medication for ADHD (Coles et al., 2020). This research supports prior recommendations (e.g., Pelham et al., 2016) showing the benefits on treatment outcomes and financial costs of starting group-based behavioral treatment before prescribing medication for ADHD. For those with prescriptions for ADHD medication, lower doses of medication can achieve comparable benefits. As pharmacy costs are one of the major expenses of ADHD, behavioral treatment could save on average $700 per case (Page et al., 2016). Behavioral treatment is thus an effective treatment and a good cost containment strategy.

Offset treatment cost of older adults

Given the increasing population of adults over 65 years old and escalating healthcare costs, the financial benefit of widespread access to behavioral modification/management training could more than offset the treatment cost (Sansoni et al., 2013). The use of behavioral modification/management services also delays the time for nursing home placements for people with dementia (Mittelman et al., 2006; Gaugler, Reese, & Mittelman, 2013; Mittelman et al., 1993; Mittelman et al., 1996).

Efficacy examples

ADHD example

One example is the treatment of children and adolescents with ADHD. The Centers for Disease Control and Prevention (CDC) recommends that ADHD treatment of all children ages 12 years old and younger should include behavioral therapy, and for children younger than 6 years of age, behavior therapy should be the first line of treatment, prior to pharmacological intervention. Further, the CDC (2020) states “the type of behavior therapy that is most effective for this age is parent training in behavior management, meaning that therapists work with parents and teach them the skills needed to help their child better manage their ADHD.”

Pediatric obesity example

The U.S. Preventive Services Task Force (USPSTF; 2017) has reviewed the evidence on obesity in children and adolescents and the benefits and harms of weight management interventions—a total of 45 trials (n = 7099) of behavioral interventions for obesity. Based on their findings, they recommend that clinicians offer or refer children and adolescents 6 years and older to comprehensive, intensive behavioral interventions to promote improvements in weight status. Comprehensive, intensive behavioral interventions (26 contact hours) in obese children and adolescents can result in improvements in weight status for up to 12 months. Although the interventions across studies varied, one component common across all effective behavioral interventions was the participation of the identified patient’s parents/guardians/caregivers. Components of the most effective interventions included sessions targeting both children and their parents. Such sessions helped parents and children engage in stimulus control and assisted participants in identifying goals, self-monitoring, and problem-solving to accomplish their selected goals.

Dementia example

Caregiver Behavior Management Training services do not only benefit the pediatric patient population. A significant amount of evidence also exists describing evidence-based intervention programs for caregivers of adult patients. These programs aim to enhance the caregiver’s ability to effectively manage behavior problems and deteriorations in functions of an adult patient with a physical or mental health condition.

One example is caregivers who provide help to older adults with dementia. Caregiver training interventions for patients with dementia focus on addressing specific behaviors the patient exhibits. Such interventions typically involve modifying patient and/or caregiver cognitions, behaviors, environments, or the precipitating events that contribute to problematic behaviors. Treatment goals of nonpharmacologic behavioral approaches include prevention, management, reduction, or elimination of behavioral occurrences (frequency, severity) and/or prevention of adverse consequences (harm to caregiver or patient) (Gitlin, Kales, Lyketsos, 2012).