Reference

Guide | Reference

115  Care Pathways Map

This chapter is optional reference for level-of-care navigation and monitoring. Most useful when planning escalation or referral.

Optional reference material; not required for routine use.

Purpose. Offer a lightweight pathway map without prescribing care. Clarify when to step up, step down, or refer.

115.1 Pathway Layers

• Self-management and brief supports.
• Outpatient psychotherapy or medication management.
• Intensive outpatient or partial hospitalization.
• Inpatient or emergency care.

115.2 Step-Up Triggers

• Escalating risk or safety concerns.
• Worsening trajectory despite adequate trial.
• Severe functional impairment or inability to maintain roles.

115.3 Step-Down Triggers

• Sustained improvement and stable supports.
• Symptom stability with low risk.

115.4 Referral Thresholds

• Medical or neurologic rule-outs required.
• Complex comorbidity or diagnostic uncertainty.
• Specialized services (sleep, neuropsych, addiction).

Documentation Output. Pathway level selected and rationale. Referral or escalation triggers noted.