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Written by Blackbird Health | March 14, 2025
Under the leadership of Nicole Garber, MD and Chief Medical Officer, Blackbird Health has reviewed its medical policies and identified the need to update lab testing guidelines to ensure precision, clinical relevance, and alignment with the highest standard of care.

Key changes to lab and genetic testing: 

  • Shift to more targeted lab testing: Instead of routinely ordering lab and genetic tests  during intake, testing will now be reserved for specific conditions such as anxiety, mood disorders, eating disorders, and for patients on medications like lithium or atypical antipsychotics. Only clinically necessary tests (e.g., CMP, CBC, TSH, Vitamin D) will be ordered to directly inform treatment based on an individual’s needs. 

  • Streamlined lab ordering: Previously, labs were often ordered automatically during intake. Now, clinicians will assess the necessity of lab tests after diagnosis, document recommendations in the medical record, and coordinate directly with the medical team. 

  • Faster communication of critical results: Critical results will be communicated to patients’ families within two hours of receipt to ensure timely medical intervention.

  • Updated Genetic Testing Policy: Pharmacogenetic testing is no longer part of intake but may be considered for patients with multiple failed medication trials, a poor response to medication, or upon family request.

How We Made These Changes: The Clinical Review Process

Dr. Nicole Garber led a comprehensive clinical review focused on evaluating the efficacy of lab testing in informing clinical decisions and improving patient outcomes. This included: 

  • Clinical Impact Analysis – Reviewed past lab data to assess how often results influenced treatment decisions.

  • Necessity and Standard of Care – Evaluated whether lab tests led to meaningful clinical actions.

  • Provider and Patient Feedback – Gathered input from clinicians, pediatricians, and families on lab testing experiences.

  • Targeted Testing Criteria – Defined clear guidelines for when lab tests should be ordered based on data and best practices.

  • Workflow Improvements – Streamlined lab ordering, ensuring efficient processing, documentation, and communication of results.

 
 
 

Why was lab testing part of the intake process before, and why is it changing now?

Previously, Blackbird Health included lab and genetic testing during intake to identify potential physiological and genetic contributors to mental health symptoms and medication response. While we believe in a holistic, understanding-first approach, we now prioritize targeted testing only when there is a clear clinical need. This shift reduces unnecessary testing and minimizes burdens on families while ensuring that all testing meaningfully informs treatment decisions.

How do you determine when lab testing is medically necessary? 

 

Lab testing is now based on clinical guidelines and the specific needs of each patient. Tests will only be ordered when a diagnosis is established, and the results will meaningfully impact treatment decisions—such as monitoring medication effects, assessing nutritional deficiencies in eating disorders, or ruling out medical conditions that mimic or contribute to psychiatric symptoms.

 

What evidence supports this new approach?

Our updated policy aligns with best practices in child and adolescent psychiatry, which recommend targeted testing based on clinical presentation. Our team carefully reviewed patient test results in conjunction with clinical impact and determined when in the process it made sense to order additional labs or genetic testing based on these findings.

 
 

Are there conditions where testing will still be required as part of intake?

Yes. Lab testing may still be required when there is a strong clinical indication, including:

  • Medication monitoring - When prescribing medications that require clinical monitoring, such as atypical antipsychotics, lithium, or Depakote.
  • Mood and physiological disorders - When evaluating mood disorders with potential physiological contributors, eating disorders, or suspected PANDAS.

Is Blackbird Health recommending pharmacogenetic testing during intake?

No. We have updated our policies and will no longer recommend pharmacogenetic testing as part of our intake process.

When might pharmacogenetic testing be recommended?

Pharmacogenetic testing may be considered in specific cases, including:

Medication intolerance or ineffectiveness – If a patient has not tolerated multiple medication trials or has had poor responses, testing may help guide the next medication choice.

Family request – If a family specifically requests pharmacogenetic testing, we can provide it as an option, though it is not required for treatment.

 

How will referring pediatricians be notified if a lab test is recommended for a mutual patient?

 

While our clinicians will determine medical necessity for lab testing, we recognize the value of close collaboration with primary care providers. Whenever appropriate, we will coordinate with referring pediatricians, especially in cases where shared medical management is needed.

 

Will Blackbird coordinate with pediatricans before ordering a test, or is this solely an internal decision?

Lab testing decisions at Blackbird are made internally by our clinical team based on medical necessity and established guidelines. While we do not routinely coordinate with referring pediatricians before ordering tests, we ensure that any clinically significant findings are communicated as needed to support continuity of care. 
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