“…For CYP that are acutely unwell and/or actively suicidal, we recommend routine comprehensive clinical assessment, including risk assessments, and inpatient admissions when required. The proposed model of care relates to clinical services delivered in the community by appropriately trained clinicians in CBT-ERP for OCD (Piacentini et al, 2021 ; Sookman et al, 2021 ). Fig.…”
Section: Closing the Gap: Novel Staged Cbt-erp For Cyp With Ocdmentioning
confidence: 99%
“…A particular strength of this model is that it takes a risk-stratified approach to mental health service delivery, determining the level of care based on level of clinical risk/need, thus broadening the scope for intervening much earlier, incorporating prevention and early intervention potential into models of care (McGorry & Mei, 2018 ; Sawrikar et al, 2021 ). Based on two decades of empirical support for CBT-ERP for paediatric OCD since the first RCTs (Barrett et al, 2004 ; POTS, 2004 ), there is now considerable support for the efficacy of CBT via multiple modalities; a multi-nation trial of dissemination in routine community care (Torp et al, 2015 ); and international knowledge and competency standards under-pinning gold-standard implementation (Piacentini et al, 2021 ). Despite all of this—there remains an unacceptable treatment and quality gap for CYP with OCD.…”
Section: Evaluation and Implementation In Practice: Future Directionsmentioning
confidence: 99%
“…A 14-nation International Obsessive–Compulsive Disorders Accreditation Task Force (ATF) of The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) has been established to develop knowledge and competency standards for implementation of specialised OCD treatments (Sookman et al, 2021 ). Piacentini et al ( 2021 ) published knowledge and competency standards for clinicians in delivery of specialised CBT-ERP for paediatric OCD based on a comprehensive literature review and expert synthesis, resulting in over 70 knowledge standards, and more than 60 specific competencies associated with evidence-based assessment and CBT-ERP treatment of CYP with OCD. The move towards established knowledge and competency standards (i.e.…”
Section: Evaluation and Implementation In Practice: Future Directionsmentioning
confidence: 99%
“…The move towards established knowledge and competency standards (i.e. Piacentini et al, 2021 ), along with future work to develop a suite of accessible training protocols and resources, will hopefully serve to better equip clinicians with the knowledge and skills to utilise empirically supported CBT-ERP in routine clinical practice and support implementation of staged CBT-ERP.…”
Section: Evaluation and Implementation In Practice: Future Directionsmentioning
Childhood obsessive–compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable “treatment gap” and “quality gap” in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.
“…For CYP that are acutely unwell and/or actively suicidal, we recommend routine comprehensive clinical assessment, including risk assessments, and inpatient admissions when required. The proposed model of care relates to clinical services delivered in the community by appropriately trained clinicians in CBT-ERP for OCD (Piacentini et al, 2021 ; Sookman et al, 2021 ). Fig.…”
Section: Closing the Gap: Novel Staged Cbt-erp For Cyp With Ocdmentioning
confidence: 99%
“…A particular strength of this model is that it takes a risk-stratified approach to mental health service delivery, determining the level of care based on level of clinical risk/need, thus broadening the scope for intervening much earlier, incorporating prevention and early intervention potential into models of care (McGorry & Mei, 2018 ; Sawrikar et al, 2021 ). Based on two decades of empirical support for CBT-ERP for paediatric OCD since the first RCTs (Barrett et al, 2004 ; POTS, 2004 ), there is now considerable support for the efficacy of CBT via multiple modalities; a multi-nation trial of dissemination in routine community care (Torp et al, 2015 ); and international knowledge and competency standards under-pinning gold-standard implementation (Piacentini et al, 2021 ). Despite all of this—there remains an unacceptable treatment and quality gap for CYP with OCD.…”
Section: Evaluation and Implementation In Practice: Future Directionsmentioning
confidence: 99%
“…A 14-nation International Obsessive–Compulsive Disorders Accreditation Task Force (ATF) of The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) has been established to develop knowledge and competency standards for implementation of specialised OCD treatments (Sookman et al, 2021 ). Piacentini et al ( 2021 ) published knowledge and competency standards for clinicians in delivery of specialised CBT-ERP for paediatric OCD based on a comprehensive literature review and expert synthesis, resulting in over 70 knowledge standards, and more than 60 specific competencies associated with evidence-based assessment and CBT-ERP treatment of CYP with OCD. The move towards established knowledge and competency standards (i.e.…”
Section: Evaluation and Implementation In Practice: Future Directionsmentioning
confidence: 99%
“…The move towards established knowledge and competency standards (i.e. Piacentini et al, 2021 ), along with future work to develop a suite of accessible training protocols and resources, will hopefully serve to better equip clinicians with the knowledge and skills to utilise empirically supported CBT-ERP in routine clinical practice and support implementation of staged CBT-ERP.…”
Section: Evaluation and Implementation In Practice: Future Directionsmentioning
Childhood obsessive–compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable “treatment gap” and “quality gap” in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.
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