None listed
Conditions
Brief summary
This trial aims to improve care for young people with obsessive–compulsive disorder (OCD) in community mental health services. It compares two evidence-based models of cognitive-behavioural therapy with exposure and response prevention (CBT-ERP): a standard approach and a stronger, more intensive approach that includes additional parent training and longer ERP sessions. Both models are expected to reduce OCD symptoms, with the stronger model leading to greater improvements for some young people. The study will also evaluate how well clinicians can learn, deliver, and sustain high-quality CBT-ERP after receiving tailored training and supervision. By improving the detection, assessment, and treatment of OCD, this project aims to increase access to effective care for young people and their families.
Interventions
Strong cognitive-behavioural therapy with exposure and response prevention (CBT-ERP): delivered to young people with parental involvement.
Strong CBT-ERP involves: 12 + 2 manualised youth weekly sessions (group or individual CBT-ERP - determined based on referrals into the services and feasibility for running a group as first preference, versus offering individual therapy in the absence of numbers for a group offering); plus 4 tele-health delivered parent training sessions in ERP; plus at least
Strong cognitive-behavioural therapy with exposure and response prevention (CBT-ERP): delivered to young people with parental involvement. Strong CBT-ERP involves: 12 + 2 manualised youth weekly sessions (group or individual CBT-ERP - determined based on referrals into the services and feasibility for running a group as first preference, versus offering individual therapy in the absence of numbers for a group offering); plus 4 tele-health delivered parent training sessions in ERP; plus at least one 3-hour long intensive ERP session (1-3 intensive sessions as needed for each child). The weekly sessions, parent training and intensive are delivered concurrently. Parent training commences week 1 alongside youth weekly sessions and is space throughout intervention. Intensive sessions are offered anytime from session 4 in the youth treatment following introduction of ERP. CBT-ERP involves psychoeducation about OCD, symptom monitoring and homework practice, cognitive therapy to address maladaptive beliefs, and graduated exposure to feared stimuli while preventing compulsive responses, alongside relapse prevention planning to consolidate gains and maintain improvements. Intensive sessions involve extended, concentrated ERP practice to accelerate therapeutic gains. Concurrent parent training provides caregivers with structured guidance and coaching to facilitate ERP implementation in the home environment and to overcome practical and behavioural barriers to treatment adherence. All aspects of the model of care (assessment and treatment) will be delivered by trained mental health clinicians already working in the collaborating youth community mental health services. Clinician training will be delivered prior to any implementation. Clinician supervision will be continually offered throughout the trials. The dose and modality of clinician training and supervision will be co-designed as part of this trial prior to implementation and recruitment. This will occur via focus groups (n=4-6 clinicians per group, two groups in each state) with clinicians at baseline before implementation, and via ongoing consultation during the trial with clinician stakeholders to assess feasibility and acceptability. Allocation will be based on geographical region where health services clustered together geographically will form one condition (north clinics versus south clinics) - so that services can refer into groups as need be for patients from similar region into the same condition. Allocation will be randomly determined in each state via computer generated randomiser.
Sponsors
Griffith University
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
6 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Child and adolescents that may be suitable for the program include those meeting the following criteria: (a) Aged 6–18 years (although some variability is expected within the services, and may include participants aged slightly younger or older, e.g., 5 or 19 years old); (b) screen-positive and/or diagnosed with OCD using validated tools (e.g., OCD diagnostic module); (c) receives care at a participating community mental health service; and (d) informed consent obtained for participation in research and data collection (consent from caregiver given for 17 and below, with assent from the young person). All clinicians within the participating health services will be offered the foundational training (training in screening and detection of OCD). To be eligible to participate as clinicians for foundational training, individuals must be: (a) employed by a participating mental health service; (b) involved in delivery or supervision of clinical services for youth; (c) registered with the relevant professional body for their profession, e.g., AHPRA; and (d) meet registration language requirements i.e., fluency in English. To be eligible to participate as a treating clinician, individuals must meet inclusion criteria above as well as the following criteria: (a) approved by their supervisor/clinical team lead to participate in training and delivery of the MoC; and (b) available and willing to attend training, participate in supervision, and deliver the MoC. Parent inclusion includes: child meeting above criteria, and parent will to participate in parent components of treatment.
Exclusion criteria
Child and adolescents may be deemed unsuitable for the program if (a) co-occurring medical condition that poses a risk to participating, (b) primary eating disorder that require priority intervention, (c) substance use disorder, (d) psychotic disorder, (e) active suicidality or risk requiring inpatient admission, or (f) intellectual impairment. Clinicians (treating clinicians) will be excluded from participating if they are unavailable during key project phases (e.g., due to extended leave or resignation).
Outcome results
None listed