2 - (SYM 69) Staged-care CBT-ERP for Paediatric OCD: improving Access and Optimising Outcomes for Young People

Cognitive-behavioural therapy involving exposure and response prevention (CBT-ERP) is an effective, tolerable, acceptable, and cost-effective treatment for paediatric OCD, whether delivered in-person or via telehealth (e.g., McGuire et al., 2015).  Yet, affected youth have limited access to this potentially curative treatment, with a staggering delay of approximately 9 years to access ANY treatment for OCD in Australia (Cooper et al., 2023), resulting in illness progression and unnecessarily high rates of hospital admissions. Barriers to care include a lack of trained clinicians, geographical and financial barriers, negative clinician perceptions about ERP, and the time intensive nature of traditional weekly CBT-ERP.  While OCD impacts youth irrespective of race, gender, socio-economic status (SES), and geography, access to care is inequitable.  Families who receive mental health services are typically Caucasian (e.g., McMiller et al., 1996), live in urban areas (e.g., Oluyomi et al., 2023), and are of higher SES (Padgett et al., 1993).  Thus, the likelihood of a longer duration of untreated illness is magnified for youth in minority groups and those residing in rural/remote areas. Based on two decades of research elucidating CBT-ERP response predictors and investigating technology-enabled approaches, we have recently proposed a multi-technology, multi-modality staged-care model of CBT-ERP for paediatric OCD (Farrell et al., 2023) that addresses barriers and inequities. Staged care is a population health–oriented service model that draws upon a range of risk indicators, to inform clinical decision making and determine level of care within hierarchically arranged treatment packages using a single prognostic index (e.g., Hickie et al., 2019).  Whilst lower intensity interventions and stepped-care models hold promise for increasing access to care, insufficiently dosed treatment for severe conditions such as OCD can result in illness deterioration and need for even greater intensity of care (Diefenbach & Tolin, 2013). Informed by evidence, our staged-care model of harnesses the power of early intervention, technology, parental support, and tailored dosing to deliver a multi-modality, multi-technology, scalable intervention, that enables access at lower levels of clinical need, whilst delivering sufficiently intensive levels of care at higher levels of need – thus, providing right care, first time for all youth. This presentation will provide an overview of our novel care model and pilot data on various components of the model.