Training the next generation of pediatric OCD therapists: Descriptors and outcomes of the IOCDF pediatric behavior therapy training institute

Abstract

Cognitive behavioral therapy with exposure and response prevention (ERP) is widely regarded as the first-line psychological treatment for pediatric obsessive-compulsive disorder (OCD), yet barriers to implementation remain, and many clinicians report discomfort or lack of knowledge in delivering ERP. This naturalistic longitudinal study examined demographics, clinical practice characteristics, and self-reported perceived learning of clinicians enrolled in the International OCD Foundation's Pediatric Behavior Therapy Training Institute (BTTI), an intensive training program for pediatric ERP for OCD. Clinicians (N = 159) who attended one of six in-person pediatric BTTI trainings from 1/2016-11/2019 completed pre-and post-training assessments and at 6-month follow-up. Main analyses used multiple imputation for missing data. As hypothesized, results showed significant improvements from pre-to post-training in clinician-reported comfort in assessing/treating pediatric OCD with a large effect size (p < .001; ES = 0.95), which remained significant at follow-up. We were unable to detect significant changes in positive beliefs about exposure (ES = 0.12), proportions of patients with OCD in clinicians' caseloads (ES = 0.33), or percentage of session time devoted to ERP (ES = 0.02); although some models were significant in sensitivity analyses. At follow-up, most clinicians (72%) reported using all skills learned in the program, although some barriers persisted, such as challenges conducting exposures outside of the office. Findings support the effectiveness of the pediatric OCD BTTI in increasing clinicians' self-reported comfort in assessing and treating OCD in children/adolescents but provide limited evidence of objective changes in ERP implementation. Future efforts should incorporate objective fidelity measures, measure patient outcomes, address barriers to skills use, and increase accessibility to ERP training.