Building capacity to treat obsessive-compulsive disorder in community practice - obsessive-compulsive disorder (OCD) is a disabling illness that significantly impairs quality of life and functioning

The National Institute of Mental Health awarded Research Foundation For Mental Hygiene, Inc. $736,483 on July 1, 2026, through the Mental Health Research Grants program (CFDA 93.242) to develop and evaluate SCALE-EX/RP, a fully remote learning collaborative designed to train community behavioral health clinic clinicians to deliver exposure and response prevention (EX/RP) for obsessive-compulsive disorder.

The recipient, operating through its New York State Psychiatric Institute division, will conduct a mixed-method evaluation using surveys and interviews with clinicians, supervisors, and clinic leaders from six certified community behavioral health clinics to identify barriers and facilitators to EX/RP implementation. Findings will inform refinement of SCALE-EX/RP, which comprises self-paced online EX/RP training courses, remote one-on-one consultations with experiential training, and a virtual learning community where clinicians engage in case-based learning, self-audit, and receive feedback from an implementation specialist. The project addresses a documented treatment gap: while randomized controlled trials show EX/RP alone or combined with serotonin reuptake inhibitors helps up to two-thirds of OCD patients achieve minimal symptoms and patients prefer EX/RP to medication alone, the evidence-based intervention remains greatly underused in community settings.

Performance occurs in New York. The project period runs from July 1, 2026, through June 30, 2029. The award is an R34 pilot effectiveness trial responding to PAR-21-131 and NIMH NOT-MH-22-170, which supports implementation science research in certified community behavioral health clinics.

First-line treatments include cognitive behavioral therapy consisting of exposure and response prevention (EX/RP) and pharmacotherapy with serotonin reuptake inhibitors (sris). Randomized controlled trials (rcts) have shown that EX/RP alone or combined with sris helps up to two-thirds of patients attain minimal symptoms. EX/RP (alone or combined with medication) is also the treatment patients typically prefer compared to medications alone. However, despite its proven efficacy and this patient preference, EX/RP is greatly underused in community settings. This R34 will begin to address this treatment GAP by testing scalable implementation strategies to train community clinicians to deliver EX/RP. In response to PAR-21-131 (pilot effectiveness trials for treatment, preventive, and services interventions) and nimh not-MH-22-170 (research using implementation science to support the delivery of evidence- based practices in certified community behavioral health clinics (ccbhcs), this R34 will develop and evaluate the feasibility and preliminary effectiveness of a fully remote EX/RP learning collaborative, called scale-EX/RP, developed with and for ccbhc clinicians. First, we will use behavior change theory to guide a mixed-method evaluation consisting of surveys and interviews with clinicians, and interviews with supervisors and clinic leaders from six ccbhc clinics to identify barriers and facilitators to EX/RP use. We will use these data to refine our initial plan for scale-EX/RP that includes self-paced online exrp training courses, remote 1:1 consultations with experiential training, and a virtual learning community comprised of ccbhc clinicians and an implementation specialist where clinicians will engage in case-based learning, self-audit and receive feedback while delivering EX/RP (aim 1). Next, we will conduct a pilot cluster RCT in adults with OCD to test our hypotheses that scale-EX/RP will lead to superior clinician fidelity to EX/RP compared to online EX/RP training courses alone and to greater improvement in hypothesized mechanisms of action: clinician knowledge, attitudes, and confidence (aim 2). Acceptability and feasibility will be evaluated with clinician surveys, time spent in training and training completion rates. Qualitative interviews with clinic members in scale-EX/RP will be used to identify barriers and facilitators to future implementation. We will also explore how clinician EX/RP fidelity influences patient EX/RP adherence, and improvement in OCD symptoms and quality of life (exploratory aim). Results will inform the design of a larger scale cluster RCT powered to test the hypothesis that training ccbhc clinicians with scale-EX/RP will lead to better patient outcomes. Our long-term goal is to increase access to EX/RP (our most effective, patient-preferred OCD treatment) while advancing knowledge of how learning collaboratives can be used to implement evidence-based treatments for severe mental illness (like EX/RP) in behavioral health.