Centering Equity in the Implementation of Exposure and Response Prevention for Pediatric OCD: Current Evidence and Future Directions

Exposure and Response Prevention (ERP), the gold standard psychosocial treatment for pediatric OCD, is severely underutilized in routine practice. The majority of youth in need do not receive ERP, with minoritized youth being even less likely to receive and benefit from ERP. Improving the equitable implementation of ERP is pivotal to improving outcomes for youth with OCD. This article examines determinants of equitable implementation and the efforts to date to improve ERP access and response across multiple levels of implementation context (e.g., clinician, innovation, societal).

Determinants exist across contextual levels that inhibit or promote ERP access and response including lack of ERP cultural responsiveness, clinician training and attitudes, client stigma, therapeutic alliance, organizational supports, and workforce shortages. Most efforts have been focused on improving access through clinician training. Emerging work has also attempted to address both access and response through expanding the workforce capacity and improving the cultural responsiveness of ERP.

The review highlights the complex, multifactorial efforts required to achieve equitable access and treatment outcomes for youth with OCD. Our review suggests that there has been a disproportionate effort to date to improve ERP access and response by targeting clinicians directly; however, sustained change is unlikely unless policy and structural factors are addressed.