Effects of Treatment Setting on Outcomes of Flexibly-Dosed Intensive Cognitive Behavioral Therapy for Pediatric OCD : A Randomized Controlled Pilot Trial

Funding Information: The study authors would like to acknowledge the planning support of Drs. Eric Storch and Katherine Martinez, the recruitment and administrative support of the Provincial OCD Program Team at BC Children's Hospital, and the participation of all families. Funding. This study was supported by postdoctoral awards to RS from the Michael Smith Foundation for Health Research (#17821) and the BC Children's Hospital Research Institute. Both awards provided salary support for RS as well as research funds to support study implementation (e.g., staff salaries, participant reimbursement, etc.). A private donation to the Provincial OCD Program via the BC Children's Hospital Foundation also supported some research costs. Funding Information: This study was supported by postdoctoral awards to RS from the Michael Smith Foundation for Health Research (#17821) and the BC Children’s Hospital Research Institute. Both awards provided salary support for RS as well as research funds to support study implementation (e.g., staff salaries, participant reimbursement, etc.). A private donation to the Provincial OCD Program via the BC Children’s Hospital Foundation also supported some research costs. Publisher Copyright: © Copyright © 2021 Selles, Naqqash, Best, Franco-Yamin, Qiu, Ferreira, Deng, Hannesdottir, Oberth, Belschner, Negreiros, Farrell and Stewart.Introduction: Optimizing individual outcomes of cognitive-behavioral therapy (CBT) remains a priority. Methods: Youth were randomized to receive intensive CBT at a hospital clinic (n = 14) or within their home (n = 12). Youth completed 3 × 3 h sessions (Phase I) and up to four additional 3-h sessions as desired/needed (Phase II). An independent evaluator assessed youth after Phase I, Phase II (when applicable), and at 1- and 6-months post-treatment. A range of OCD-related (e.g., severity, impairment) and secondary (e.g., quality of life, comorbid symptoms) outcomes were assessed. Results: Families' satisfaction with the treatment program was high. Of study completers (n = 22), five youth (23%) utilized no Phase II sessions and 9 (41%) utilized all four (Median Phase II sessions: 2.5). Large improvements in OCD-related outcomes and small-to-moderate benefits across secondary domains were observed. Statistically-significant differences in primary outcomes were not observed between settings; however, minor benefits for home-based treatment were observed (e.g., maintenance of gains, youth comfort with treatment). Discussion: Intensive CBT is an efficacious treatment for pediatric OCD. Families opted for differing doses based on their needs. Home-based treatment, while not substantially superior to hospital care, may offer some value, particularly when desired/relevant. Clinical Trial Registration: www.ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03672565, identifier: NCT03672565.Peer reviewe

The comparative impact of different forms of violence exposure in youth on long-term adult outcomes

Violence exposure during childhood and adolescence is associated with a wide range of negative emotional and behavioural outcomes. Despite an extensive body of research, there are numerous problems with respect to how violence exposure has been operationalized and measured; design and methodology (i.e., cross-sectional or short-term longitudinal studies); limited outcome measures; and overall conflicting findings. Further, there is a paucity of research examining the effects of violence exposure during youth on long-term adult outcomes. Given the considerable individual variability that exists with respect to the effects of violence exposure, longitudinal research is needed to clarify the comparative impact of different types of violence exposure across locations. Using a large and racially diverse community sample (n = 753; male = 58%; Black = 46%), the current longitudinal study aimed to elucidate the comparative and cumulative effect of different types of violence exposure (witnessing versus victimization) across different locations (home, school, neighbourhood) occurring during youth (lifetime through grade 8) on long-term adult (age 25) outcomes of internalizing, externalizing, and attention problems; substance use; and intimate partner violence perpetration. Results indicated that victimization, but not witnessing violence, predicted all five adult outcomes. More specifically, being victimized in the home setting was associated with the widest range of negative outcomes (internalizing, externalizing, and attention problems), while school victimization was specifically associated with substance use problems in adulthood. The nature and severity of direct victimization may put youth at greater risk for developing emotional and behavioural dysregulation, and the home and school settings appear to be important contexts for adolescent development. Additionally, when youth experienced multiple types of violence across multiple locations (cumulative violence exposure), they experienced a broader and more diverse range of negative outcomes in adulthood. This study extended existing research on the effects of violence exposure during childhood and adolescence. Taking a life-course perspective, these findings demonstrate that violence exposure has long-term negative effects evident well into adulthood, with victimization at home and school as more robust predictors of negative adult outcomes than exposure to neighbourhood violence. Based on these findings, preventing and effectively addressing youth victimization, especially at home and school, must be a top research, practice, and policy priority