NIH grant: Building Capacity To Treat Obsessive-Compulsive Disorder In Community Practice (1R34MH137291-01A1)

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NIH grant 1R34MH137291-01A1: Building Capacity To Treat Obsessive-Compulsive Disorder In Community Practice
Institute: {'code': 'MH', 'abbreviation': 'NIMH', 'name': 'National Institute of Mental Health', 'admin_org_id': '12500050', 'admin_funding_url': ''}. PI: Sapana R. Patel. Award: $736483.
Start: 2026-07-01T00:00:00.
Obsessive-compulsive disorder (OCD) is a disabling illness that significantly impairs quality of life and
functioning. 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.

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