Guidance
Appendix D: Technical detail on the criteria for audit
Appendix D: Technical detail on the criteria for audit
Possible objectives for an audit
One or more audits could be carried out in different care settings to ensure that:
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individuals with OCD or BDD are involved in their care
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treatment options are appropriately offered and provided for individuals with OCD or BDD.
People that could be included in an audit and time period for selection
A single audit could include all individuals with OCD or BDD. Alternatively, individual audits could be undertaken on specific groups of individuals such as:
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people with OCD or BDD at a particular stage (for example, to study assessment)
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a sample of people with OCD or BDD from particular populations in primary care.
Measures that could be used as a basis for an audit
Please see tables below.
1. Possible objective for audit To improve access to specialist OCD/BDD multidisciplinary healthcare across the individual's lifespan |
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Criterion |
Exception |
Definition of terms |
Each PCT, mental healthcare trust, and children's trust that provides mental health services has access to a specialist multidisciplinary OCD/BDD team.
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None |
A specialist OCD/BDD team is able to conduct expert assessment, specialist cognitive‑behavioural and pharmacological treatment and provide age‑appropriate care A liaison function will aim to: increase skills in the assessment and evidence‑based treatment of people with OCD or BDD; provide high‑quality advice; aid understanding of the needs of family/carers and developmental needs |
2. Possible objective for audit To decrease delays in the patient pathway for people who are re‑referred for treatment of OCD/BDD |
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Criterion |
Exception |
Definition of terms |
People with OCD or BDD who have relapsed following successful treatment are seen by a healthcare professional as soon as possible if re‑referred, and where there has been no response to treatment are appropriately supported.
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Person with OCD or BDD refuses re‑referral |
None |
3. Possible objective for audit To improve the initial treatment of adults who have mild OCD or BDD, or those who prefer a low intensity psychological treatment |
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Criterion |
Exception |
Definition of terms |
In their initial treatment, adults who have mild OCD or BDD, or those who express a preference, are offered a low intensity psychological treatment.
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Low intensity treatments (less than 10 therapist hours) include:
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4. Possible objective for audit To improve the treatment of adults who have been unable to engage with, or where there has been no response to, low intensity treatment |
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Criterion |
Exception |
Definition of terms |
Where adults have been unable to engage with low intensity treatment, or there has been no response to low intensity treatment, adults with mild OCD are offered more intensive treatment interventions.
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More intensive treatment interventions include: a choice of either a course of an SSRI, or more intensive CBT (including ERP) (of more than 10 therapist hours per patient) |
5. Possible objective for audit To improve the treatment of adults who have OCD with moderate functional impairment |
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Criterion |
Exception |
Definition of terms |
Adults who have OCD with moderate functional impairment are offered the choice of either a course of an SSRI or more intensive CBT (including ERP).
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Children and young people |
More intensive CBT (including ERP) means: more than 10 therapist hours per patient |
6. Possible objective for audit To improve the treatment of adults who have BDD with moderate functional impairment |
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Criterion |
Exception |
Definition of terms |
Adults who have moderate BDD are offered the choice of an SSRI or more intensive individual CBT (including ERP) or an SSRI.
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Children and young people |
CBT (including ERP) means: ERP that addresses key features of BDD. |
7. Possible objective for audit To improve the care of children and young people who have OCD with moderate to severe functional impairment and those who have OCD with mild functional impairment for whom guided self‑help has been ineffective or refused |
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Criterion |
Exception |
Definition of terms |
Children and young people who have OCD with moderate/severe impairment or those with mild impairment where there is no response to guided self‑help, or where guided self‑help has been refused, will be offered CBT (including ERP) as the treatment of choice.
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Children and young people who refuse CBT (including ERP) |
CBT (including ERP) means: treatment involving the family or carers and adapted to suit the developmental age of the child. Group or individual formats should be offered depending upon the preference of the child or young person and their family or carers |
8. Possible objective for audit To improve the care of children (aged 8–11 years) who have OCD or BDD with moderate to severe functional impairment if there has not been an adequate response to CBT (including ERP) involving the family or carers |
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Criterion |
Exception |
Definition of terms |
Children who have OCD or BDD where there has not been an adequate response to CBT (including ERP) attend a multidisciplinary review (with family/carers) where the use of an SSRI is considered in addition to ongoing psychological treatment.
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Children who respond to CBT (including ERP) |
Children: aged Careful monitoring: being seen frequently on an appropriate and regular basis agreed by the patient, his or her family or carers and the healthcare professional, and recorded in the notes |
9. Possible objective for audit To improve the treatment of young people (aged 12–18 years) who have OCD or BDD with moderate to severe functional impairment if there has not been an adequate response to CBT (including ERP) involving the family or carers |
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Criterion |
Exception |
Definition of terms |
Young people who have OCD or BDD where there has not been an adequate response to CBT (including ERP) attend a multidisciplinary review (with family/carers) where the use of an SSRI is considered in addition to ongoing psychological treatment
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Young people who respond to CBT (including ERP) |
Young people: aged 12–18 years Careful monitoring: being seen frequently on an appropriate and regular basis agreed by the patient, his or her family or carers and the healthcare professional, and recorded in the notes |
10. Possible objective for audit To improve the treatment of children and young people who have BDD |
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Criterion |
Exception |
Definition of terms |
Children and young people with BDD are considered for CBT (including ERP) as first‑line treatment.
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Children or young people who refuse treatment |
Children: aged Young people: aged 12–18 years. CBT (including ERP) means: involving the family or carers and adapted to the developmental age of the child or young person |