An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia.

BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines recommend that individual cognitive-behaviour therapy (CBT) is offered to all people with a diagnosis of schizophrenia. In addition, the guidelines recommend that family intervention (FI) should be offered to all families of people with schizophrenia who are in close contact with the service user. However, implementation into routine services is poor. AIMS: To survey mental health services to investigate how many people with a diagnosis of schizophrenia and their families are offered and receive CBT or FI. METHODS: A comprehensive audit of a random sample of 187 service users receiving care from one, large mental health care trust in North West England was conducted over a 12-month period. RESULTS: The audit recorded that only 13 (6.9%) of services users were offered and 10 (5.3%) received individual CBT, while 3 (1.6%) services users were offered and 2 (1.1%) received FIs within the 12-month audit period. CONCLUSIONS: Implementation of CBT and FI is poor, particularly for FI. Reasons for poor implementation and service implications are discussed.

Cognitive behavioral therapy for pediatric obsessive-compulsive disorder: development of expert-level competence and implications for dissemination.

Pediatric obsessive-compulsive disorder (OCD) is associated with substantial morbidity, comorbidity, family difficulties, and functional impairment. Fortunately, OCD in youth has also been found responsive to cognitive behavioral therapy (CBT) both alone and in combination with medication. This paper highlights key areas a treatment provider must be highly knowledgeable in to be considered an expert in cognitive behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). We describe the areas of knowledge that must be mastered to gain expertise, as well as the more difficult to quantify personal qualities that may allow a clinician to convey this knowledge in an expert manner. We provide detailed discussions of CBT theory, assessment strategies, implications of the treatment outcome literature for clinical decision-making, and how best to navigate CBT. We also discuss what the expert needs to accomplish by engaging youth and families throughout the evaluation and treatment process.