Appendix A: Technical detail on the criteria for audit

Guidance

Possible objectives for an audit
People that could be included in an audit and time period for selection
Measures that could be used as a basis for an audit

Appendix A: 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:

individuals with obsessive-compulsive disorder (OCD) or body dysmorphic disorder (BDD) are involved in their care
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:

people with OCD or BDD at a particular stage (for example, to study assessment)
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**
Criterion	Exception	Definition of terms
Each primary care trust, mental healthcare trust, and children's trust that provides mental health services has access to a specialist multidisciplinary obsessive-compulsive disorder (OCD)/body dysmorphic disorder (BDD) team. a) Operational policies in each primary care trust, mental healthcare trust and children's trust that provides mental health services specify procedure for accessing specialist OCD/BDD team b) Specialist teams offer a liaison function to other mental health professionals	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 or 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**
Criterion	Exception	Definition of terms
People with obsessive-compulsive disorder (OCD) or body dysmorphic disorder (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. a) Operational policies indicate the re‑referral pathway b) Operational policies indicate that care coordination or other suitable process is followed for people where there has been no response to treatment	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**
Criterion	Exception	Definition of terms
In their initial treatment, adults who have mild obsessive-compulsive disorder (OCD) or body dysmorphic disorder (BDD), or those who express a preference, are offered a low intensity psychological treatment. a) Clinical notes indicate that people are informed of low intensity treatment options b) Clinical notes indicate the clinical outcome of low intensity interventions	Adults with moderate to severe OCD or BDD Children and young people Adults who refuse this treatment	Low intensity treatments (less than 10 therapist hours) include: brief individual cognitive behavioural therapy (CBT; including ERP [exposure and response prevention]) using structured self‑help materials brief individual CBT (including ERP) by telephone group CBT (including ERP) – note the patient may be receiving more than 10 hours of therapy in this format

**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**
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 obsessive-compulsive disorder (OCD) are offered more intensive treatment interventions. a) Clinical notes indicate that people have been informed of the possibility of intensive cognitive behavioural therapy (CBT; including ERP [exposure and response prevention]) or a selective serotonin reuptake inhibitor (SSRI) b) Clinical notes indicate the clinical outcome of the intervention offered	Adults where there is improvement with low intensity interventions Children and young people Adults who refuse these treatments	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**
Criterion	Exception	Definition of terms
Adults who have obsessive-compulsive disorder (OCD) with moderate functional impairment are offered the choice of either a course of a selective serotonin reuptake inhibitor (SSRI) or more intensive cognitive behavioural therapy (CBT; including ERP [exposure and response prevention]). a) Clinical notes indicate that people have been informed of the possibility of more intensive CBT (including ERP) or an SSRI b) Clinical notes indicate the clinical outcome of the intervention offered	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**
Criterion	Exception	Definition of terms
Adults who have moderate body dysmorphic disorder (BDD) are offered the choice of a selective serotonin reuptake inhibitor (SSRI) or more intensive individual cognitive behavioural therapy (CBT; including ERP) or an SSRI. a) Clinical notes indicate that people have been informed of the possibility of intensive individual CBT (including ERP [exposure and response prevention]) or an SSRI b) Clinical notes indicate the clinical outcome of the intervention offered	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
Criterion	Exception	Definition of terms
Children and young people who have obsessive-compulsive disorder (OCD) with moderate or 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 cognitive behavioural therapy (CBT; including ERP [exposure and response prevention]) as the treatment of choice. a) Clinical notes indicate that the child or young person and the family or carer were informed of possibility of CBT b) Clinical notes identify the clinical outcome of CBT	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 to 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
Criterion	Exception	Definition of terms
Children who have obsessive-compulsive disorder (OCD) or body dysmorphic disorder (BDD) where there has not been an adequate response to cognitive behavioural therapy (CBT; including ERP [exposure and response prevention]) attend a multidisciplinary review (with family or carers) where the use of a selective serotonin reuptake inhibitor (SSRI) is considered in addition to ongoing psychological treatment. a) Clinical notes indicate a multidisciplinary review occurred and identified that the use of an SSRI in addition to ongoing psychological treatment was explored in detail b) Clinical notes indicate that careful monitoring was carried out c) Clinical notes indicate the clinical outcome of the intervention offered	Children who respond to CBT (including ERP)	Children: aged 8 to 11 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

9. Possible objective for audit: to improve the treatment of young people (aged 12 to 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
Criterion	Exception	Definition of terms
Young people who have obsessive-compulsive disorder (OCD) or body dysmorphic disorder (BDD) where there has not been an adequate response to cognitive behavioural therapy (CBT; including ERP [exposure and response prevention]) attend a multidisciplinary review (with family or carers) where the use of a selective serotonin reuptake inhibitor (SSRI) is considered in addition to ongoing psychological treatment a) Clinical notes indicate a multidisciplinary review occurred and identified that the use of an SSRI in addition to ongoing psychological treatment was explored in detail b) Clinical notes indicate that careful monitoring was carried out c) Clinical notes indicate the clinical outcome of the intervention offered	Young people who respond to CBT (including ERP)	Young people: aged 12 to 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**
Criterion	Exception	Definition of terms
Children and young people with body dysmorphic disorder (BDD) are considered for cognitive behavioural therapy (CBT; including ERP [exposure and response prevention]) as first‑line treatment. a) Clinical notes indicate that the healthcare professional responsible has discussed the need for CBT (including ERP) and an arrangement has been made b) Clinical notes indicate the clinical outcome of the intervention offered	Children or young people who refuse treatment	Children: aged 8 to 11 years. Young people: aged 12 to 18 years. CBT (including ERP) means: involving the family or carers and adapted to the developmental age of the child or young person