While many effective treatments for OCD have been developed through research, most of the studies used did not include diverse groups of research participants. This lack of diversity led to a gap in learning how treatments can be adapted to meet the unique needs of diverse populations. These needs can be influenced by many aspects of identity including race, ethnicity, culture, income, gender identity, sexual orientation, immigration status, and other socioeconomic and cultural factors—or their unique combinations.

To help clinicians adapt OCD treatments to meet the challenges of all clients, Dr. Sanchez and her team carried out three study goals. The first was to learn what OCD and anxiety treatment look like at a public mental health clinic. By examining 3,286 anonymous treatment notes for 104 young people, the team found that ERP can be successfully used in a public mental health setting, but can benefit from additional factors that address cultural and socioeconomic stressors. The second goal was to learn about how therapists make decisions to adapt ERP for diverse youth and about the client/family experience of receiving treatment.  Understanding client social identities and environment was shown to be key to treatment planning, and client-therapist relationship building and culturally responsive adaptations were crucial for successful ERP. The third goal was to develop a toolkit to support therapists delivering culturally responsive ERP. This toolkit — the Revamping Evidence-based Supports to Promote Effective Culturally Responsive Treatment (RESPECT) for OCD & Anxiety — is currently being developed for public use, and received feedback from 182 therapists on factors such as delivering ERP in a culturally responsive way and incorporating other strategies to address cultural and contextual factors that can affect young people.