Childhood obsessive–compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable “treatment gap” and “quality gap” in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.

儿童强迫症（OCD）是影响儿童和青少年的最普遍和最致残的心理健康状况之一。尽管与儿童强迫症相关的痛苦和负担有据可查，并且可以获得经验支持的治疗，但在为患有强迫症的青少年提供服务方面仍然存在不可接受的“治疗差距”和“质量差距”。治疗差距代表着大量从未接受过强迫症心理健康服务的儿童，而质量差距则代表着虽然获得了服务但没有接受基于暴露和反应预防的循证认知行为治疗的儿童和青少年（CBT-ERP）。我们提出了一种新颖的 CBT-ERP 阶段性护理模式，旨在改善高质量 CBT-ERP 的治疗机会，并提高青少年的治疗效果。在阶段性护理中，患者接受分层安排的服务包，这些服务包根据治疗方案的强度、持续时间和组合而有所不同，提供从预防、早期干预到一线和二线治疗的护理。基于对治疗结果和治疗反应预测因素的文献的全面回顾，我们提出了一种初步分期算法来确定临床护理水平，该算法由三个关键决定因素提供信息：疾病的严重程度、合并症和既往治疗史。拟议的儿科强迫症临床分期模型优先考虑为各个疾病阶段和疾病程度的儿童提供高质量的护理，利用经验支持的 CBT-ERP，跨多种模式，结合循证的临床决策启发法。虽然有证据支持，但所提出的分期模型在准备好投入黄金时间之前需要进行实证验证。