What is a stepped care approach?

Stepped Care is a system of delivering and monitoring mental health treatment so that the most effective, yet least resource intensive treatment, is delivered first, only “stepping up” to intensive / specialist services as required and depending on the level of patient distress or need.

Clinical trials in primary care settings in Europe indicate that it is at least as effective as traditional care and has the potential for health system improvements in efficiency.  No research has been published to date on the use of stepped care in postsecondary health care settings, however there are many proponents of the value of adopting stepped care models on campuses such as Dr. Peter Cornish from Memorial University and Dr. Rice Fuller from the University of New Brunswick.

Stepped care provides a framework for the care of individuals with significant mental health concerns that uses limited resources to their greatest effect on a population basis. Stepped care requires treatments of differing intensity. For example, there are less intensive treatments such as brief therapies, group treatments and self-help approaches (e.g. bibliotherapy) to more intensive treatments such as counselling, interpersonal therapy etc. For some individuals, lower levels of care would never be appropriate or may not be preferred by the consumer. Thus, stepped interventions offer a variety of treatment options to match the intensity of the patient’s presenting problem as well as potential patient preference.

Stepped care models also provide information to aid clinicians in decision making regarding selection of treatment strategies that are most appropriate for an individual client.

The model is founded on the following beliefs[1]:

  • People should not have to wait for psychological service
  • Different people require different levels of care
  • Finding the right level of care often depends on monitoring outcomes
  • Moving from lower to higher levels of care based on client outcomes often increases effectiveness and lowers costs overall

Who uses this approach?

Different steps might involve different professionals and would depend on the model utilized. With pure self-help as the initial step, no professionals would be required for this. Subsequent steps could include practice nurses or primary care mental health workers to provide guided self-help, then individual therapy from a clinical psychologist or mental health nurse.

What models exist on Ontario campuses?

The stepped care model was first developed in the UK (O’Donohue & Draper, 2011)[2][3] which has laid the foundation for other stepped care models which have developed.

In Canada, Dr. Peter Cornish from Memorial University has developed a unique but untested model of stepped care for secondary mental health care settings. Memorial University is planning to implement a campus-wide, community development approach to wellness promotion and, the stepped care model would be an integral component of this proposed direction. Click here to read about the Memorial University Stepped Care Model.

Based on the Cornish and Fuller model, Georgian College has recently developed their own stepped care model. Click here to view Georgian College’s Stepped Care Model.

Washington Mind, a mental health and wellbeing organization based in the United Kingdom, has also adapted a Stepped Care model into their framework. Click here to read more and see their stepped care diagram below:

Washington Mind_Stepped-Care Model

Learn more

  • O’Donohue, W. T., & Draper, C. (2011). The case for evidence-based stepped care as part of a reformed delivery system. In W. T. O’Donohue and C. Draper (Eds.), Stepped-Care and e-health. New York: Springer Science
  • Cornish, P. (2014) Memorial University Stepped Care Model. Communique. 14.3
  • Von Korff & Tiemens (2000), Individualized stepped care of chronic illness. Western Journal of Medicine. v.172 (2). Accessed from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070776/

References

[1] Von Korff & Tiemens (2000), Individualized stepped care of chronic illness. Western Journal of Medicine. v.172 (2). Accessed from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070776/
[2] O’Donohue, W. T., & Draper, C. (2011). The case for evidence-based stepped care as part of a reformed delivery system. In W. T. O’Donohue and C. Draper (Eds.), Stepped-Care and e-health. New York: Springer Science.
[3] Aherne (2013) Stepped Care in primary mental health services revisited. Presentation access from: http://npce.eu/mediapool/113/1137650/data/20130613/20130530_NPCE_Limmerick_conference_presentation_Dr_DAherne.pdf