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Guiding Principles for Implementing Stepped Care in Mental Health: Alignment on the Bigger Picture

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Stepped care models are a mental healthcare delivery framework in which a continuum of support allows selection of a range of interventions to match a client’s evolving needs and preferences. Currently in use in multiple settings worldwide, stepped care has the potential to provide a needed advance for the development of comprehensive mental health systems. However, definitions of stepped care lack consistency, resulting in differing interpretations reflected in variable implementation, ultimately limiting its replicability, utility and potential for impact. To help foster greater alignment in research and practice, we propose a set of principles for stepped care which can provide guidance on how to bridge multiple mental health services together, reduce fragmentation, and respond to the full breadth of mental health needs along a continuum of care in diverse settings. We hope that articulating these principles will foster discussion and spur mental health stakeholders to translate them into actionable standards.

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The authors acknowledge the support of the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health. This review was conducted through Frayme, a Network of Centres of Excellence which supports international collaborations between researchers, knowledge users, and their partners, to accelerate knowledge translation in mental health service delivery for young people.

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Correspondence to S. Mughal.

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A. Churchill and A. Jaouich are both employed with Stepped Care Solutions. Stepped Care Solutions is a not-for-profit mental health system consultancy group and is the developer of the Stepped Care 2.0 model.

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Mughal, S., Salmon, A., Churchill, A. et al. Guiding Principles for Implementing Stepped Care in Mental Health: Alignment on the Bigger Picture. Community Ment Health J 59, 1035–1042 (2023).

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