Abstract
Over the past decade, various approaches to stepped care have been touted as a potential solution for a range of challenges facing the world of mental health and substance use (MHSU) services. Stepped care models, including models like Stepped Care 2.0 (SC2.0), promise significant benefits both for clients and for those working to deliver MHSU services, by improving efficiency, creating a more client-centered approach to care, reducing wait times, and extending forms of care to populations that have often been excluded from more traditional ways of delivering mental health care.
The goal of this chapter was to evaluate the evidence for stepped care through a scoping review of the literature on stepped care models for MHSU service delivery to youth and young adults between the ages of 12 and 24. We selected this age range in particular because this is the age group that many MHSU services using stepped care for youth and young adults are intended to serve.
This review found that published, peer-reviewed evidence needed to support decision-making is far behind existing practice, in part because the term “stepped care” is used to refer to a wide range of different models. As there is no consensus definition of stepped care, more research is needed before definitive claims can be made about the efficacy of particular models like SC2.0.
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Notes
- 1.
Depression and anxiety are commonly comorbid mental health disorders (Bennett et al., 2018). Rates of anxiety disorder among youth with depression have been reported to range from 15% to 75%, while depressive disorders have been shown to occur in 10% to 15% of youth with an anxiety disorder (Bennett et al., 2018; Cummings et al., 2014).
- 2.
For the systematic component of our review, we further refined our inclusion criteria to include only studies that reported clinical and/or functional outcomes for clients/patients/participants who received care via a stepped care model. We excluded reviews, commentaries, letters to the editor, study protocols, and editorials at this stage. Using these criteria, we identified 29 studies. To consolidate the evidence base, studies that used the same study sample were grouped by study team (i.e., if a research team conducted a randomized controlled trial (RCT) and then conducted additional analyses on the same data generated by the original RCT, these studies were represented as a single study). This yielded 24 grouped studies. Of the 24 grouped studies of interest, 14 reported on symptom severity or changes in diagnoses related to anxiety and/or depression.
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Salmon, A., Berger, M., Fernando, S., Snow, M.E. (2023). Stepped Care, a Closer Look: Reviewing Evidence and Evaluating Outcomes. In: Cornish, P., Berry, G. (eds) Stepped Care 2.0: The Power of Conundrums. Springer, Cham. https://doi.org/10.1007/978-3-031-45206-2_9
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