The National Institute for Health and Clinical Excellence (NICE) recommends a range of psychological therapies to treat people with depression and anxiety disorders and bring them to recovery. It also recommends these therapies are used to provide a system of stepped care.
Stepped care has two principles:
- treatment should always have the best chance of delivering positive outcomes while burdening the patient as little as possible, and
- a system of scheduled review to detect and act on non-improvement must be in place to enable stepping up to more intensive treatments, stepping down where a less intensive treatment becomes appropriate and stepping out when an alternative treatment or no treatment become appropriate.
Stepped care models standardise systems and procedures with an explicit aim of improving efficiency. If someone has depression, low mood or an anxiety disorder, they should have access to a National Institute of Health and Care Excellence (NICE) approved Cognitive Behavioural Therapy (CBT) treatment in a stepped care model first before other forms of intervention are used that may be less efficacious and take longer to derive benefit. It directly reduces waiting times and increases the numbers of people who can access at any one time. The recommended option within a stepped care model should be the least restrictive of those currently available, but still likely to provide significant gain in improvement of the presenting problem for the person. The stepped care model is also self- correcting, so if a higher intensity of intervention is required the patient can be supported to access this in a timely way. The definition of ‘least restrictive’ may refer to the impact in terms of cost and personal inconvenience, and well as referring to the amount of time required to support the treatment (i.e. treatment intensity). In stepped care, more intensive face to face treatments are generally reserved for people who do not benefit from simpler first-line treatments first. The two models of stepped care are pure stepped care where the majority of patients receive a low intensity intervention first and stratified. The two pilot sites each tested a model of stepped care.
Stepped care model for common mental health problems:
Stepped Care Model IAPT 2011
UEA Stepped Care Decision Making Tool
Stepped Care Useful Information:
|Commissioning Stepped Care||Delivering Stepped Care||Doncaster Demonstration Site|
|Maple Report||Self-Help Models in Practice||
Access, Effectiveness and Efficiency