Frequently Asked Questions
What is Stepped Care 2.0?
Stepped Care 2.0© (SC2.0) is a model for systems of care that provides rapid, same day, flexible access to wellness and mental health resources. The approach is aimed at ensuring open access to care and empowering people to maximize and manage their own health to the best of their ability.
How is SC2.0 different from other Stepped Care models?
SC2.0 was developed in Canada at Memorial University of Newfoundland. It offers the lowest level of intervention intensity warranted by the initial and ongoing assessments in accordance with client preference and readiness. It integrates a range of established and emerging online mental health programs systematically along dimensions of treatment intensity and associated client autonomy. Treatment intensity can be either stepped up or down depending on the level of need. SC2.0 advances the UK model and the reimagined model described by O’Donohue and Draper (2011), extending it to mental health promotion and illness prevention activities, creating a framework for the full continuum of care. Programs can be selected and arranged based on intensity, cost and level of engagement. The model becomes a useful heuristic for system building and community collaboration.
Why do we need SC2.0?
SC2.0 provides a framework to shift the risk paradigm, which has dominated our society and mental health systems. This risk paradigm directs the majority of resources to a small proportion of the population who we fear (without much evidence) could present a risk of harm to self or other in the future. SC2.0 provides a framework that distributes care more appropriately and systematically across the entire population, ensuring a balance on wellness promotion, illness prevention, low-intensity supports, recovery-oriented care, intensive treatment and risk management.
Who will benefit from SC2.0?
Clients, clinicians and administrators will benefit from the organization of diverse care options within a system that guides decision making through ongoing monitoring of the interventions. SC2.0 can help both providers and clients recognize how the programming fits together in a systematic and coherent way. This will improve access and ensure that people receive the right care, at the right time. Not surprisingly, clients are satisfied, and staff morale increases through the implementation of SC2.0.
What can clients expect from SC2.0?
Clients can expect to gain access to more care options, more quickly. They will feel more empowered through greater involvement in treatment decision making.
How is step level decision making done?
Stepping decisions are made in collaboration with clients as they monitor their progress, assess their needs and consider the wide range of care options available. Clients do not have to start with lower-intensity services; however, it makes sense for people to start with the lowest-intensity intervention that meets their needs. Treatment choices are based on readiness, need and preference, as well as information on what is required and what can be expected from a particular intervention to achieve positive results. Clients can make use of resources and services from more than one step at the same time.
How is risk managed when referring to low-intensity steps?
A common myth associated with SC2.0 is that low-intensity programming is emphasized at the expense of high-intensity care. The fact is that implementation of SC2.0 typically allows for the expansion of intensive and specialized care for those who need it. Clients get it when they ask for it and providers find more time in their schedules to deliver it.
Is SC2.0 evidence-informed?
Yes, Stepped Care is an evidence-informed system of intervention stages.1, 2, 3 SC2.0 extends the original U.K. model, as well as O’Donohue and Draper’s re-imagined version.4 SC2.0 draws on recovery-oriented principles5 and emerging single-session or one-at-a-time therapy literature.6, 7, 8, 9, 10 Studies in Australia and in the UK have found that Stepped Care is cost-effective.11, 12 Stepped Care models have also been shown to have positive effects on rates of recovery for common mental health disorders, such as depression and anxiety.13, 14, 15 Continuous outcome monitoring allows clinicians and clients to adjust treatment based on current mental health symptoms, progress and process data.16, 17 Research has found that such feedback-informed treatment can improve mental health outcomes, such as treatment response and remission rates, compared to treatment as usual.18, 19, 20, 21, 22 When SC2.0 was implemented in university counselling centres, the number of clients seeking service and appointment attendance increased, while wait times and session duration were reduced.23 Outcomes from the implementation of the SC2.0 model at the Wellness Clinic at Memorial University and in the Mental Health Commission of Canada’s SC2.0 Demonstration Project in Newfoundland and Labrador showed greater access and decreased wait times, while maintaining client and provider satisfaction.24 The implementation, scaling and evaluation of SC2.0 are ongoing in Canada and in the United States within post-secondary settings, provincial and territorial care systems and nationally, through the Wellness Together Canada portal.
1 National Institute for Health and Clinical Excellence (NICE). (2009). Depression in adults: Recognition and management. Clinical Guideline 90. https://www.nice.org.uk/guidance/cg90
2 National Institute for Health and Clinical Excellence (NICE). (2011). Common mental health problems: Identification and pathways to care. Clinical Guideline 123. https://www.nice.org.uk/guidance/cg123
3 National Institute for Health and Clinical Excellence (NICE). (2019). Generalised anxiety disorder and panic disorder in adults: Management. Clinical Guideline 113. https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance
4 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 & C. Draper (Eds.), Stepped care and e-health: Practical applications to behavioral disorders (pp. 1-16). Springer Science. https://doi.org/10.1007/978-1-4419-6510-3_1
5 Mental Health Commission of Canada. (2015). Guidelines for recovery-oriented practice: Hope, dignity, inclusion. https://www.mentalhealthcommission.ca/sites/default/files/2016-07/MHCC_Recovery_Guidelines_2016_ENG.PDF
6 Cannistrà, F., Piccirilli, F., Paolo D’Alia, P., Giannetti, A., Piva, L., Gobbato, F., Guzzardi, R., Ghisoni, A., & Pietrabissa, G. (2020). Examining the incidence and clients’ experiences of single session therapy in Italy: A feasibility study. Australian and New Zealand Journal of Family Therapy, 41(3), 271-282. https://doi.org/10.1002/anzf.1421
7 Hoyt, M. F., & Talmon, M. (Eds.). (2014). Capturing the moment: Single session therapy and walk-in services. Crown House Publishing Limited.
8 Hoyt, M. F., Young, J., & Rycroft, P. (2020). Single session thinking 2020. Australian and New Zealand Journal of Family Therapy, 41(3), 218-230. https://doi.org/10.1002/anzf.1427
9 O’Neill, I. (2017). What’s in a name? Clients’ experiences of single session therapy. Journal of Family Therapy, 39(1), 63-79. https://doi.org/10.1111/1467-6427.12099
10 Rodda, S., Lubman, D., Jackson, A., & Dowling, N. (2017). Improved outcomes following a single session web-based intervention for problem gambling. Journal of Gambling Studies, 33(1), 283-299. https://doi.org/10.1007/s10899-016-9638-2
11 Chatterton, M. L., Rapee, R. M., Catchpool, M., Lyneham, H. J., Wuthrich, V., Hudson, J. L., Kangas, M., & Mihalopoulos, C. (2019). Economic evaluation of stepped care for the management of childhood anxiety disorders: Results from a randomised trial. Australian and New Zealand Journal of Psychiatry, 53(7), 673-682. https://doi.org/10.1177/0004867418823272
12 Coulton, S., Bland, M., Crosby, H., Dale, V., Drummond, C., Godfrey, C., Kaner, E., Sweetman, J., McGovern, R., Newbury-Birch, D., Parrott, S., Tober, G., Watson, J., & Wu, Q. (2017). Effectiveness and cost-effectiveness of opportunistic screening and stepped-care interventions for older alcohol users in primary care. Alcohol and Alcoholism, 52(6), 655-664. https://doi.org/10.1093/alcalc/agx065
13 Collins, P., Walsh, Z., Walsh, A., Corbett, A., Finnegan, R., Murphy, S., Clogher, L., Cleary, E., & Kearns, S. (2020). A 360° evaluation of stepped-care psychotherapy: APSI yrs 4-5. Mental Health Review Journal, 25(2), 127-138. https://doi.org/10.1108/MHRJ-02-2020-0014
14 Firth, N., Barkham, M., & Kellett, S. (2015). The clinical effectiveness of stepped care systems for depression in working age adults: A systemic review. Journal of Affective Disorders, 170, 119-130. https://doi.org/10.1016/j.jad.2014.08.030
15 Gyani, A., Shafran, R., Layard, R., & Clark, D. M. (2013). Enhancing recovery rates: Lessons from year one of IAPT. Behaviour Research and Therapy, 51(9), 597-606. https://doi.org/10.1016/j.brat.2013.06.004
16 Gual-Montolio, P., Martínez-Borba, V., Bretón-López, J. M., Osma, J., & Suso-Ribera, C. (2020). How are information and communication technologies supporting routine outcome monitoring and measurement-based care in psychotherapy? A systematic review. International Journal of Environmental Research and Public Health, 17(9), 3170. https://doi.org/10.3390/ijerph17093170
17 Lewis, C. C., Boyd, M., Puspitasari, A., Navarro, E., Howard, J., Kassab, H., Hoffman, M., Scott, K., Lyon, A., Douglas, S., Simon, G., & Kroenke, K. (2019). Implementing measurement-based care in behavioral health: A review. JAMA Psychiatry, 76(3), 324-335. https://doi.org/10.1001/jamapsychiatry.2018.3329
18 Gondek, D., Edbrooke-Childs, J., Fink, E., Deighton, J., & Wolpert, M. (2016). Feedback from outcome measures and treatment effectiveness, treatment efficiency, and collaborative practice: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 43, 325-343. https://doi.org/10.1007/s10488-015-0710-5
19 Guo, T., Xiang, Y.-T., Xiao, L., Hu, C.-Q., Chiu, H. F. K., Ungvari, G. S., Correll, C. U., Lai, K. Y. C., Feng, L., Geng, Y., Feng, Y., & Wang, G. (2015). Measurement-based care versus standard care for major depression: A randomized controlled trial with blind raters. The American Journal of Psychiatry, 172(10), 1004-1013. https://doi.org/10.1176/appi.ajp.2015.14050652
20 Knaup, C., Koesters, M., Schoefer, D., Becker, T., & Puschner, B. (2009). Effect of feedback of treatment outcome in specialist mental healthcare: Meta-analysis. The British Journal of Psychiatry, 195(1), 15-22. https://doi.org/10.1192/bjp.bp.108.053967
21 Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy (Chic), 55(4), 520-537. https://doi.org/10.1037/pst0000167
22 Shimokawa, K., Lambert, M. J., & Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78(3), 298-311. https://doi.org/10.1037/a0019247
23 Cornish, P. A., Berry, G., Benton, S., Barros-Gomes, P., Johnson, D., Ginsburg, R., Whelan, B., Fawcett, E., & Romano, V. (2017). Meeting the mental health needs of today’s college student: Reinventing services through Stepped Care 2.0. Psychological Services, 14(4), 428-442. https://doi.org/10.1037/ser0000158
24 Mental Health Commission of Canada. (2019). Newfoundland and Labrador Stepped Care 2.0 E-Mental Health Demonstration Project Final Report. https://www.mentalhealthcommission.ca/sites/default/files/2019-09/emental_health_report_eng_0.pdf