Stepped Care 2.0 is adapted from the original UK model and the re-imagined model described by O’Donahue and Draper (2011). These models of care aim to reduce the burden of mental illness on society through more efficient self-corrective systems of care offering the lowest level of intervention intensity warranted by the initial and ongoing assessments. Treatment intensity can be either stepped up or down depending on the level of client distress or need. Stepped Care 2.0 distinguishes itself from these earlier versions in four major ways:
- It ensures more rapid access to care through single-session walk-in clinics that offer solutions immediately with only minimal assessment. We start strong and start simple. Clients and providers openly engage in a trial and error approach. If initial rapid solutions prove insufficient, clients and providers fail forward with other options and, if appropriate, engage in more in depth assessment.
- It extends strengths and solution-focused principles throughout the stepped care continuum. As Mosh Talmon of Single-Session fame himself admits, single-session is a misnomer and his colleague Michael Hoyt suggests the term “one-at-a-time services” is a better descriptor (see Hoyt et al., 2018). Treating every encounter at any step as if it could be the last ensures that care is optimized at every moment.
- It shifts the emphasis on monitoring towards variables that are more predictive of therapeutic success, including client capacities, therapeutic engagement and readiness to become actively involved in the change process. Structuring monitoring along multiple dimensions of stakeholder investment, programming intensity, client capacities, client needs, and client readiness has potential for scaling through electronic medical record integration and commercialization.
- It extends the reach of the model to include health and mental health promotion and illness prevention activities through population based programming (see figure below). With objective continuous outcome monitoring applied to both clinic and whole population interventions, the model becomes a useful heuristic for administrative decision making as well as community collaboration.
Stepped Care 2.0 provides rapid, same day, flexible access to wellness and mental health resources. Rapid upstream access is important since early intervention is key to preventing more serious health and mental health conditions.The approach is aimed at empowering clients to maximize and manage their own health to the best of their ability. Clients of Stepped Care 2.0 have a variety of options:
- 24/7 web portal access to community service directories, navigation strategies, information about mental health in general, and self-help tools.
- Same-day access to a mental health support session in which a targeted problem is resolved (yellow box above with arrows extending in fan shape to the right). Clients can choose to work with either a physician or a mental health provider at these single session clinics on a walk-in basis.
- Access by scheduled appointment to consult with a mental health specialist for assessment and the development/implementation of a plan for more intensive programming (blue box above with arrows extending in fan-shape downwards).
Stepped care 2.0 was developed at Memorial University of Newfoundland. Treatment intensity can be either stepped up or down depending on the level of client distress, need, and more importantly readiness to engage actively in the growth process (see x-axis in the figure below). Programs can also be selected and arranged based on stakeholder engagement or investment (y-=axis in figure below). Stepping decisions are made collaboratively by clients and providers through regular and continuous outcome monitoring using a variety of valid and reliable assessment tools.