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 was developed at Memorial University of Newfoundland. The steps are arranged on three dimensions: autonomy, stakeholder investment, and readiness for change. The x-axis represents autonomy. Autonomy is highest on the left side and lowest on the right. Programs are also organized according stakeholder investment (y-=axis in figure below). Finally, step arrangement corresponds to clients’ readiness to engage actively in the growth process (see z-axis in the 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.
There are nine steps in SC2.0. These are described below.
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 in Newfoundland and Labrador 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.
- Phone or text access to peer support or, if urgent, professional crisis counsellors.
- Service users can walk in for a single-session to identify & address a targeted need. The outcome could be no further service, a return visit initiated by the service user, or suggestion / recommendation of services within stepped care system. The expectation is for a mutually agreed upon outcome.