Increasing Access - Stepped Care Flashcards
Bower and Gilbody (2005)
Stepped care - treatment split into steps that increase in intensity and resource use, with diagnostic assessment after each step, acting as balance between low-intensity and high-intensity interventions
No requirement to involve a single therapeutic approach throughout
Promising, but potential clinical and economical benefits dependent upon underlying assumptions of equivalence in terms of clinical outcomes, efficiency in terms of resource use and cost, and acceptability of ‘minimal interventions’ to patients and therapists > need to compare stepped-care to traditional approach
IAPT
Improving Access to Psychological Therapies (NHS) movement bands treatments into low-intensity and higher-intensity which involves a stepped care approach
Rapee et al (2017)
RCT comparing stepped-care (low-intensity intervention > manualised standard CBT > individual formulation-based intervention, with average number of sessions in CBT being 8) against validated CBT for youth with ADs (Cool Kids; Rapee et al., 2006), involving 10 60m individual sessions over 12 weeks with AMS-Ex model, parents in all sessions for those <13 and fewer in adolescence
No significant difference on any measure, but total therapist time per child significantly shorter to deliver stepped-care compared with CBT, and within stepped-care, first 2 steps returned strongest treatment plans, so restricting it to these steps would have led to considerable time saving with modest loss in efficacy
Chatterton et al (2019)
Economic evaluation of Rapee et al (2017) showed no significant differences in combined index of health sector and societal costs, but significantly lower societal costs when reported independently (in stepped-care)
