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Stepped care in psychological therapies: access, effectiveness and efficiency

Narrative literature review

National Primary Care Research and Development Centre, University of Manchester

Simon Gilbody, DPhil, MRCPsych

Academic Unit of Psychiatry, University of Leeds, UK

Correspondence: Dr Peter Bower, National Primary Care Research and Development Centre, 5th Floor, Williamson Building, University of Manchester, Manchester M13 9PL, UK. Tel: 0161 275 7638; e-mail: peter.bower{at}man.ac.uk

Declaration of interest None.

Background There is a significant gap between the demand for psychological therapy services and the available supply. One proposal to overcome this problem is to increase efficiency of provision through the adoption of briefer ‘minimal interventions’ within stepped care models.

Aims To examine the theoretical underpinnings of stepped care, together with the practicalities of the adoption of this system of care.

Method Narrative literature review.

Results The potential clinical and economic benefits of stepped care are dependent upon underlying assumptions of equivalence in terms of clinical outcomes, efficiency in terms of resource use and costs, and acceptability of ‘minimal interventions’ to patients and therapists. Illustrative studies of these issues are considered.

Conclusions Although psychological services might benefit from the adoption of the stepped care model, a substantial research agenda needs to be fulfilled before a judgement can be made as to whether stepped care might be an efficient method of delivering psychological services.

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