Youth, family and caregiver, and service provider perspectives of a stepped care model to provide mental health and substance use supports

Stepped Care Solutions

Many young people with mental health and/or substance use (MHSU) concerns do not have access to timely, appropriate, and/or effective services. Stepped care models (SCM) hav emerged as a guiding framework for care delivery. To better understand service users’ perspectives on SCMs, Youth, family/caregivers, and service providers associated with Foundry (integrated youth services) participated in focus groups between December 2019 and February 2020. Components of SCM were highlighted as strengths or areas requiring improvement. Choice in care options and drop-in models of service delivery were generally considered to be positive, while perspectives on online counselling were mixed. Navigating the system with multiple providers, wait times, and inconsistent hours of operation were cited as challenges to receiving care. Clear and consistent communication related to the SCM, including what the full model entails and the role of family members and peers would improve implementation and acceptance of the model.


Karen Tee
Dr. Karen Tee, Associate Executive Director, Foundry, British Columbia, Canada: Karen is a Clinical Psychologist passionate about early intervention in youth and young adult mental health. She brings over 20 years of direct service and program development and management experience in youth mental health. At Foundry, she is responsible for providing clinical leadership and overseeing service implementation, and in collaboration with Foundry Network clinical leaders, has been leading the development and implementation of Foundry’s Integrated Stepped Care Model. 

AnnMarie Churchill
AnnMarie is Executive Director of Stepped Care Solutions and a Research Fellow at Memorial University working on the CIHR Pragmatic Trial- Digitizing Stepped Mental Health Care. AnnMarie holds a PhD in Experimental Psychology, a Masters in Social Work and is a registered social worker in the province of NL.

Jai Shah
Jai Shah is a psychiatrist and researcher interested in the early phases of psychotic illness (including at-risk populations), early intervention, and the design and delivery of mental health services for youth. He is an Assistant Professor in McGill’s Department of Psychiatry, a Full Researcher at the Douglas Hospital Research Center, and is supported by an FRQS Clinician-Scientist Award.Jai is also a Principal Investigator with ACCESS Open Minds, a pan-Canadian network dedicated to developing, implementing and evaluating a transformation of youth mental health services for youth aged 11-25.  

Alexia Jaouich
A strategic and empathic system change leader and psychologist with over 18 years of experience, Alexia offers expertise in implementing large-scale, evidence-based, innovative mental health programs at the organizational and systems level. Alexia served as the strategic lead on the development of SC2.0’s core components and implementation guide and continues to lead the effort to build implementation best practices into the SC2.0 model. With a passion for and an expertise in Implementation Science, Alexia has provided training, coaching and consultation to individuals and organizations at the provincial, national and international level in the field’s best practices to achieve best possible outcomes for those we serve.

Key takeaways

  • Study: perspective of eight focus groups were compared between December 2019 and February 2020; half of them had been using stepped care and the other half hadn’t
    • The goal of this comparison was to conduct a reflection of Stepped Care 2.0
  • Stepped care created a common language used to explain health care options and processes
  • Goes beyond the medical model
  • Focuses on relationship building to provide integrated services
  • “Supports need to come from the bottom up and the top down”
    • Have to be committed to providing enough resources to support the services, the population and go beyond the medical model
  • Informed choice: explain the intervention, what they can expect, how the services are provided, what’s expected of you
  • All the steps are equally valued

Key Learning Objectives (defined by presenters)

  1. Participants will gain generalizable insights related to the implementation of mental health and substance use services in a stepped care approach from the perspective of youth, family and caregivers, and service providers based on the Foundry experience
  2. Promising practices for the implementation of stepped care services and supports for youth are identified
  3. Opportunities for improvement and future research related to implementation of stepped care services and supports are considered 

Key Themes

  1. Revising health services for youth and families
  2. Access to care

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