Stepped Care, an Emerging Service Model in Youth Mental Health

With the newfound attention and energy geared towards youth mental health services, it’s important that we do a better job of delivering services that are well attuned to the specific needs of presenting youth. One such model is that of stepped care, which aims to provide the right interventions, at the right time. However, while stepped care has long been advocated for in youth mental health, there has been relatively little evaluation of its impact and outcomes. This symposium begins just that, including both a review of the literature as well as focus groups involving key stakeholders. In addition to youth and their families/carers, it will be helpful for clinicians, service planners, researchers and policy-makers alike.

Presenters and slide deck

Annmarie Churchill, Memorial University of Newfoundland

AnnMarie Churchill is a Research Fellow in Stepped Care at Memorial University of NL and a Registered Social Worker. AnnMarie was the clinical lead on the SC/eMH Demonstration Project for Newfoundland and Labrador and is the trainer and clinical lead on the CIHR Prgamatic Trial: Digitizing Stepped Care. In addition to leading the NL focus groups on Stepped Care, AnnMarie provided direction and consultation on the Foundry SC focus groups. Currently AnnMarie is the Executive Director for Stepped Care Solutions, one of the lead organizations for Wellness Together Canada, the Health Canada funded portal that is providing mental health and substance use supports in response to the COVID pandemic.

Amy Salmon, University of British Columbia

Dr. Amy Salmon is a Clinical Associate Professor at UBC’s School of Population and Public Health, Associate Director and Head of the Knowledge Translation program at the Centre for Health Evaluation and Outcomes Sciences (CHÉOS). Her research program aims to understand and improve the mobilization of research evidence through implementation science and knowledge translation approaches, with a focus on health systems and services interventions supporting individuals with integrated health and social care needs. Prior to joining CHÉOS, Dr. Salmon had an extensive career as front-line worker, health care administrator, and a consultant for local, provincial and federal governments. Her current research is funded by the Canadian Institutes for Health Research, the Public Health Agency of Canada, St. Pauls’ Foundation, and the Vancouver Foundation.

Joanna Henderson, CAMH

Jai Shah is a youth psychiatrist and a clinician-scientist based at McGill University in Montreal, who has been deeply involved in and committed to early intervention efforts in psychosis and youth mental health. He is involved in the pan-Canadian service transformation project ACCESS Open Minds, which takes place across 6 provinces and territories, and leads a 5 year CIHR Network grant to recommend a common protocol and data platform to support youth mental health services evaluation. In all cases, he is concerned not just with research but also implementation in services and broader health systems. He is a member of the Lancet Commission on Youth Mental Health, and trained in medicine, health policy and economics, bioethics, and genetics before coming to mental health.

Karen Tee, Foundry BC


Key Learnings

  • There is a great deal of heterogeneity in stepped care models for youth and young adults.
  • More research is needed on interventions for this population.
  • Youth, partners/caregivers and service providers can provide valuable insights into how stepped care is presented and framed.

Thoughts from those with Lived/Living Expertise

What are some of the highlights?

  • Excellent and clear explanation of how stepped care works.

How can information gained be used? 

  • Stepped Care can be especially helpful for youth who are first accessing mental health services but there may also be a challenge around how to integrate folks who are already receiving care and choosing the order of the steps.

What are the implications?

  • Creating a more clear process for navigating the mental health system through steps can remove barriers for youth, as a common challenge for youth navigating the system is feeling like the process is unclear or random.
  • Having clearly laid out steps from the onset of care could help youth better understand the process and path that they are on.

What would you like to know more about?

  • In the comparison of stepped care compared to “usual care” – what is usual care?

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