Frayme Supported Project 

Stepped Care Literature Review


While Stepped Care Models (SCM) are emerging as a rational approach to mental health (and to a lesser extent, substance use) service delivery and planning, there remain substantial gaps in knowledge surrounding the formation, implementation, operation, and outcomes expected of SCMs, including for youth services. There are strong arguments to be made for SCM, including economic and client preference, yet little is known about whether they have been successfully deployed in delivery models. To date, there is no available literature synthesis providing a systematic appraisal of the evidence surrounding stepped care.


Frayme’s Stepped Care Working Group partnered with the Centre for Health Evaluation and Outcome Studies (CHEOS), based in British Columbia, Canada to review the literature addressing the effectiveness of SCMs for improving mental health and substance use treatment outcomes for youth and young adults. This literature review will support the ongoing development and evaluation of SCMs in integrated youth services and synthesize the current body of knowledge regarding SCMs.

Two manuscripts have been completed and will be submitted for publication. 1) A scoping review assessing the available peer-reviewed and grey literature for models and outcomes associated with mental health and substance use SCMs for youth and young adults; and 2) a systematic review to address whether stepped care models are effective in improving mental health outcomes for youth 12-24 with mood and anxiety disorders. A third paper, currently under development, will highlight current gaps in the definition and terminology around stepped care, number and categorization of steps, and interventions within steps.


Increased understanding of the extent of implementation of stepped care models in youth services, and increased awareness of the key gaps in knowledge related to the effectiveness and implementation of these models.


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