Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults

Abstract

Aims Many young people with mental health and/or substance use concerns do not have access to timely, appropriate, and effective services. Within this context, stepped care models (SCMs) have emerged as a guiding framework for care delivery, inspiring service innovations across the globe. However, substantial gaps remain in the evidence for SCMs as a strategy to address the current systemic challenges in delivering services for young people. This scoping review aims to identify where these gaps in evidence exist, and the next steps for addressing them. Methods A scoping review was conducted involving both peer‐reviewed and grey literature. Eligible studies explored SCMs implemented in the various health care settings accessed by young people aged 12–24 seeking treatment for mental health and substance use challenges. After screening titles and abstracts, two reviewers examined full‐text articles and extracted data to create a descriptive summary of the models. Results Of the 656 studies that were retrieved, 51 studies were included and grouped by study team for a final yield of 43 studies. Almost half of the studies were focused on the adult population (i.e., 18 and over), and most did not specify interventions for young people. Among the SCMs, substantial variability was found in almost every aspect of the models. Conclusions Considering the current body of evidence, there is an urgent need for a consensus position on the definition, implementation, and outcome measures required for rigorously assessing the utility of SCMs for young people.

Characterizing mental health related service contacts in children and youth: a linkage study of health survey and administrative data

“…As such, the coordination of care across and within sectors are critical components of mental health services for children and youth [ 21 ]. Further research is needed to better understand coordination of care across sectors and models of stepped care, where children and youth with the greatest needs receive more specialized care [ 31 ].…”

Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion

“…The stepped care model, used increasingly to guide clinical practice and evaluate complex interventions in community-based mental health programs ( 67 – 69 ), was chosen as the conceptual framework for the study. Model 1, published in the “gaming my way to recovery” protocol ( 64 ), presents an adapted version of the traditional stepped care model for categorizing target populations and mental health conditions.…”

The Longitudinal Youth in Transition Study (LYiTS) Cohort Profile: Exploration by Hospital- Versus Community-Based Mental Health Services

“…Recommended stepped-care service delivery models suggest high-intensity interventions, such as pharmacological treatment, should be implemented only for youth with more intensive symptom management needs. 32 Accordingly, we hypothesized that youth receiving hospital-based care, where there is a higher density of medical specialists, would report a higher symptom burden. Against expectations, we found no differences in psychiatric symptoms (mean levels or proportion with clinically elevated score), substance use or functioning.…”