Definition
Stepped care models are minimally intensive care models for treating conditions or changing behaviors. Patients are initially typically provided with an easy-to-disseminate, low-cost, minimally intensive intervention. If this does not produce remission of undesirable symptoms or sufficient behavior change, patients are provided with a slightly more intensive and more costly intervention. This continues until patients receive an intervention that produces the desired outcome. Ideally, each patient receives the least resource-intensive yet most effective treatment they need. Stepped care models require repeated assessments to determine if a treatment is effective (and can be stepped down), too burdensome (and should be stepped down), ineffective (and must be stepped up), when another treatment becomes available and more likely to produce better effects (requiring deimplementation of the current treatment and...
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References and Further Readings
Bair, M. J., Ang, D., Wu, J., Outcault, D. S., Sargent, C., Kempf, C., Froman, A., Schmid, A., Damush, T., Yu, Z., Davis, W. L., & Kroenke, K. (2015). Evaluation of stepped care for chronic pain (ESCAPE) in veterans of the Iraq and Afghanistan conflicts: A randomized clinical trial. JAMA Internal Medicine, 175(5), 682–689. https://doi.org/10.1001/jamainternmed.2015.97.
Carels, R. A., Darby, L., Cacciapaglia, H. M., Konrad, K., Coit, C., Harper, J., Kaplar, E. M., Young, K., Baylen, A. C., & Versland, A. (2007). Using motivational interviewing as a supplement to obesity treatment: A stepped-care approach. Health Psychology, 26(3), 369–374. https://doi.org/10.1037/0278-6133.26.3.369.
Carels, R. A., Wott, C. B., Young, K. M., Gumble, A., Darby, L. A., Oehlhof, M. W., Harper, J., & Koball, A. (2009). Successful weight loss with self-help: A stepped-care approach. Journal of Behavioral Medicine, 32(6), 503–509. https://doi.org/10.1007/s10865-009-9221-8.
Jacobi, C., Beintner, I., Fittig, E., Trockel, M., Braks, K., Schade-Brittinger, C., & Dempfle, A. (2017). Web-based aftercare for women with bulimia nervosa following inpatient treatment: Randomized controlled efficacy trial. Journal of Medical Internet Research, 19(9). https://doi.org/10.2196/jmir.7668.
Kidorf, M., Neufeld, K., King, V. L., Clark, M., & Brooner, R. K. (2007). A stepped care approach for reducing cannabis use in opioid-dependent outpatients. Journal of Substance Abuse Treatment, 32(4), 341–347. https://doi.org/10.1016/j.jsat.2006.09.005.
Waring, M. E., Schneider, K. L., Appelhans, B. M., Busch, A. M., Whited, M. C., Rodrigues, S., Lemon, S. C., & Pagoto, S. L. (2014). Early-treatment weight loss predicts 6-month weight loss in women with obesity and depression: Implications for stepped care. Journal of Psychosomatic Research, 76(5), 394–399. https://doi.org/10.1016/j.jpsychores.2014.03.004.
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Goldstein, C.M., Jones, S. (2019). Stepped Care Models. In: Gellman, M. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6439-6_102012-1
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DOI: https://doi.org/10.1007/978-1-4614-6439-6_102012-1
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