Impact of a Progressive Stepped Care Approach in an Improving Access to Psychological Therapies Service: An Observational Study

Abstract

The national (English) Improving Access to Psychological Therapies (IAPT) programme advocates stepped care as its organizational delivery, yet there is limited evidence regarding the efficacy of stepped care as a service model, heterogeneity of definition, and differences in model implication in both research and routine practice. This study aims to contribute to the discussion regarding the stepped care definition and delivery, and explores the impact on clinical outcomes where different types of stepped care have been implemented within the same service. This study compares the outcomes of treatment completers with an allocated/matched care model and a progression/pure stepped care model. This study also explores the assumption that patients who score severe on psychological measures, and therefore are potentially complex, would achieve better outcomes in a matched care model.

An observational cohort study, analyzing retrospective data over a 4 year period, in a single IAPT service, where delivery changed from one type of stepped care model to another. Chi square and logistic regression tests were used. Outcomes in each model type were compared, alongside baseline factor variables. A subgroup of those scoring moderate to severe on psychological measures at first session was analysed.

Data was collected on 16,723 patients who had completed treatment over a 4 year period, a significant association was observed between a recovery outcome and model type, in favour of progression/pure stepped care, a similar relationship was observed for the moderate to severe scores. Further research building upon the current study and literature comparing stepped care models and controlling for confounding variables, with a cost effectiveness analysis would be beneficial for clinical implication and service design and delivery.