Stepped care models
Anxiety
The quick reference guide (amended) for NICE clinical guideline CG22 on anxiety summarises the stepped approach to care for the management of anxiety, which recommends care at different stages of the patient journey, represented as different steps:
Step 1: Recognition and diagnosis
Step 2: Treatment in primary care
Step 3: Review and consideration of alternative treatments
Step 4: Review and referral to specialist mental health services
Step 5: Care in specialist mental health services
Depression
The quick reference guide (amended) for NICE clinical guideline CG90 on depression identifies a stepped care framework that aims to match the needs of people with depression to the most appropriate services, depending on the characteristics of their illness and their personal and social circumstances. Each step represents increased complexity of intervention, with higher steps assuming interventions in previous steps.
Step 1: Recognition in primary care and general hospital settings
Step 2: Treatment of mild depression in primary care
Step 3: Treatment of moderate to severe depression in primary care
Step 4: Treatment of depression by mental health specialists
Step 5: Inpatient treatment for depression
Obsessive-compulsive disorder
The quick reference guide for NICE clinical guideline CG31 on obsessive-compulsive disorder summarises the stepped care model, which aims to provide the most effective but least intrusive treatment appropriate to an individual's needs. It assumes that the course of the disorder is monitored and that referral to the appropriate level of care is made depending on the person's difficulties. Each step introduces additional interventions; the higher steps normally assume that interventions in previous steps have been offered and/or attempted. However, there may be situations where an individual may be referred to appropriate care at any level.
Step 1: Awareness and recognition by individuals, public organisations and the NHS
Step 2: Recognition and assessment by GPs, primary care and general health settings (including hospitals)
Step 3: Management and initial treatment by GPs, primary care team, primary care mental health workers, family support teams
Step 4: Multidisciplinary care in primary or secondary care
Step 5: Multidisciplinary care with expertise in obsessive-compulsive disorder/body dysmorphic disorder
Step 6: Inpatient care or intensive treatment programmes
This page was last updated: 05 May 2010
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