This project will address key uncertainties in the implementation and underlying assumptions of stepped care for patients with depression, through a systematic review and feasibility study.

Project Overview

Stepped care is proposed as a means for improving access to psychological treatments. However, there are many important unanswered questions about its implementation. Moreover, current interest in stepped care rests on three assumptions for which there is little or no evidence – that minimal interventions can provide equivalent health benefits to traditional (high intensity) psychological therapies, at least for some patients; that using minimal interventions will allow current healthcare resources to be used more efficiently; that the stepped care approach is acceptable to patients and professionals. The aim of this project will be to advance the development and evaluation of stepped care as a possible means for improving access to psychological therapies. Its specific objective will be to address some of the key uncertainties in its implementation and underlying assumptions of equivalence, efficiency and acceptability. Following the Medical Research Framework for the evaluation of complex interventions, I propose undertaking (1) a systematic review to inform the theoretical foundations and implementation of stepped care, and (2) a mixed-methods study to examine the feasibility of conducting a definitive RCT of stepped care vs. high intensity psychological interventions for patients with depression. This project will comprise my PhD which will commence in October 2012.

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