Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia.
RMIT University, Melbourne, Australia.
Int J Ment Health Nurs. 2024 Dec;33(6):2026-2042. doi: 10.1111/inm.13427. Epub 2024 Sep 20.
The stepped care model (SCM) is a patient-centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword-based search using terms like "stepped care model," "mental health," and "primary care"; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross-sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost-effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally.
阶梯式护理模式（SCM）是一种以患者为中心的心理健康护理方法，提供从最基础到最强化的一系列服务，以满足个体需求。本范围综述考察了在初级心理健康服务中应用 SCM 的采用、有效性、挑战和影响。来自全球各地的证据表明该模式具有可行性、有效性和实用性。本综述探讨了现有的文献，阐明了基本概念并确定了现有知识空白。文献检索包括 CINAHL、MEDLINE、PsycINFO、Scopus、联邦大学图书馆、Google 和 Google Scholar 数据库。使用“阶梯式护理模式”、“心理健康”和“初级保健”等术语进行了基于关键词的系统搜索，并结合了关键词和主题词。该搜索策略考虑了相关性、出版日期、目标和结果等因素进行了细化。该策略共产生了 20 篇文献，这些文献包括随机对照试验和横断面研究。本综述支持在初级心理健康护理中采用 SCM，但也承认需要进一步研究。综述的主要内容包括成本效益、不同诊断、疗效和模型的结构配置。明确的治疗细节、交付方法、干预持续时间和时间顺序至关重要。这种系统方法增强了不同 SCM 模型和领域的可推广性，从而得出可靠的推论。总之，SCM 有望增强心理健康服务的提供。然而，需要进一步研究确定其有效性的因素，并了解 SCM 的不同实施方式。这种探究为在澳大利亚和国际上实施和推进心理健康服务奠定了基础。
