Mughal S, Young B, Churchill A, Rash J, Tee K, Salmon A, Shah J L
Department of Psychiatry, McGill University, Montreal, QC, Canada.
Douglas Mental Health University Institute, Montreal, QC, Quebec, Canada.
Early Interv Psychiatry. 2025 Jun;19(6):e70057. doi: 10.1111/eip.70057.
Stepped care (SC) is being adopted in many countries as a framework for organising mental health care in diverse contexts. However, there is a lack of consistency in how SC has been defined and operationalised, limiting its effective application in practice. We describe the development of standards for implementing SC models in Canadian child and youth mental health (CYMH) contexts using a consensus-based approach. These standards are intended to support systems planners in creating cohesive CYMH systems across Canadian settings.
This study employed learning alliance and Delphi methodologies. A pan-Canadian multi-round Delphi process conducted in English and French was used to derive consensus on the inclusion and wording of individual clauses in the standard. Consensus with a threshold of 70% was set to determine the inclusion of individual clauses in the final standard.
Sixty-eight individuals participated in the Delphi study (with a 76.48% retention rate) representing lived experience, service delivery, policy, and research expertise. Over three rounds, 29 clause items were revised and reduced to a final list of 24 clause items comprising SC implementation standards. Participant feedback indicated a desire for reduced ambiguity, considerations of the limitations of patient autonomy, and the need to clarify roles and responsibilities in system-wide activities.
The results of this Delphi study represent the first multi-stakeholder, consensus-driven set of standards for implementing SC in CYMH settings across Canada. With these standards, we aspire to provide a blueprint for mental health systems advocacy and reform toward stronger, more coordinated CYMH systems.
逐步照护（SC）在许多国家被用作在不同环境中组织精神卫生保健的框架。然而，SC的定义和实施方式缺乏一致性，限制了其在实践中的有效应用。我们描述了采用基于共识的方法制定在加拿大儿童和青少年精神卫生（CYMH）环境中实施SC模型的标准的过程。这些标准旨在支持系统规划者在加拿大各地创建具有凝聚力的CYMH系统。
本研究采用学习联盟和德尔菲方法。通过以英语和法语进行的泛加拿大多轮德尔菲过程，就标准中各个条款的纳入和措辞达成共识。设定70%的阈值作为共识标准，以确定最终标准中各个条款的纳入情况。
68人参与了德尔菲研究（保留率为76.48%），代表了生活经验、服务提供、政策和研究专业知识。经过三轮，29个条款项目进行了修订，最终缩减为包含SC实施标准的24个条款项目的清单。参与者的反馈表明，他们希望减少模糊性，考虑患者自主权的局限性，以及需要在全系统活动中明确角色和责任。
这项德尔菲研究的结果代表了加拿大首个多利益相关方、基于共识驱动的在CYMH环境中实施SC的标准集。有了这些标准，我们希望为精神卫生系统的宣传和改革提供一个蓝图，以建立更强大、更协调的CYMH系统。
