Annals of Behavioural Science

A Systematic Review Investigating the Comparative Effectiveness and Efficiency of a Multi Clinician Stepped Care Workforce Vs. a Single Clinician Stepped Care Workforce for Delivering Psychological Treatments

Background: Stepped care has been promoted as one solution to improving access to psychological services. In the United Kingdom (UK) and Australia a new workforce has been established for the implementation of stepped care. Thus, there are two different models of stepped care: Multi clinician stepped care (MCSC) and single clinician stepped care (SCSC). Given that the MCSC improving access to psychological therapies initiative in the UK was initially economically motivated, it was of interest to discover whether or not an MCSC workforce is more effective and efficient than an SCSC workforce. The objective of this review was to answer the research question “Is an MCSC workforce more effective and efficient than an SCSC workforce?”. Methods: A comprehensive systematic review was conducted to identify studies comparing the effectiveness and efficiency of MCSC with SCSC programs in terms of patient outcomes, patient satisfaction, waiting times, and cost-effectiveness. Results: The systematic review revealed that there are no studies comparing MCSC with SCSC. Conclusion: The rationale for an MCSC workforce is not clear. The findings of this systematic review are discussed in terms of the way in which treatments are conceptualised and delivered including adopting a patient-led approach to appointment scheduling and a patient-perspective attitude towards treatment provision and recovery. Keywords: Stepped care; Psychological treatment; Workforce; Patient-led; Patient perspective Abbreviations: MCSC: Multi Clinician Stepped Care; SCSC: Single Clinician Stepped Care; NICE: National Institute of Clinical Excellence; CBT: Cognitive Behaviour Therapy; RCT: Randomised Controlled Trial; LOCF: Last Observation Carried Forward; IAPT: Improving Access to Psychological Therapies; PWP: Psychological Wellbeing Practitioner; GP: General Practitioner; PHQ-9: Patient Health Questionnaire-9; RI: Reliable Improvement; CSC: Clinically Significant Change; PCT: Perceptual Control Theory; GEL: Good Enough Level

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Author(s):

Timothy A Carey

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