Section 1: Context and Definition
The Current State of Mental Health Service Delivery on Campus
There are significant challenges facing mental health service providers/programs on campus. For instance, 70 per cent of post-secondary students report feeling overwhelming anxiety, leading to disproportionate demand for counselling centres. Other challenges to campus mental health programs include growing student diversity, ever-increasing symptom severity and cuts to funding.
Mental health concerns on campus have traditionally been treated by psychotherapy, delivered through 50-minute, one-on-one sessions between a client and counsellor, but this approach has become largely ineffective given the current landscape of post-secondary services. As one-on-one psychotherapy is time consuming and resource intensive, this current approach won’t resolve supply and demand problems, is expensive, and often doesn’t fit the lifestyles or needs of students today. Increasingly, campuses need to position themselves to pivot to a more sustainable model of care.
The current state of mental health service delivery on campus requires a creative solution: Stepped Care.
The Stepped Care Model prioritizes distribution of limited mental health resources in a way that maximizes effectiveness and best suits the needs of all students.
What is Stepped Care?
Stepped Care is a system of delivering and monitoring mental health treatment so the most effective, yet least resource-intensive treatment, is delivered first. Program intensity can then be either “stepped up” or “stepped down” depending on the level of client need. For example, less intensive treatments include self-help approaches or peer support, and more intensive treatments can include individual therapy or psychiatric consultation. Throughout the process, mental health indicators are monitored to give both the provider and client feedback on their progress and to empower the client to participate actively in care options, decisions and delivery.
The Stepped Care Model is founded on the beliefs that people shouldn’t have to wait for psychological services, people require different levels of care, and finding the right level of care often depends on monitoring outcomes.
Stepped Care 2.0
Stepped Care 2.0 re-imagines the original Stepped Care Model, with the main difference being that Stepped Care 2.0 is more client-centric. Therapists share responsibility of care with clients and, as a result, clients are more attentive to their needs and level of engagement.
Benefits to Stepped Care 2.0
- It promotes client responsibility, autonomy and resilience
- Steps are based in part on client readiness for change
- It includes face-to-face and/or online components to meet clients where they are
- It applies solutions-focused, strengths-based interventions first
- It ensures rapid access to prevent more serious health and mental health conditions
Monitoring: a key feature of Stepped Care 2.0
Prior to all sessions, clients complete an outcome monitoring survey (e.g., the ORS/SRS, OQ-45, CCAPS, BHM-20/43). The CelestHealth monitoring system, which includes the BHM-20/43, is particularly well suited to Stepped Care because, in addition to tracking mental health symptoms/deficits, it assesses capacities including readiness for change, wellness, functioning, and engagement with the health care professional. This assessment takes approximately 90 seconds to complete and is used to make collaborative decisions on treatment options. Stepping decisions are facilitated by this ongoing, session-by-session monitoring.
Note: In the following sections of this document, all references to “Stepped Care” will be referring to Stepped Care 2.0.