Evaluating stepped care in the Waitemata District Health Board Mental Health Service: implementation of the stepped care model of healthcare provision
This thesis aims to evaluate the effectiveness of the stepped care model of healthcare provision for psychological therapies in the secondary mental healthcare sector in New Zealand over a nine month period. It follows an earlier literature review of stepped care and the collaborative creation of a research design with the Waitemata District Health Board (WDHB) mental health service. The Waitemata District Health Board mental health service aims to increase access to psychological therapies for those seeking help with mental health disorders, without increasing existing resources. Evidence from overseas studies of stepped care in primary care mental health support, suggest that this model shows the potential to increase access to psychological therapies without sacrificing quality of care. The literature review revealed no published research evaluated the implementation of stepped care in the secondary mental healthcare sector or from the perspective of all stakeholders.
The guidelines of programme evaluation were used to evaluate the implementation from the perspective of all stakeholders and to allow barriers to the implementation of stepped care or data collection to be highlighted and addressed over the evaluation period. A research design was collaboratively created with the WDHB mental health service; a three month prospective cohort study followed by a six month experimental case control. Stepped care was introduced in the Rodney Adult District Mental Health Services (RAMHS) and North Shore Team One (NS1) was used as control in both the prospective cohort study and experimental case control.
Several barriers to the use of outcome measurement and the introduction of stepped care were found and discussed. The stepped care model was not introduced in its proposed form by the end of the evaluation and all evaluation strategies were unable to be carried out as proposed Results suggested that the stepped care model increased access to psychological talking therapies without sacrificing quality of care. The use of outcome measurement was found to be a good fit with stepped care guidelines and continued support for this may continue to improve client outcomes, support therapists and enable the WDHB mental health service to target support in appropriate areas.