Stepped Care
The stepped-care model of depression draws attention to the different needs that depressed children and young people have – depending on the characteristics of their depression and their personal and social circumstances – and the responses that are required from services. It provides a framework in which to organise the provision of services that support both healthcare professionals and patients and their parent(s) or carer(s) in identifying and accessing the most effective interventions (see table below).
Table. The Stepped Care Model
| Focus | Action | Responsibility |
|---|---|---|
| Detection | Risk Profiling | Tier 1 |
| Recognition | Identification in presenting children or young people | Tiers 2-4 |
| Mild depression (including dysthymia) | Watchful waiting Non-directive supportive therapy/group cognitive behavioural therapy/guided self-help |
Tier 1 Tier 1 or 2 |
| Moderate to severe depression | Brief psychological therapy +/– fluoxetine |
Tier 2 or 3 |
| Depression unresponsive to/recurrentdepression/psychotic depression | Intensive psychological therapy +/– fluoxetine, sertraline, citalopram, with an antipsychotic |
Tier 3 or 4 |
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