Proposed Standards for Implementing Stepped Care Models in Child and Youth Mental Health Service Systems: Results of a Pan-Canadian Delphi Study

Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.