Exploring stepping-up in a stepped care model of service delivery

This thesis adds to 'the literature on stepping-up which is a defining feature of the proposed stepped care model for delivering psychological therapies in primary care. A literature review synthesises primary studies which investigate potential predictors of outcome following Low Intensity Psychological Interventions (LIP I) for people with anxiety and/or depression. It is concluded that the limited literature is methodologically weak and that data collected in routine clinical practice is required to investigate this area further. The research report explores stepping-up from LIPI to CBT within the UK pilot site for the stepped care model. Using routinely collected data from this site, Study 1 found that people who were stepped-up did not differ significantly in assessment characteristics or their outcomes compared to those who received only LIPl or CBT. Also, stepping-up cannot be predicted from the assessment variables currently collected by this service. In Study 2 eleven people who had been stepped-up were interviewed about their service experience; Using Interpretative Phenomenological Analysis five super-ordinate themes emerged along with a common process of making sense of the experience of stepping-up. Together these studies suggest that stepping-up can produce acceptable outcomes and the experience of stepping-up is affected by other aspects of the service. Further research is required to explore the outcomes and experiences of service users in relation to the different reasons for stepping-up which emerged in these studies. It is also suggested that the therapeutic alliance may be an important factor to investigate in relation to LIPI and their outcomes.