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Table 2 Characteristics of stepped care services by site

From: Delivering stepped care: an analysis of implementation in routine practice

  Site A Northern Urban/Rural Site B Northern Urban Site C Southern Urban/Rural Site D Southern Urban
Site Specialist Trust-led Primary Care-led Specialist Trust Primary Care led with Specialist Trust partner
Assessment Qualified mental health practitioner face to face Para-professional or qualified mental health worker face to face Senior mental health worker in a GP based clinic triaging direct to steps from written information or following telephone or face to face appointment Para-professional or psychologist face to face
Step 2 low-intensity Guided self-help delivered by para-professionals; group classes by para-professionals and qualified mental health workers Guided self-help delivered by para-professionals; group classes by para-professionals and qualified mental health workers Self-directed cCBT,1 guided self-help and group classes by para-professionals and qualified mental health workers Guided self-help delivered by para-professionals, cCBT, group classes by para-professionals
Step 3 high-intensity Short-term evidence-based psychological interventions delivered by a mental health practitioner or practice-based counsellor Short-term psychological interventions including brief CBT delivered by a mental health practitioner Short-term psychological interventions including brief CBT and group work delivered by trained para-professionals and mental health practitioners Psychology, and counselling
Step 4 high-intensity Complex evidence-based psychological interventions delivered by psychological services, CMHT, 2 or the psychiatric service Specialised psychological treatment delivered by community mental health teams, psychology and psychotherapy services working within the specialist mental health trust Not specified Psychology, psychotherapy and community mental health teams
Step 5 high-intensity Crisis teams, self-harm liaison and in-patient admission by specialist clinical teams Crisis teams, self-harm liaison and in-patient admission by specialist clinical teams Not specified Not specified
  1. 1 cCBT: computerised Cognitive Behaviour Therapy; 2 CMHT: Community Mental Health Team