Stepped Care

Stepped Care ApproachStepped Care Approach

Stepped Care Approach

A stepped approach for the treatment of depression within primary care
Step One Early IdentificationStep One Early Identification

Step One Early Identification

Action: Screening and Assessment
Step Two Mild DistressStep Two Mild Distress

Step Two Mild Distress

Action: Active Monitoring
Step Three Moderate To Severe DistressStep Three Moderate To Severe Distress

Step Three Moderate To Severe Distress

Action: More Intensive Intervention and Close Monitoring
Step Four Recurrent, Atypical & High RiskStep Four Recurrent, Atypical & High Risk

Step Four Recurrent, Atypical & High Risk

Action: Risk Management, Complex Psychological Intervention

Active Monitoring

Initial monitoring at 1-2 weeks by face-to face/phone/text/email to: Monitor after initiation of an antidepressant, if at increased risk of suicide*:
  • See at 1 week
  • Monitor 1-2 weekly, preferably face-to-face, until risk is not significant
  • Monitor at least 2-weekly until clear improvement
  • *If there are urgent concerns, contact the Crisis Resolution Team on 0800 745 477
  • https://bpac.org.nz/2017/suicide.aspx

Monitor after initiation of an antidepressant, if not at increased risk of suicide:
  • Review weekly within 1-2 weeks
  • Monitor at least 2-weekly until clear improvement
If Clinical Assessment at 3-4 weeks indicates no treatment response:
  • Consider intensifying, changing or augmenting measures taken to date which may include:
    • Changing antidepressant or
    • Changing to or adding a psychological therapy
If Clinical Assessment at 4-6 weeks indicates no treatment response consider:
  • Increasing the dose
  • Changing antidepressant
  • Changing to or adding a psychological therapy

If there is a lack of satisfactory response after a trial of two antidepressants given sequentially at an adequate dose for an adequate time (with or without psychological therapy) then refer to Te Haika.

Consider Step Two: Brief Interventions.

*The source is from http://www.bpac.org.nz/magazine/2009/adultdep/docs/bpjse_adult_dep_appendix_pages30-40_pf.pdf.