CBTp Stepped Care

The Model

Stepped healthcare is a system of delivering and monitoring treatments so that the most effective, yet least resource-intensive intervention is delivered to patients. The approach is a well-recognized model within the medical field and has been appropriated for use in psychotherapeutic interventions both in the United States (Hegel et al., 2002) and abroad (Jolley et al., 2015).

The work being conducted in the SPIRIT lab at the University of Washington represents the first time that the stepped care model has been applied to CBT for psychosis in the United States (Kopelovich, Strachan, Sivec & Kreider, 2019).

The CBTp-Stepped Care (CBTp-SC) model functions as both an implementation and service delivery strategy. As an implementation approach, the CBTp-SC allows for a greater number of behavioral health practitioners to be trained in CBTp interventions by engaging providers with a spectrum of knowledge, skills, and abilities in cognitive behavioral therapy. Using the stepped care model, case managers, nurses, peer specialists, and other allied healthcare workers are learning to administer a packaged set of CBTp interventions. As a service delivery model, CBTp interventions are easier and more expedient for individuals with psychotic disorders to access, so wait times are reduced and CBTp becomes more likely to be offered as standard of care.


The Evidence

CBTp Stepped Care has intuitive appeal to address the critical shortage of trained CBTp practitioners. A recently-published mixed methods quantitative and qualitative evaluation supports its acceptability, feasibility, appropriateness, and efficiency among CBTp Stepped Care clinicians and administrators that are currently sustaining the model (Kopelovich, Maura, Blank, & Lockwood, 2022).


The Vision

CBTp Stepped Care is appropriate for large healthcare systems that rely on a diverse workforce to meet the clinical needs of clients experiencing psychosis. Stepped Care models of implementing and delivering CBTp can address the mandate set forth by the U.S. Department of Health and Human Services that “CBTp should be implemented within our mental health systems, and CBTp-informed care at a minimum should be implemented in primary care, correctional, forensic, and educational settings” (SAMHSA, 2021). To consult with Dr. Kopelovich on whether CBTp Stepped Care is a good fit for your organization or region or to learn more about the UW SPIRIT Lab approach to systematic implementation of CBTp Stepped Care, please reach out to us at cbtecho@uw.edu


Hegel, M.T., Imming, J., Cyr-Provost, M., Noel, P.H. Areán, P.A., Unützer, J. (2002). Role of behavioral health professionals in a collaborative stepped care treatment model for depression in primary care: Project IMPACT. Families, Systems & Health 20(3), 265-277.

Jolley, S., Garety, P., Peters, E., Fornells-Ambrojo, M., Onwumere, J., Harris, V., Brabban, A., Johns, L. (2015). Opportunities and challenges in Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI): Evaluating the first operational year of the South London and Maudsley (SLaM) demonstration site for psychosis. Behaviour Research and Therapy. 24-30.

Kopelovich, S., Strachan, E., Sivec, H., & Krieder, V. (2019). Stepped Care as an implementation and service delivery model for cognitive behavioral therapy for psychosis. Community Mental Health Journalhttps://doi.org/10.1007/s10597-018-00365-6

Kopelovich, S.L., Maura, J., Blank, J., Lockwood, G. (2022). Sequential mixed method evaluation of the acceptability, feasibility, and appropriateness of cognitive behavioral therapy for psychosis stepped care. BMC Health Serv Res 22, 1322. https://doi.org/10.1186/s12913-022-08725-5

SAMHSA. (2021). Routine Administration of Cognitive Behavioral Therapy for Psychosis as the Standard of Care for Individuals Seeking Treatment for Psychosis. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-03-09-001.pdf

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