Stepped-Care Practices in the Pediatric Setting

In behavioral health, weekly 50-minute individual therapy is considered the standard. However, there is a large and growing unmet need for mental health services, and increasing the number of providers is not likely to offset this gap. Therefore, stepped-care models aim to more efficiently distribute health care resources by matching individuals to a level of care that is the least intensive while still likely to provide clinical benefit. Lower-intensity treatments include self-help methods such as bibliotherapy or computer-assisted therapy, group therapy, and brief or short-term individual therapy. After monitoring response to treatment, patients may be subsequently “stepped up” to more intense treatments only as needed. This chapter provides an overview of stepped-care models of pediatric behavioral health care, including the benefits and risks of this model. Empirical support related to stepped-care approaches for assessment and treatment of common pediatric conditions, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, depression, and anxiety, are presented. Finally, issues related to translating stepped care into practice and recommendations for supervision within pediatric stepped-care models are discussed.