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Tracing the missteps of stepped care: Improving the implementation of stepped care through contextual behavioral science (Pages 109-116)

Journal of Contextual Behavioral Science (JCBS)

Volume 23, January 2022, Pages 109-116


Leah LaLonde, Jessica Good, Efthymia Orkopoulou, Michael Vriesman, Alexandros Maragakis


Stepped care is an organizational model of healthcare service provision that organizes interventions into a hierarchy from least-to-most intensive, intrusive, and costly. The intervention intensity should be based on feasibility, cost, severity of the presenting case, and patient and clinician preferences. Patients can be “stepped” up or down, depending on progress. Despite the rich, theoretical literature suggesting the effectiveness of stepped care, its implementation is accompanied by challenges that impede its proliferation in applied settings. This paper provides a review of the barriers to stepped care, including negative perceptions, tendency toward defensive medicine, lack of guidance in decision-making, the need for measurement tools designed for stepped care, and healthcare system factors that discourage stepped care. Specific recommendations are discussed for how a contextual behavioral science approach can reduce barriers to implementing stepped care models of behavioral health service delivery.

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