STEPS: Stepped Care Trial


NICE recommends that depression treatment be organised using a system called stepped care. (Image via Shutterstock)

STEPS: Stepped Care Trial

NICE recommends that depression treatment be organised using a system called stepped care. This requires that almost all patients receive a ‘low-intensity’ treatment such as guided self-help and only those patients who do not respond are given more intensive treatment, such as cognitive behaviour therapy. Increasing Access to Psychological Therapy (IAPT) Services, including Devon’s Depression & Anxiety Service, are organised in this way.  Unfortunately, we do not know if this is acceptable to patients or if this is an efficient way of organising care.  This has implications for the NHS in terms of cost but also for patients who may not receive the most appropriate treatment for them. 

NICE has recommended that research be carried out to test stepped care. In the long term, we want to run a clinical trial of stepped care, comparing it to more intensive treatment.  This will tell us how these ways of treating patients compare in terms of cost and patient outcomes.  Before we can do this we need to undertake a feasibility study to develop and test our methods and our procedures.  We also want to know if stepped care is acceptable to patients and to clinicians and how they think it should be organised.

In STEPS we are conducting a small randomised controlled trial of stepped care versus intensive therapy.  We will also collect information on the acceptability of stepped care through qualitative interviews.  Having analysed this, we will use it to write an application for a large randomised controlled clinical trial of stepped care.  Our results on the acceptability of stepped care will be of immediate interest to patients and health care professionals.

The Principal Investigator for STEPS is Jacqueline J. Hill, Exeter Graduate Fellow, supervised by Professors David A. Richards and Willem Kuyken.

The feasibility trial will begin in October 2013.

The protocol paper for STEPS is available from Trials journal with the following citation:

Trials.2014, 15:452

DOI: 10.1186/1745-6215-15-452

For more information

Please contact Jacqueline J. Hill or call 01392 725273