University of Washington Department of Psychiatry And Behavioral Sciences

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 in the United Kingdom (Jolley et al., 2015).

The work being conducted at Evidence Based Practices for Adults 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 model acts as both an implementation and service delivery strategy. As an implementation approach, the CBTp Stepped Care Model allows for a greater number of community mental health providers 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.

Access the concept paper here (


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 Journal.


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