Stepped care in psychological therapies: access, effectiveness and efficiency This narrative review explores the concept of stepped care in psychological therapies, focusing on its potential to improve access, effectiveness, and efficiency. The review highlights the significant gap between the demand for psychological therapy services and the available supply, suggesting that stepped care models could help address this issue by using briefer, 'minimal interventions' more efficiently. Stepped care is a model of healthcare delivery that involves a series of treatment steps, starting with the least intensive interventions and progressing to more intensive ones as needed. It is designed to be self-correcting, meaning that if a treatment is not effective, the system can adjust to provide more appropriate care. The model is based on three key assumptions: that minimal interventions can provide significant health gains equivalent to traditional therapies, that they are more efficient in terms of resource use, and that they are acceptable to both patients and professionals. The review discusses the clinical and economic implications of stepped care, noting that while there is some evidence supporting its effectiveness, more research is needed to fully evaluate its potential. It also highlights the importance of considering patient acceptability and the need for a comprehensive research agenda to determine the optimal implementation of stepped care models. The review also addresses the challenges in evaluating stepped care, including the difficulty in proving equivalence between minimal interventions and traditional therapies, the potential for cost-shifting, and the need for more rigorous studies to assess the model's effectiveness. It suggests that modeling could be a useful tool in the short term to assess the potential benefits of stepped care. In conclusion, while stepped care has the potential to improve the efficiency of psychological therapy services, further research is needed to fully understand its effectiveness and to determine the best way to implement it. The review emphasizes the importance of addressing key research questions related to the clinical and economic assumptions underlying stepped care models.Stepped care in psychological therapies: access, effectiveness and efficiency This narrative review explores the concept of stepped care in psychological therapies, focusing on its potential to improve access, effectiveness, and efficiency. The review highlights the significant gap between the demand for psychological therapy services and the available supply, suggesting that stepped care models could help address this issue by using briefer, 'minimal interventions' more efficiently. Stepped care is a model of healthcare delivery that involves a series of treatment steps, starting with the least intensive interventions and progressing to more intensive ones as needed. It is designed to be self-correcting, meaning that if a treatment is not effective, the system can adjust to provide more appropriate care. The model is based on three key assumptions: that minimal interventions can provide significant health gains equivalent to traditional therapies, that they are more efficient in terms of resource use, and that they are acceptable to both patients and professionals. The review discusses the clinical and economic implications of stepped care, noting that while there is some evidence supporting its effectiveness, more research is needed to fully evaluate its potential. It also highlights the importance of considering patient acceptability and the need for a comprehensive research agenda to determine the optimal implementation of stepped care models. The review also addresses the challenges in evaluating stepped care, including the difficulty in proving equivalence between minimal interventions and traditional therapies, the potential for cost-shifting, and the need for more rigorous studies to assess the model's effectiveness. It suggests that modeling could be a useful tool in the short term to assess the potential benefits of stepped care. In conclusion, while stepped care has the potential to improve the efficiency of psychological therapy services, further research is needed to fully understand its effectiveness and to determine the best way to implement it. The review emphasizes the importance of addressing key research questions related to the clinical and economic assumptions underlying stepped care models.