Newfoundland and Labrador Stepped Care 2.0 Demonstration Project – Final Report

The Newfoundland and Labrador Stepped Care 2.0* e-mental health demonstration project was launched in September 2017. It was made possible through a partnership between the Mental Health Commission of Canada (MHCC), Memorial University of Newfoundland (MUN), the Government of Newfoundland and Labrador (N.L.), its four regional health authorities (RHAs), and CHANNAL.

The introduction of Stepped Care 2.0 is part of a mental health system transformation taking place across N.L. Based on the model developed and implemented in the U.K., stepped care offers an evidence-based, client-centred stage system of care that prioritizes the most effective and least intensive treatment. Our demonstration project focused on implementing and evaluating the Stepped Care 2.0 model, which consists of rapid access single session clinics, recovery-oriented treatment principles, and e-mental health programming offered with each step. The U.K. model helped stakeholders see how new approaches and access options could fit with more traditional programs while introducing them to recovery-oriented, strengths-based practices.

Initially, N.L.’s Stepped Care 2.0 training sought to integrate recovery-oriented practices. More recently, it has become a more coherent and accessible system of care through the integration of e-mental health programs into each stage of care. These programs allow clients to access mental health care how, when, and where they prefer to receive it. Much of the training, implementation, and change management for staff and managers was undertaken to support Towards Recovery: The Mental Health and Addictions Action Plan for Newfoundland and Labrador. This action plan responds to recommendations set out in a report by the All-Party Committee on Mental Health and Addictions that focused on mental health and addictions reform.

This document outlines the context for the e-mental health demonstration project and describes its objectives, methods, and implementation phases, along with preliminary data collected between September 2017 and March 2019. It also incorporates observations from project team members and experts across Canada who attended a November 2018 Toronto-based quality improvement workshop on the project.

Key Messages

• Stepped Care 2.0 is a promising model for integrating e-mental health interventions, recovery principles, and single session rapid access counselling with traditional (or established) in-person programming on a provincial scale.
• e-Mental Health programming can best be implemented in jurisdictions with the political will to achieve mental health system change, which, among other things, provides an environment that enables measured risk taking and innovation.
• The principles of recovery-oriented practice — such as person-first and holistic care, choice and autonomy, dignity of risk, and client-provider collaboration — are key values for implementing Stepped Care 2.0 and transforming mental health care. People with lived experience and their families should be at the centre of care.
• Large-scale implementation of Stepped Care 2.0 and e-mental health at the provincial level requires dedicated staff positions, including a provincial project lead, site implementation managers (e-mental health managers), dedicated trainers (Stepped Care 2.0, single session, e- mental health, etc.), and cross-site coordination, evaluation support, and implementation expertise.
• Implementation of Stepped Care 2.0 that includes e-mental health requires early and frequent engagement with a diversity of stakeholders, including medical and non-medical service providers, people with lived experience and their families, policy makers, researchers, community mental health organizations, and others with specialty expertise (e.g., IT).
• Implementation of e-mental health requires careful attention to system integration, change management, training, and platform development.

Stepped Care 2.0©, coined by Peter Cornish, is under copyright. Throughout this document it will appear as Stepped Care 2.0.