Depression in children and young people: identification and management in primary, community and secondary care.

Stepped Care

The stepped-care model of depression draws attention to the different needs that depressed children and young people have – depending on the characteristics of their depression and their personal and social circumstances – and the responses that are required from services. It provides a framework in which to organise the provision of services that support both healthcare professionals and patients and their parent(s) or carer(s) in identifying and accessing the most effective interventions (see table below).

Table. The Stepped Care Model

Focus Action Responsibility
Detection Risk Profiling Tier 1
Recognition Identification in presenting children or young people Tiers 2-4
Mild depression (including dysthymia) Watchful waiting
Non-directive supportive therapy/group cognitive behavioural therapy/guided self-help
Tier 1
Tier 1 or 2
Moderate to severe depression Brief psychological therapy
+/– fluoxetine
Tier 2 or 3
Depression unresponsive to/recurrentdepression/psychotic depression Intensive psychological therapy
+/– fluoxetine, sertraline, citalopram, with an antipsychotic
Tier 3 or 4

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