stepped care pathways are the systems by which we deliver and monitor psychiatric treatments so that the most effective and least resource-intensive treatments are applied at the right time.
In Canada, we have remarkable strength in perinatal mental health research, leadership and clinical work. There aren't many of us, but those of us who are here.... Well, my colleagues are great; I'm just okay.
When we're talking about a stepped care model, I think we'd be talking about starting with some quality standards around preconception information and prevention, as well as detection, assessment, intake and treatment. All of this would be, of course, measurement based.
We have lots of wonderful measures in the perinatal mental health space, like the Edinburgh postnatal depression scale and so forth. We'd be talking about trying to identify those individuals who require treatment and then identifying some low-intensity treatments that could be used by most.
There is a model within the Ontario structured psychotherapy program that could be used, whereby classes and self-directed psychotherapies.... CBT-based would usually be a low-intensity intervention. We would monitor responses to those interventions and determine if people needed more, if they had a poor treatment response, if the treatment wasn't good for them or if they didn't agree with it. Then we could move up to higher-intensity treatments, like individual or group-structured evidence-based psychotherapies, cognitive behavioural therapy, interpersonal psychotherapies and things like that. Then we go to medications and so forth.