Abstract
BACKGROUND: A stepped care approach to treating anxiety and depression is common in mental health services. Low-intensity interventions, typically based on cognitive behavioural principles, are offered first, followed by high-intensity therapy if required. In the English National Health Service Talking Therapies (NHS TT) programme, different types of therapists deliver low- and high-intensity interventions. 'Stepping up' therefore involves changing therapist, and often an additional wait, which could both disrupt treatment flow.In NHS TT, many low-intensity therapists subsequently train at high intensity. Once dual-trained, they typically deliver only high-intensity treatment. With both skillsets, they could theoretically deliver a full stepped care pathway, avoiding potential disruption linked to stepping up. AIMS: To explore a blended treatment approach, where dual-trained therapists move between low- and high-intensity flexibly based on patient need. METHOD: Ten dual-trained therapists across 4 services treated 43 patients. Patients with clinical complexities more likely to eventually require high-intensity support were selected. Propensity score matching was used to identify matched control groups from a pool of patients who received stepped care. Treatment characteristics and clinical outcomes were compared. Feedback was obtained from patients, therapists and supervisors. RESULTS: Compared with matched controls, who received low- then high-intensity treatment, blended treatment required four fewer sessions on average, saving a third of therapist time and was completed 121 days sooner. The reliable recovery rate (54.1%) was 9% higher than the stepped care group (44.7%), which is clinically, although not statistically, significant. Blended treatment showed a non-significantly higher reliable deterioration rate. Patient feedback was positive. Therapists and supervisors highlighted advantages alongside practical challenges. CONCLUSIONS: The blended approach showed promise as an efficient and effective method to deliver therapy when clinicians are dual-trained. Larger-scale studies, and consideration of implementation challenges, are needed. However, results suggest that this approach could potentially offer more flexible and seamless care delivery.