Proposed standards for implementing stepped care models in child and youth mental health service systems: Results of a pan-Canadian Delphi study
Bibliographic record
Abstract
Background: Stepped care is being adopted in many countries as a framework for organizing mental health care in diverse contexts. However, there is a lack of consistency in how it has been defined and operationalized, limiting its effective application in practice. We describe the development of standards for implementing stepped care in Canadian child and youth mental health contexts using a consensus-based approach. These standards are intended to support systems planners in creating more cohesive child and youth mental health systems across Canadian settings. Methods: This study employed learning alliance and Delphi methodologies. A pan-Canadian multi-round Delphi process conducted in English and French was used to derive consensus on the inclusion and wording of individual clauses in the implementation standard. Consensus with a threshold of 70% was set to determine inclusion of individual clauses in the final standard. Results: 68 individuals participated in the Delphi study (with a 76.48% retention rate) representing lived experience, service delivery, policy, and research expertise. Participant feedback indicated a desire for greater specificity, disagreements regarding the concept of shared decision-making, and pragmatic questions about leading systems-wide activities. Over 3 rounds, 29 clause items were revised and reduced to a final list of 24 clause items comprising implementation standards. Discussion: The results of this study represent the first multi-stakeholder, consensus-driven set of standards for implementing stepped care in child and youth mental health settings across Canada. With these standards, we aspire to provide a blueprint for advocacy and reform toward stronger, more coordinated mental health systems.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".