Aims Many young people with mental health and/or substance use concerns do not have access to timely, appropriate, and effective services. Within this context, stepped care models (SCMs) have emerged as a guiding framework for care delivery, inspiring service innovations across the globe. However, substantial gaps remain in the evidence for SCMs as a strategy to address the current systemic challenges in delivering services for young people. This scoping review aims to identify where these gaps in evidence exist, and the next steps for addressing them. Methods A scoping review was conducted involving both peer‐reviewed and grey literature. Eligible studies explored SCMs implemented in the various health care settings accessed by young people aged 12–24 seeking treatment for mental health and substance use challenges. After screening titles and abstracts, two reviewers examined full‐text articles and extracted data to create a descriptive summary of the models. Results Of the 656 studies that were retrieved, 51 studies were included and grouped by study team for a final yield of 43 studies. Almost half of the studies were focused on the adult population (i.e., 18 and over), and most did not specify interventions for young people. Among the SCMs, substantial variability was found in almost every aspect of the models. Conclusions Considering the current body of evidence, there is an urgent need for a consensus position on the definition, implementation, and outcome measures required for rigorously assessing the utility of SCMs for young people.

Stepped care models have the potential to provide a much needed framework for the development of comprehensive mental health systems. However, definitions of stepped care lack consistency, resulting in varying interpretations reflected in its implementation. To help foster greater alignment in research and practice, we propose a set of principles for stepped care which can provide guidance on how to bridge multiple mental health services together, reduce fragmentation, and respond to the full breadth of mental health needs along a continuum of care in diverse settings. We hope that articulating these principles will spur mental health stakeholders to translate them into actionable standards.

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Single-session, or one-at-a-time, open-access care is central to the mental health care system transformation process now underway in several parts of Canada. Single-session principles align well with a mental health recovery strategy and the new Stepped Care 2.0 (SC2.0) model under consideration across Canada. SC2.0 provides a framework for integrating single-session open-access care within the broader mental health ecosystem. Through continuous co-design the model connects values and addresses inevitable tensions that arise when attempting system integration. Model development and scaling is still in the early stages. More work needs to be done, including both program evaluation and independent research. Continued critical attention is the only way to maximize impact at a population level. With open access to an array of resources, organized to meet people where they are in terms of readiness, functioning and capacity for engagement, population mental health is possible. This paper highlights the importance and effectiveness of open-access counseling in a stepped care framework.

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