Level Up Your Campus With The Stepped Care Model For Mental Health Services

College counseling centers across the country are struggling to keep up with demand as more students are seeking counseling for mental health concerns than ever before. While this may be seen as a positive result of reduced stigma surrounding mental health care, for campus health and student affairs teams it presents a challenge. Today over 50% of college students seek counseling, while the mean student-to-counseling staff ratio is 1,411 to 1.

“We will likely never be able to hire our way out of the service demand problem. The field could benefit from a paradigm shift that expands access to effective resources without a large corresponding increase in capital outlay.”
-Meeting the Mental Health Needs of Today’s College Student: Reinventing Services through Stepped Care 2.0

One solution that nearly 40% of universities have adopted is known as stepped care. This model of care has the potential to not only help alleviate the high demand for mental health services, but also provide more customized treatment for students’ individual needs. One-on-one, in-person counseling might be extremely beneficial for some students, but a stepped care model acknowledges that there may be less intensive but equally effective options for others.

What is Stepped Care?

Stepped care is a holistic menu of services that aims to connect students to the most effective yet least resource-intensive option first. Students are “stepped up” to more intensive services as necessary.

Stepped care is a holistic approach that addresses prevention through intervention, and helps ensure students are getting the support they need—not more, not less—instead of giving individual counseling to every student with a mental health concern.

Most stepped care models involve a wide array of services ranging from campus-wide screening and outreach to individual counseling, and when necessary, off-campus referrals. Based on a student’s needs, they may be referred to resources such as a peer support group, an anxiety workshop, a mindfulness class, or online therapy.

This approach can not only mitigate the workload of counseling center staff; it also connects students with the most appropriate form of help to meet their mental wellness needs.

For example, the top presenting problem that students come to the counseling center with is anxiety. Talk therapy or psychiatric services may be unnecessary if that student can turn to a resource like an anxiety workshop offered on campus.

How Schools Are Using Stepped Care Models

How colleges and universities use the stepped care model varies depending on the student population’s specific needs, as well as the school’s availability of resources. Most who are moving toward a focus on general mental wellness rather than solely reactive care have various tiers from proactive to reactive, and from autonomy to intervention.

For example, the stepped care approach implemented at the University of Dayton (shown below) has resources to help students practice self-care as the most proactive and autonomous tier, moving up the ladder to online trainings, peer groups, individual counseling, and at the very top tier—immediate care for crisis situations.

At Calvin University in Grand Rapids, Michigan, prior to their stepped care model students detaulted to one-on-one sessions at the counseling center. After implementing their stepped care model (see it here), the university saw a “significant reduction in crisis care appointments” and went from a two or three week wait for appointments to same-day availability.

Customizing A Stepped Care Model For Your Institution

Some college counseling centers and student affairs teams have 20 steps in their stepped care approach; others have as few as four. To define the levels on your campus stepped care model, here’s an example of where to start by sketching your own graph:

  1. Label the axes with level of resource intensity, and level of student autonomy
  2. Fill in existing campus resources where they belong on your graph
  3. Identify any gaps in care
  4. Explore tools or brainstorm programming that fill these gaps and are within your budget

Keep in mind that investing in prevention methods pays off, and has been proven to increase student satisfaction, increase retention, improve reputation and alumni giving, and increase tuition dollars. Early observations of the stepped care model suggest that it improves outcomes (such as reduced counseling waitlists), and increases access to care. Getting all campus leaders and administrators on board with this shift is important in order to successfully implement a comprehensive mental health plan.

Where Does a Tool Like Kognito Fit Into a Stepped Care Model?

As published in an academic article on stepped care in Psychological Services, mental health services have mostly been “organized in a manner that is neither accessible nor enticing to youth most in need.” The article goes on to recognize that the student population spends a lot of time online, and traditional mental health programs have failed to make resources and services accessible in this environment.

Kognito’s role-play simulations for higher education can help fill gaps in a stepped care model by providing online simulation trainings that are accessible to students and staff from anywhere. These programs can help increase health-seeking behaviors, teach the campus community to recognize signs of distress in others, and increase the awareness of specific campus resources.


Sarah DeWitt, Coordinator of Health Education and Wellness Promotion at the University of Dayton, says when they shifted to a stepped care model, the college recognized that mental health needs to be a shared responsibility for all members of the community. The university utilizes Kognito as part of its third tier, which focuses on developing student skills. Kognito’s mental health training module, which many campuses are using for all first-year students, as well as Dayton’s in-person trainings and workshops, are helping the college improve mental health literacy on campus.

“[Kognito has] been critical to building our ethic of wellbeing here at the University of Dayton. All members of our community can feel empowered to take an active role in supporting students who are in distress,” Sarah says.

Want to discover how Kognito’s suite of higher education simulations can fit into your holistic stepped care approach to campus wellbeing? Learn more about our approach to comprehensive mental health prevention and access a free demo of our student training here.

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