Peter A Cornish

• PhD
• Managing Director at University of California, Berkeley

Government of New Brunswick implemented One-at-a-Time (OAAT) therapy, a single-session approach to care, within Addiction and Mental Health (A&MH) services. We conducted interviews to understand determinants of implementation from program champions. Champions of the OAAT therapy implementation (N = 19; Child/Youth n = 8, Adult n = 11) working withi...

This study examines the process of implementing One-at-a-Time (OAAT; i.e., single-session) therapy into child and youth addiction and mental health services in New Brunswick. The implementation process was retrospectively mapped onto implementation science frameworks. Providers were recruited to participate in research associated with the system ch...

Since it was first developed in the Canadian province of Newfoundland and Labrador, the Stepped Care 2.0 (SC2.0) model for mental health care has been adopted by a wide range of organizations in Canada and the United States, from provincial governments to university mental health centers. As SC2.0 grows and expands, however, questions have arisen a...

Stepped Care 2.0 is flexible. It is not a staging or pathways model. In keeping with recovery principles and values, clients are able to chart their own course. Preference is guided by establishing clear expectations. As part of the informed consent process, clients learn what they can expect from the wide variety of available options. They also le...

The nine levels of Stepped Care 2.0 are designed to maximize choice. They also facilitate care adaptations as needs, motivation, and readiness evolve. Their arrangement on dimensions of stakeholder engagement, and both treatment intensity and client autonomy, enables full transparency. Providers and help-seekers are able to see the forest and the t...

Mental health is a topic of growing interest, but there is no crisis. Rates of mental illness are stable, while demand is escalating. Increases in help-seeking could be a function of rising perceived value of mental health and wellness programming. However, at the same time, there are signs that some forms of stigma could be increasing. In this cha...

Stepped Care 2.0 is founded on the principle of open access. This means that care is available to anyone on a same-day basis through multiple access point modalities. This upstream approach ensures that people get care at the right time and context, regardless of the severity of their symptoms. By removing barriers to access, providers can capture...

Recovery values and principles guide the paradigm shift, allowing care practices to move beyond the disease model of mental distress. While recovery programming maintains care aimed at symptom relief, it expands the focus to include the development of strengths, hope, and resilience. The goal is to maximize agency, autonomy, and empowerment. This i...

There are many more questions than answers facing those interested in transforming mental health-care systems. While we promised to, in this book, go deep by exploring the conundrums arising from our Stepped Care 2.0 (SC2.0) work, it feels like we have only scratched the surface. Recognizing the complexities of transforming a mental health system c...

Background: Providers who work within addiction and mental health (A&MH) services in New Brunswick (NB), Canada completed training in Stepped Care 2.0 and One-at-a-Time (OAAT) therapy as part of a provincial practice change initiative to implement a provincial stepped care model. The present study aimed to identify: (1) the perceived acceptability...

Background: The Department of Health of the Government of New Brunswick and Regional Health Authorities elected to implement Stepped Care 2.0 (SC2.0) in 2021, and began with One-at-a-Time (OAAT) therapy in Community Addiction and Mental Health Centres (CAMHCs) to facilitate rapid access to addiction and mental healthcare. This study: 1) explicated...

Background Mental health challenges are highly prevalent in the post-secondary educational setting. Screening instruments have been shown to improve early detection and intervention. However, these tools often focus on specific diagnosable conditions, are not always designed with students in mind, and lack resource navigational support. Objective...

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...

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 integr...

Recovery values and principles guide the paradigm shift, allowing care practices to move beyond the disease model of mental distress. While recovery programming maintains care aimed at symptom relief, it expands the focus to include the development of strengths, hope and resilience. The goal is to maximize agency, autonomy and empowerment. This inc...

Stepped Care 2.0 is collaborative in design and application. Co-design underlies all activity, whether at the system transformation level, at an interprofessional case conference, on a research team or in each encounter between a client and a provider. Initial co-design is guided by implementation science with careful attention to change management...

Stepped Care 2.0 is flexible. It is not a staging or pathways model. In keeping with recovery principles and values, clients are able to chart their own course. Preference is guided by establishing clear expectations. As part of the informed consent process, clients learn what they can expect from the wide variety of available options. They also le...

Mental health is a topic of growing interest but there is no crisis. Rates of mental illness are stable, while demand is escalating. Increases in help-seeking could be a function of rising perceived value of mental health and wellness programming. However, at the same time, there are signs that some forms of stigma could be increasing. In this chap...

The nine levels of Stepped Care 2.0 are designed to maximize choice. They also facilitate care adaptations as needs, motivation and readiness evolve. Their arrangement on dimensions of stakeholder engagement, and both treatment intensity and client autonomy, enables full transparency. Providers and help-seekers are able to see the forest and the tr...

Stepped Care 2.0 is founded on the principle of open access. This means that care is available to anyone on a same-day basis through multiple access point modalities. This upstream approach ensures that people get care at the right time and context, regardless of the severity of their symptoms. By removing barriers to access, providers can capture...

Stepped Care 2.0 can facilitate a long-overdue paradigm shift in mental healthcare organization and treatment. The core components of Stepped Care 2.0 are identified and related to Indigenous wisdom that has stood the test of time. The concept of synergy is introduced and contrasted with the scarcity-based risk paradigm that dominates our Eurocentr...

Although Stepped Care 2.0 is a new model, programming and principles are familiar to many. What is new, are the processes for system building and adjustment discussed in Chap. 6. Equipped with these processes many institutions are adopting variations of the model to suit their unique ecosystems. Specifically, post-secondary counselling centres acro...

Background: Access to multidisciplinary pain management treatment in Canada is limited, with wait times up to 4 years. Stepped care approaches to mental health treatment have led to substantial reduction and elimination of wait times and may be applicable to chronic pain settings. There is no unifying framework for stepped care chronic pain progra...

Introduction Approximately one-third of adults with chronic pain also report clinically relevant levels of depression. Internet-delivered psychological therapies such as Cognitive Behavioural Therapy (iCBT) and Acceptance and Commitment Therapy (iACT) have been developed to overcome barriers of access to services and ensure the timely delivery of c...

This book is a primer on Stepped Care 2.0. It is the first book in a series of three. This primer addresses the increased demand for mental health care by supporting stakeholders (help-seekers, providers, and policy-makers) to collaborate in enhancing care outcomes through work that is both more meaningful and sustainable. Our current mental health...

Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly...

There has been a consistent increase in counselling needs in university populations over the past 25 years. Currently young adults are the population that is the most susceptible to being diagnosed with a mental illness. Students also seem to face unique barriers to receiving the proper treatment that they require for their mental health needs. Per...

A new stepped care model developed in North America re-imagines the original United Kingdom model for the modern university campus environment. It integrates a range of established and emerging online mental health programs systematically along dimensions of treatment intensity and associated student autonomy. Program intensity can be either steppe...

There has been a consistent increase in counselling needs in university populations over the past 25 years. Currently young adults are the population that is the most susceptible to being diagnosed with a mental illness. Students also seem to face unique barriers to receiving the proper treatment that they require for their mental health needs. Per...

The benefits of interprofessional care in providing mental health services have been widely recognized, particularly in rural communities where access to health services is limited. There continues to be a need for more continuing interprofessional education in mental health intervention in rural areas. There have been few reports of rural programs...

Background. This study was designed to assess the efficacy of a well-established self-help program in actual rural practice conditions. Methods. The forty-five health professionals invited to participate in this randomized controlled trial (read self-help book, Feeling Good: The New Mood Therapy versus treatment as usual) were asked to select...

Self-help is no help: negative study results lead to important lessons 111 I n training mental health profes-sionals in rural areas across New-foundland and Labrador over the past decade, 1,2 we have learned that prac titioners are in need of practical and realistic ways to address the mental health concerns of their patients. In one of our early p...

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10-session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty-five professionals, representing 15 professions, attended at least some...

Patients' mental health issues have become an increasing focus of Canadian family physicians' practices. A self-help approach can help meet this demand, but there are few guidelines for professionals about how to use mental health self-help resources effectively. To aid health professionals in integrating self-help materials into their mental healt...

The benefits of interprofessional care in providing mental health services have been recognized, particularly in rural communities where health services are limited. In addition, there is a need for more continuing professional education in mental health intervention in rural areas. Although interprofessional collaboration and continuing education...

This paper reports on the results of a demonstration project that examined the role of telehealth/telemedicine (hereafter referred to as telehealth) in providing interdisciplinary mental health training and support to health professionals in a rural region of Atlantic Canada. Special emphasis was placed on addressing the question of how training mi...

Increasingly, demands are placed on counselors and therapists to provide briefel; more focused treatment. This article argues that principles of individual thempy can be easily integrated with techniques of group thempy in an eight-session counseling group. The authors outline ways of combining these approaches during all phases of group developmen...

Although researchers have begun to show critical interest in men as gendered beings, theoretical models capable of cultivating alternative, more psychologically and socially adaptive patterns of male development are lacking. A small purposively drawn sample of eight profeminist men, along with one father's rights activist, were asked to recount the...

Large numbers of students with learning disabilities (LD) are now seeking postsecondary education in Canada. Many of these students are not prepared for the personal and academic challenges associated with higher education because their disability self-awareness level and self-advocacy skills have not been adequately developed. This article describ...