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STEPPS for Emotional Intensity Renee Harvey Consultant Clinical Psychologist February 2008.

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Presentation on theme: "STEPPS for Emotional Intensity Renee Harvey Consultant Clinical Psychologist February 2008."— Presentation transcript:

1 STEPPS for Emotional Intensity Renee Harvey Consultant Clinical Psychologist February 2008

2 Steering groups Development of Business Case Funding issues Care pathways and models Management workshops Staff training and development Risk management panel Service Development Context

3 Women’s Service – East Sussex Lewes Prison Training projects: Surrey-Sussex courses Basic awareness Cognitive Analytic Therapy STEPPS Current initiatives in Sussex

4 Systems Training for Emotional Predictability and Problem Solving Nancee Blum, Norm Bartels, Don St John, Bruce Pfohl Black D, Blum N, et al. The Stepps Group Treatment Program for outpatients with Borderline Personality Disorder, J Contemporary Psychotherapy, Fall 2004, 34, 3, 193+ STEPPS :

5 STEPPS currently in: Iowa and many other US states Netherlands Argentina Canada Australia New Zealand Spain Norway Germany

6 THE NETHERLANDS Adhesie: a multi-function MH provider 850 Staff, 8000 clients (pop: 350000 Dutch programme: VERS Started 1998: 5000 trained, 80% clinics

7 IOWA, Oct 07 Setting University, Hospital & Medical School Population demographics Health care system

8 STEPPS GROUPS Day and evenings Long distances: family / carer involvement Group setup Stairways

9 Demand Diagnosed Cluster B Disorders: 198 Prevalence of 10 – 13% (all PD) = 155,000 – 180,000 in Sussex ….Where are they??.. Accessibility For Clients For Professionals Cost Involvement of system WHY STEPPS?

10 WHO COULD BENEFIT FROM STEPPS? Inclusion criteria - Borderline PD/Emotional Intensity - Age ranges - Gender mix - Education level - Complexity : Tier 2 Tier 3

11 Locality Tier 4: Specialist, Inpatient and Intensive Services Tier 5: Secure and Forensic PD Services Tier 6: DSPD Units  Tier 3: Intensive Day Services, Crisis Support and Case Management Tier 2: Community-based Treatment & Case Management Tier 1: Consultation, Support and Education Personality Disorder NHS Services: The Vision    Broadmoor HMP Whitemoor HMP Grendon HMP LowNewton s Regional referrals National referrals Specialist services     Regional referrals NOMS Forensic services Non-forensic services  Relative volume of need Case management & pathway ‘lanning Gatekeeping using shared protocols Key NOMS          NOMS

12 Exclusion criteria No emotional intensity Inability to tolerate groups Unmotivated to do tasks Doesn’t recognise problem Life chaotic, with minimal support Additional diagnosis of severe problem which might interfere (e.g. substance misuse, ED)

13 STEPPS and the BPD Care Pathway STEPPS is ‘value added’ … to: Existing care Individual psychological therapy Other needed therapeutic input, e.g. - Eating disorder treatment - Arts therapies Individual remains within team, and is not referred away or discharged. Treatment continues after STEPPS

14 1. Crisis and Risk Management 2. Skills Development and Life Management 3. Therapy - Out-of-hours contact - Time-out / Respite - Place of safety - Management of Axis 1 crises - Dealing with trauma - Self-development - Attachment - Motivation - Skills: Managing emotions Communication STEPPS Relationships (etc) - Personal health management - Spiritual needs management - Practical life management - Housing - Finances - (Return to) work - Children & family issues Therapeutic model

15 The First Group Horsham Jan – July 2007

16 Referrals received 24 Some service users did not express interest on discussion with referrer. No. Assessed 19 3 assessed as inappropriate for group 1 declined after assessment 15 were assessed as suitable and asked to confirm their interest. 14 positive replies received. No. starting group 14 No. completed 8 = 62%. (38% drop-out rate is within the expected range)

17 1. After I read “The Experience of Being a Borderline” I cried, I cried a lot. I was reading me. It helped me, for the first time in my life to understand, I am not alone, I am not a freak, I am not an alien lost on the wrong planet. All my life this is how I have been feeling about myself. So scared and alone and totally lost with my emotions. I live in fear of what each day is going to bring. Am I going to be happy, sad, go into a mad rage, scream, shout, punch, break things. Drive too fast, drink too much, cut myself or even worse. I now feel hope, I have been found, I am not alone, I am afraid but I want to work at stepps. I have very strong feelings of optimism and it is a feeling I like. Some comments and feedback:

18 2.‘I have learnt a lot about myself since being on the STEPPS course…The Course has given me the opportunity to look at myself in a positive way rather than negative. I always knew I was different, but until STEPPS I was always uncomfortable with who I was and never really understood myself. I felt like an Alien living on the wrong planet. Now I am aware of E.I.D. my illness and that others like me are having similar problems. Struggling with there emotions. I feel that I am no longer alone, I have hope and there is help out there. The STEPPS course is a lot of hard work and you really have to work hard but it is worth it. It is worth every minute you spend doing it. You really do reap what you sow. You do not see results instantly and for some it may seem that things get worse before they begin to show positive results. There really is a light at the end of the tunnel believe me.’

19 3. ‘I certainly hope that these STEPPS programmes continue to help make a difference to others lives how it has mine. Thank you for everything and planting the seed and allowing it the time and space to grow.’


21 Six groups across West Sussex The Roll-out & Research Northern Southern

22 Research 48-60 participants Assessments at 6 times: Screening, pre-, during & post-group, at 6 months and 12 months –ZAN-BPD –MCMI-III –SCL-90 –BDI –PANAS-X –CORE –BEST Treatment team rating

23 STAIRWAYS Early intervention Parenting Eating disorders Self-harm Substance misuse Adaptations & Additions

24 Tier 3 service Pilot 3-day per week specialist service in Horsham Day hospital services in Brighton & Hove Women’s Service

25 References Black D, Blum N, et al. The Stepps Group Treatment Program for outpatients with Borderline Personality Disorder, J Contemporary Psychotherapy, Fall 2004, 34, 3, 193+ STEPPS Group Treatment for Borderline Personality Disorder in The Netherlands Authors: Van Wel, Bas ; Kockmann, Ina ; Blum, Nancee ; Pfohl, Bruce; Black, Donald; Heesterman, Wilma. Annals of Clinical Psychiatry (after Jan 1, 2004), Volume 18, Number 1, January-March 2006, pp. 63-67(5)Annals of Clinical Psychiatry (after Jan 1, 2004) The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder, Journal of Contemporary Psychotherapy 34, Number 3 / September, 2004Journal of Contemporary Psychotherapy34, Number 3 / September, 2004

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