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STEPPS for Emotional Intensity

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Presentation on theme: "STEPPS for Emotional Intensity"— Presentation transcript:

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

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

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

4 STEPPS : 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+

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: Dutch programme: VERS Started 1998: trained, 80% clinics

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

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

9 WHY STEPPS? 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

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

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

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 Therapeutic model 2. Skills Development and Life Management 3. Therapy
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

15 The First Group Horsham Jan – July 2007

16 Referrals received 24 No. Assessed 19 No. starting group 14
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 positive replies received. No. starting group 14 No. completed 8 = 62%. (38% drop-out rate is within the expected range)

17 Some comments and feedback:
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.

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 The Roll-out & Research
Six groups across West Sussex 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 Adaptations & Additions
STAIRWAYS Early intervention Parenting Eating disorders Self-harm Substance misuse

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 (5) The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder, Journal of Contemporary Psychotherapy 34, Number 3 / September, 2004

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