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STEPPS for Emotional Intensity
Renee Harvey
Consultant Clinical Psychologist
February 2008
• Steering groups
• Development of Business Case
• Funding issues
• Care pathways and models
• Management workshops
• Staff training and development
• Risk management panel
Service Development Context
Women’s Service – East Sussex
• Lewes Prison
• Training projects:
• Surrey-Sussex courses
• Basic awareness
• Cognitive Analytic Therapy
• STEPPS
Current initiatives in Sussex
•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 :
STEPPS currently in:
Iowa and many other US states
Netherlands
Argentina
Canada
Australia
New Zealand
Spain
Norway
Germany
THE NETHERLANDS
•Adhesie: a multi-function MH provider
•850 Staff, 8000 clients (pop: 350000
•Dutch programme: VERS
•Started 1998: 5000 trained, 80% clinics
IOWA, Oct 07
Setting
• University, Hospital &
Medical School
• Population demographics
• Health care system
STEPPS GROUPS
• Day and evenings
• Long distances: family /
carer involvement
• Group setup
• Stairways
•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?
WHO COULD BENEFIT FROM
STEPPS?
• Inclusion criteria- Borderline PD/Emotional
Intensity- Age ranges- Gender mix- Education level- Complexity :
Tier 2Tier 3
Locality Locality Locality Locality 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
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)
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
1. Crisis andRiskManagement
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
The First Group Horsham Jan – July 2007
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)
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:
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.’
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.’
Six groups across West Sussex
The Roll-out & Research
Northern
Southern
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
• STAIRWAYS
• Early intervention
• Parenting
• Eating disorders
• Self-harm
• Substance misuse
Adaptations & Additions
Tier 3 service
• Pilot 3-day per week specialist service in Horsham
• Day hospital services in Brighton & Hove
• Women’s Service
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)
• The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder, Journal of Contemporary Psychotherapy 34, Number 3 / September, 2004
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