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STEPPS for Emotional Intensity

STEPPS for Emotional Intensity. Renee Harvey Consultant Clinical Psychologist February 2008. Service Development Context. Steering groups Development of Business Case Funding issues Care pathways and models Management workshops Staff training and development

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STEPPS for Emotional Intensity

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  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: 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. 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 • - Borderline PD/Emotional Intensity • - Age ranges • - Gender mix • - Education level • - Complexity : • Tier 2 • Tier 3

  11. Personality Disorder NHS Services: The Vision  National referrals  Key Tier 6: DSPD Units NOMS  • Broadmoor • HMP Whitemoor • HMP Grendon • HMP LowNewton Non-forensic services Regional referrals Forensic services   Regional referrals Tier 5: Secure and Forensic PD Services Relative volume of need  NOMS Case management & pathway ‘lanning Gatekeeping using shared protocols Tier 4: Specialist, Inpatient and Intensive Services  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. - Out-of-hours contact - Time-out / Respite - Place of safety - Management of Axis 1 crises 1. Crisis and Risk Management 2. Skills Development and Life Management 3. Therapy - Dealing with trauma - Self-development Therapeutic model - 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. 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.

  17. 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.’

  18. 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.’

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

  20. 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

  21. Adaptations & Additions • STAIRWAYS • Early intervention • Parenting • Eating disorders • Self-harm • Substance misuse

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

  23. 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 Psychotherapy34, Number 3 / September, 2004

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