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