Implementing STEPPS ( Systems Training for Emotional Predictability and Problem

Solving) in different service settings within a pathway for Borderline

Personality DisorderPersonality Disorder

December 2012

Renee Harvey Brian SoltsConsultant Clinical Psychologist Consultant Clinical PsychologistClinical Lead for Personality Disorders Clinical Lea d for Specialist Services

• What is STEPPS?

• How do we conceptualise where STEPPS fits within an overarching care pathway? pathway?

• Where are we making adaptations?

• ... And what are we learning?

Making a start can be daunting...

Overview of STEPPS

• ‘Psychoeducational’ Group• CBT + Schema Therapy• 20 Weeks, 90 – 120 minutes, plus homework• 8 – 12 per group• 8 – 12 per group• 2 group leaders, CBT trained• 1:1 Clinician Reinforcer• Reinforcement team (client’s wider system)• Evening for families/carers

Worldwide

47 USA States6 Provinces in CanadaUKAustraliaNew ZealandEurope:

ArgentinaKenyaSouth AfricaJapan

Prisons in: Europe: •Spain•France•Germany•The Netherlands•Norway•Belgium•Italy

Prisons in: •Minnesota•Nevada•Florida•Wisconsin•California•Pennsylvania•Iowa

Next Groups: 2007-2012

Highland Edinburgh

Milton Keynes

Sussex

Kent

Essex

Surrey

Oxfordshire

Berkshire

ManchesterMilton Keynes

STEPPS groups to 2012

Stairways Current Planned

Service provision in Sussex

STEPPS embedded in Tier 3 programme

Tier 3 Specialist services

Tier 4 Joint working

Specialist Services

STEPPS embedded within a range of services and options

Early interventionTier 1: PC

Tier 2 Community

Tier 3

Tier 4Forensic

services

1.Bluebell

House

2.Lighthouse

Phase 1 Phase 2 Phase 3 Phase 4

Tier 1

Tier 2

2.Lighthouse

STEPPS and

STAIRWAYS

Early intervention

CAMHS P/C

• STEPPS: Jan 2007 to Sept 2012:

• 410 people started a STEPPS Group

• 266 (65% completed 20 weeks)

TIER 2

• 266 (65% completed 20 weeks)

• STAIRWAYS : 8 teams currently running or planning groups.

Outcomes

• Large database being drawn up.

• Reports from each group:

• Dramatic improvements in 2 -3 • Dramatic improvements in 2 -3 participants in each group

• Demonstrable benefits in most of rest

• Popular with clients. Demand increasing

• Popular with clinicians.

Service User Involvement

• Volunteers

• Group ‘graduate’ participation in • Group ‘graduate’ participation in delivery

• Training and support

STEPPS in the Tier 3 Service:

• Weekly STEPPS group

• 2 x 2 hour ‘practice’ sessions

• Individual work on Emotional Intensity

Continuum when needed

In addition: Consolidation groupPreparation group (planned)

STEPPS in the Tier 3 Service:

Challenges:

• Variability in participation

• Some struggling with reading

• Group size

• More 1:1 work• More 1:1 work

Clinicians: Positive influence on Tier 2 work

Noticing changes in people

* Reduction in Sect.136 presentations reported

TIER 1: CAMHS

• Pilot Group: Feb – July 2012• Parallel groups for young people and

parents / carersparents / carers• 8 participants aged 16-18• male and female• 9 parents/family members • 2 group leaders per group

•Manual revision after group

TIER 1: Early Intervention: Primary Care

• Pilots started : March 2012 (Essex and Sussex)

. Manual revised (preliminary). Manual revised (preliminary)- Shortened- Modular format

• Adults, mixed gender, 8 to 12 per group

TIER 4: Prison and Probation services

• Pilots due to start:

•Oct 2012 / Jan 2013

• Women in Probation Services

• Prison group: to be decided

Therapy Pathway

1. Crisis and Risk Management

2. Skills Development and2. Skills Development andLife Management Incl. STEPPS

3. Psychological Therapy

Forensic:

• ‘cut off the upward flow’ and ‘provide exit strategies’

•‘New roots’ in the community

Embed Principles into 2 ° Care

• Improve confidence/Increase

competence: change attitudes

• Reduce admissions

• Focus on recovery

• Positive risk management

Bite-size PD/STEPPS Training –helpful on inpatient

The paradox of 1° care: Commissioning a ‘pre-diagnostic’ care package / ‘features’ of BPD

•High levels of complexity ‘held’ in 1° care

•Avoid the need to escalate: skills focus for staff and clients

What about their children?

•Adaptations for adolescents + parents

• Grow healthier social networks

• Positive risk management

Start somewhere... Anywhere... Wherever you start, aim to get growth by supporting

practitioners (training, supervision, skills development)

Don’t let anyone underestimate how far some clients and their families might grow...

Work together... To build a bigger picture, sustainable growth...

For more information…

Contact: Renee Harvey: renee.harvey@sussexpartnership.nhs.uk