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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
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• 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?
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Making a start can be daunting...
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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
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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
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Next Groups: 2007-2012
Highland Edinburgh
Milton Keynes
Sussex
Kent
Essex
Surrey
Oxfordshire
Berkshire
ManchesterMilton Keynes
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STEPPS groups to 2012
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Stairways Current Planned
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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
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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
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• 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.
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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.
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Service User Involvement
• Volunteers
• Group ‘graduate’ participation in • Group ‘graduate’ participation in delivery
• Training and support
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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)
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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
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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
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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
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TIER 4: Prison and Probation services
• Pilots due to start:
•Oct 2012 / Jan 2013
• Women in Probation Services
• Prison group: to be decided
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Therapy Pathway
1. Crisis and Risk Management
2. Skills Development and2. Skills Development andLife Management Incl. STEPPS
3. Psychological Therapy
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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
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Start somewhere... Anywhere... Wherever you start, aim to get growth by supporting
practitioners (training, supervision, skills development)
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Don’t let anyone underestimate how far some clients and their families might grow...
Work together... To build a bigger picture, sustainable growth...