STEPPS New adaptations March 2015 Renee Harvey Consultant

STEPPS New adaptations March 2015 Renee Harvey, Consultant Clinical Psychologist Paula Henley-Cragg, Team Leader, CAMHS Jo Burgess, Clinical Nurse Specialist, CAMHS

Nancee Blum, Norm Bartels, Don St John, Bruce Pfohl, 2009

OVERVIEW OF STEPPS • Psychoeducational Group • Cognitive Behaviour Therapy + Schema Therapy • Standard version: 20 wks, STEPPS-EI: 13 wks, STEPPS-YP: 18 wks • 90 – 120 minutes • 8 – 12 per Group • 2 Group Leaders, CBT trained. • 1: 1 Reinforcer • Reinforcement ‘team’ – evening ; CAMHS – parents’/carers’ group

After STEPPS … STAIRWAYS • 24 Lessons • Two-weekly • One year • STEPPS ‘graduates’ only

STEPPS and STAIRWAYS

Other versions VERS-Training : The Netherlands In Italy: In Germany:

Worldwide 47 USA States 6 Provinces in Canada UK Australia New Zealand Europe: • Spain • France • Germany • The Netherlands • Norway • Belgium • Italy • Sweden Argentina Kenya South Africa Japan Prisons in: • Minnesota • Nevada • Florida • Wisconsin • California • Pennsylvania • Iowa

STEPPS in the UK 2006: International Conference : London 2007: First Group: Horsham, W Sussex

Next Groups: 2007 -2013 Highland Edinburgh Dumfries & Galloway Borders Milton Keynes Manchester Essex Oxfordshire London Berkshire Kent Somerset Surrey Sussex

RESEARCH AND OUTCOMES TO DATE • STEPPS was recognised in 2012 in the USA by NREPP (the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices). • Growing evidence base worldwide, in community and prison settings • Groups running successfully for people with BPD, as well as mixed psychiatric diagnosis including mood disorders; proposed trial for ASD

Implementation of STEPPS within the PD pathway in Sussex Phase 1 Phase 2 Phase 3 Phase 4 Forensic/ Tier 4 Residential (Future) 1. Bluebell House Tier 3 2. Lighthouse 3. (E. Sussex) Tier 2 STEPPS and STAIRWAYS Early intervention Tier 1 CAMHS P/C 2007

Adapting the programme Tier 1: STEPPS-EI (13 weeks) Tier 2: STEPPS + Clinician Reinforcement + System reinforcement + STAIRWAYS Tier 3: Preparation for groups Building motivation STEPPS consolidation STAIRWAYS CAMHS: STEPPS-YP (18 weeks) + Parents/Carers Group + Clinician Reinforcement

New Versions • STEPPS-EI – for Primary Care • STEPPS-YP – for young people in CAMHS • STEPPS-HI - (in development)

TIER 1: STEPPS-EI: Primary Care Pilots started : March 2012 (Essex and Sussex) • Manual revised - Shortened - Diagnostic language modified - Modular format: Intro + 1 + 2 • Adults, mixed gender, 8 to 12 per group

TIER 1: STEPPS-YP - CAMHS • Pilot Group: Feb – July 2012 • Parallel groups for young people and parents / carers • 8 participants aged 16 -18 • male and female • 9 parents/family members • 2 group leaders per group • 2 nd group with revised Manual: Jan 2014

Preliminary feedback: • Young people very sensitive to anything seeming ‘childish’ • The material definitely needs modifying • The importance of thorough assessment • Working with the system for good support, communication and crisis management • The importance of follow-up.

From the Young People: • It has helped me to look differently at my emotions and know that it’s okay to feel that way. • It has helped a lot. I am more aware when I am vulnerable to harm • I have had to face up to my difficulties and have been taught how to better communicate myself to others. • I can communicate better and no longer self harm.

From the Parents/Carers • The only people who understand what I’m going through are here, on a Tuesday night • Trying to understand what I may have done, and working with guilt feelings • I have backed off, and she is taking responsibility – for the first time • My husband I both feel we have changed and have noticed this change of behaviour in one another

• ‘I can see changes in front of my eyes’ ‘I’m not sure I can believe it yet!’ • ‘ This has been a godsend’ • ‘I feel we have a future – a future as mum and daughter – as friends – and as her reinforcer which is how we laughingly refer to me!’ However… ‘It’s early days – will the change last? ’ ‘There is a lot of secrecy – I don’t really know yet’

• Since 2013 • We have completed 2 pilot groups • Adapted the original manual • Started a third group • Received positive feedback • Video

• What we have learned; • Peer facilitators are great • Location matters • As does persistence • Video

• What Next? • To offer more training in the Adolescent manual • To adapt the manual, younger age group, transition, and co-morbidities • Stairways • To keep going!

Thanks! Contact info: renee. harvey@sussexpartnership. nhs. uk