An Evaluation of an Adapted STEPPS Group Within Forensic Services

Study Overview
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Brief Summary
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The purpose of this study is to determine how effective the STEPPS-HI group is at improving emotional regulation skills in those with identified difficulties in this area within forensic inpatient services. In addition, to explore whether there is increased acceptability of the adapted STEPPS group (STEPPS-HI) for this client group.

Detailed Description
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Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a manualised group programme for people primarily with a diagnosis of Borderline Personality Disorder (BPD). Although, STEPPS groups have been run within prisons in USA, it has been less formally evaluated within forensic psychiatric settings except for Pipon-Young & Cole (2012). Taking the learning from these studies into account, significant adaptations to the current STEPPS manual are needed to increase the acceptability and applicability of the group within forensic settings. Following the adaption of the STEPPS manual for a forensic inpatient population (STEPPS HI), this research aims to investigate how effective the group is at improving emotional regulation skills in those with identified difficulties in the area as well as whether there is increased acceptability of the adapted group for the participants. The outcome of the research is intended to provide feedback on the adaption of the STEPPS manual and also an evaluation of the revised programme.

Official Title
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Adapting the Systems Training and Emotional Predictability and Problem Solving Group (STEPPS) for Service Users With Complex Needs. A Pilot Evaluation of STEPPS High Intensity (STEPPS HI) Within Forensic Inpatient Services

Conditions
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Personality Disorder

Intervention / Treatment
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* Behavioral: Adapting STEPPS within forensic inpatient services.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years or older. To give informed consent to participate in the study. Currently a resident in a low or medium secure unit. Has been diagnosed as meeting DSM-IV criteria for a personality disorder at some stage in their mental health history. Has identified difficulties with emotional regulation. Be willing and have suitable abilities to participate in a group. To be assessed by the clinical team as sufficiently psychologically robust to participate in the group and the research. Exclusion Criteria: Psychiatric/psychological or any other difficulties that would mean that participants could not give informed consent. Intellectual/cognitive impairment which prohibits participants ability to consent or fully comprehend the study or study materials. Non-English speakers as there is no provision for interpreters. Unable to manage a group environment due to risk to self and others including bullying and violence (this will be assessed by the clinical and STEPPS-HI facilitation team. No evidence of emotional regulation difficulties.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: STEPPS within forensic services.<br>Forensic inpatients attend the STEPPS-HI group. Consent will be obtained. Pre and post group psychometric questionnaires will be completed as well as each service user attending a short semi-structured interview following the conclusion of the group . Primary nurse will fill in pre and post group questionnaires. Facilitators will complete short feedback forms each session and attend a focus group upon completion. Psychology Assistants/Interns will collect records of self harm and violence/aggressive incidents for each service user as well as records of nursing observation level and leave status taken. | Behavioral: Adapting STEPPS within forensic inpatient services.<br>* This study will focus upon delivering the STEPPs-HI group within Forensic Healthcare Inpatient Services.<br>* Other names: STEPPS-HI;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To assess change from baseline (start of group) on the Symptom Checklist-Revised (SCL-90-R), reassessing at end of group (26 weeks later). | To assess change from baseline (start of group) on the Symptom Checklist-Revised (SCL-90-R), reassessing at end of group (26 weeks later). | Assess at baseline (start of group) and reassess end of group (26 weeks later) | 
| To assess change from baseline (start of group) on the Zanarini Rating Scale for Borderline Personality Disorder, reassessing at end of group (26 weeks later). | To assess change from baseline (start of group) on the Zanarini Rating Scale | Assess at baseline (start of group) and reassess end of group (26 weeks later) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Overt Aggression Scale (MOAS: Yudofsky, J. M. Silver, W. Jackson, J. Endicott, & D. W. Williams, 1986). | Modified Overt Aggression Scale (MOAS: Yudofsky, J. M. Silver, W. Jackson, J. Endicott, & D. W. Williams, 1986). | Assess at baseline (start of group) and reassess end of group (26 weeks later) | 
| Circumplex of Interpersonal Relationships in Closed Living Environments (CIRCLE; Blackburn & Renwick, 1996). | Circumplex of Interpersonal Relationships in Closed Living Environments | Assess at baseline (start of group) and reassess end of group (26 weeks later) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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STEPPS-HI, personality disorder, evaluation, forensic