Evaluation of a brief intervention within a stepped care whole of service model for personality disorder

Abstract

BackgroundAlthough there is growing evidence that stepped models of care are useful for providing appropriate, person centered care, there are very few studies applied to personality disorders. A brief, four session, psychological treatment intervention for personality disorder within a whole of service stepped care model was evaluated. The intervention stepped between acute emergency crisis mental health services and longer-term outpatient treatments.MethodsStudy 1 used service utilization data from 191 individuals referred to the brief intervention at a single community health site in a metropolitan health service. Proportions of individuals retained across the intervention and the referral pathways accessed following the intervention were examined.Study 2 examined 67 individuals referred to the brief intervention across 4 different sites in metropolitan health services. A range of measures of symptoms and quality of life were administered at the first and last session of the intervention. Effect sizes were calculated to examine mean changes across the course of the intervention.ResultsStudy 1 found that 84.29% of individuals referred to the intervention attended at least 1 session, 60.21% attended 2 sessions or more and 41.89% attended 3 or more sessions. 13.61% of the sample required their care to be “stepped up” within the service, whereas 29.31% were referred to other treatment providers following referral to the intervention. Study 2 found a significant reduction in borderline personality disorder symptom severity and distress following the intervention, and an increase in quality of life. The largest reduction was found for suicidal ideation (d = 1.01).ConclusionsBrief psychological intervention was a useful step between acute services and longer-term treatments in this stepped model of care for personality disorder. Suicide risk and symptom severity reduced and quality of life improved, with only a small proportion of individuals requiring ongoing support from the health service following the intervention.

Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained?

“…Indeed this model is based on the following beliefs: people should not have to wait for psychological service; different people require different levels of care; finding the right level of care often depends on monitoring outcomes; moving from lower to higher levels of care based on client outcomes often increases effectiveness and lowers costs overall [22]. In addition, this model has already been described and evaluated for patients with BPD and did show an improvement regarding suicide risk, symptom severity and quality of life as well as a reduction of the treatment cost [23][24][25].…”

Assessing the efficacy of a stepped-care group treatment programme for borderline personality disorder: study protocol for a pragmatic trial

“…The authors proposed that the availability of more than one type of therapeutic intervention would better address issues with heterogeneity, patient preferences and finite resources. Further, Huxley et al [10] reported on the effectiveness of a brief 3-4 session intervention as an initial step in the treatment journey. The authors noted that the variety of pathways patients followed subsequent to the intervention was reflective of the heterogeneity of crisis presentation, supporting the importance of variety in intensity and treatment type for this population.…”

Bridging the Gap in Community Care for Patients With Borderline Personality Disorder: Protocol for Qualitative Inquiry Into Patient, Caregiver, and Clinician Perspectives on Service Gaps and Potential Solutions for Severe Emotion Dysregulation (Preprint)

“…Patients with BPD require services that are more accessible, engaging, and stable and that keep them safe and help set goals for their future -regardless of ability or willingness to participate in more structured therapy approaches. One potential solution to this problem is the implementation of stepped care [43][44][45], a care pathway that matches intervention intensity to patients' severity and needs [46,47]. A small but growing body of literature suggests that stepped care results in more timely and accessible care and may provide effective treatment for emotion dysregulation [48].…”