Symposium Title: Stepped care for borderline personality disorder: A real-world example
Chair: Dr Cathy Ludbrook, Clinical Lead
The state-wide BPD Collaborative (BPD Co) initiative was developed in response to the demonstrated need for enhanced, evidence-based BPD service development in South Australia. A stepped model of care was adopted with the aim of making broad system change and ultimately increasing the availability of different treatment modalities at varying stages of care.
This symposium will provide an overview of the model of care and the initial three years of implementing the model in the “real-world”. We will focus on four areas of the model – brief intervention, short-term group program, shared care and our training programme. Each area of service delivery will be described with consideration of enablers, barriers, outcomes and implementation lessons-learned.
Presentation 1: Building capacity, changing attitudes: The BPD Co training programme
Presenter: Cathy McLeod Everitt, Service Development Manager
Background: Borderline personality disorder is a mental health condition which has been associated with stigma across health care settings, impacting on the availability and quality of care (Klein et al., 2021). Training for health care staff has been viewed as one method for challenging stigma through attitudinal change.
Objectives: To describe the range of training activities delivered by BPD Co including Foundations Skills, Responding to Crises associated with BPD, BPD Core Competencies, Gold Card brief intervention training and Good Psychiatric Management. We will explore the impact of training on clinician attitudes and implementation of the state-wide stepped model of care.
Methods: An audit of activity and staff attitudes collected before and after training will be described across the various training programmes.
Findings: A large number of staff across both public and private sectors have participated in BPD Co training sessions over the past three years with shifts in staff attitudes, willingness and confidence. Further research is required to explore whether this facilitates broader system impact.
Presentation 2:
Title: Gold Card SA: State-wide delivery of a brief intervention for people with borderline symptoms in crisis
Presenter: Dr Dianna Bartsch, Research Coordinator
Background: Gold Card is a brief intervention which has been found to be a useful step between acute services and longer-term treatments in a stepped care whole service model for personality disorders (Huxley et al., 2019). South Australia adopted this model with the view of making it available state-wide.
Objectives: To report Gold Card SA activity and outcomes across both metropolitan and regional areas over the first three years of implementation. We will review patient-reported outcomes and consider enablers, challenges, and future steps.
Methods: A retrospective audit was undertaken of Gold Card SA service delivery for adults aged 18 + years across metropolitan and regional South Australia between December 2019 to December 2022. Patient-reported outcomes and service utilisation data (e.g., inpatient bed days and emergency department presentations) were reviewed before and after the intervention to explore impact.
Findings: The results from the retrospective audit suggest a reduction in psychopathology and service utilisation before and after the intervention. We will discuss the potential for Gold Card SA for young people (under 18 years) presenting to services in crisis.
Presentation 3:
Presenter: Laura Cooke-O’connor, Advanced Clinician/Coordinator
Title: Road Maps: Navigating an intermediate step in care
Background: The capacity of tertiary and private sector mental health service providers to offer evidence-based interventions for BPD can be limited by cost and duration. Long waitlists necessitate alternative approaches to care. Less resource-intensive treatments could be developed by integrating common factors of effective therapies for BPD (Choi-Kain et al., 2016).
Objectives: To describe outcomes for Road Maps a short-term group which has been piloted with adults and youth who meet diagnostic criteria for BPD in South Australia.
Methods: We describe initial findings from the pilot evaluation of Road Maps, in which change in outcomes for a naturalistic waitlist control was compared to the intervention group (before and after group). Findings will be reported for both the adult group (18 + years) and the youth adaptation (16 years +).
Findings: Road Maps received favourable feedback from both Adult and Youth participants. We will report adult and youth outcomes compared for those in the naturalistic vs waitlist control conditions.
Presentation 4:
Presenter: Dr Cathy Ludbrook, Clinical Lead
Title: Shared care for people with severe and complex presentations of BPD
Background: People with severe and complex presentations of BPD may be referred to BPD Co for shared care provided in partnership with tertiary mental health service providers across Local health networks in South Australia.
Objectives. We aim to describe the consumer profile and activity that has occurred in the Shared Care stream of service delivery between 2019 and 2023.
Methods: A retrospective audit of over 150 shared care referrals was undertaken over the first three years of service delivery. Descriptive data will be reported summarising the key activities involved in the shared care stream and to explore a demographic profile of the population.
Findings: Consumers referred to shared care are likely to experience severe symptoms of BPD, significant comorbidity and psychosocial dysfunction. Key activities include consultation, case review, management plans, psychiatric assessments with a small proportion of consumers engaging in intensive evidence-based therapy. Considerations for the future refinement of shared care pathways, enablers and challenges for stakeholder engagement will be discussed.