1. Delivering the ‘I Can Feel Good’ programme in Medium Secure Services Presented by: Sarah Ashworth, Forensic Psychologist in Training Dr Natalie Brotherton, Principal Clinical Psychologist Partnerships in Care Midlands

2. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Presentation Aims What we’ve done o I Can Feel Good Programme Medium Secure Overview o Adaptations o Practical Issues o Explore outcomes What we’re going to do o Reflections o New adaptations o Consider future directions o Conclusions

3. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people How we Adapted it for Medium Secure Structured check-in Skills/flash cards More role plays (very popular!) Encouraging patients to take the lead Behavioural incentives (biscuits and buffet!) Staff involvement and training…

4. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Staff Awareness Training Recommended by Ingamells & Morrissey (2014), aimed to o Increase knowledge about the programme o Increase confidence to support patients using their skills o Increase motivation to help us and the patients Positive findings regarding identified aims More work to be done regarding behavioural application Ashworth, S., Mooney, P. & Tully, R. J. (2016). Adapted DBT Programme For Individuals With Intellectual Disabilities And Problems Managing Emotions: Staff Awareness Training. Advances in Mental Health and Intellectual Disabilities,10 (3), 185-198.

5. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Examples of Training

6. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people What We’ve Done Commenced 15 th September 2014… …completed 09 th November 2015! Group ranged from 4 - 8 patients (5 consistent each module) Members of the in-house DBT consultation group Supervision with programme authors Examined data sets…

7. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Outcomes - Group Measures OverallMindfulnessManaging FeelingsCoping in CrisisPeople Skills Behavioural data (Incident report forms, IR1; seclusion rates etc.) Clinical Observations Psychometric Assessment Emotion Problems Scale – Behaviour Report Brief Questionnaire for Assessment of Attention Emotion Control QuestionnaireCoping Response InventoryCIRCLE IIP-32 Cognitive and Affective Mindfulness Scale - Revised Index

8. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Overall Programme – EPS BRS Profile

9. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Mindfulness Module – BQAA and CAMS-R

10. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Managing Feelings Module - ECQ

11. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Coping in Crisis Module - CRI

12. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Coping in Crisis Module - CRI

13. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Blackburn Interpersonal Circle

14. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Outcomes - Clinical Observations Observed improvements: o Social support (validation/empathy towards peers) o Self esteem (taking part, leading tasks) o Motivation (weeks off/work through break/more often/longer?) o Social skills (turn taking) o Practice task completion o Willingness to engage in/lead mindfulness Observed Challenges: o Understanding of mindfulness

15. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people I Can Feel Good: Second Edition – Why? Linehan (2014) DBT Skills Training: Second edition Reflections from first cohort Unremarkable data set versus noticeable improvements within the group – how do capture observed benefits? Consultation with original authors Trial new edition

16. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Proposed Adaptations New structure to incorporate new skills Enhancing ease of use mindfulness booster, more exercises Language change from cool to cold Diary card to assist individual work GAS - attempt to capture additional therapeutic factors Training - providing guidance Pictorial aids and written examples for different populations and variety of environments

17. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Example New Programme Structure

18. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Example New Diary Card

19. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Example New Skill - Plan Ahead Introduce and discuss: o the idea of planning what might happen in difficult situations o the idea of planning to cope with what might happen Introduce the ‘Plan Ahead’ skill Provide three examples of difficult situations Work through each element of the skill as a group Role play Get feedback on their experience of coping when they had planned ahead Practice Task - Use Plan Ahead skill and record

20. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Example New Skill – Plan Ahead 1. Describe the situation that you need to plan for 2. Decide which skills you want to use to help you cope 3. Imagine the situation in your mind as clearly as you can 4. Practice in your mind how you will cope well 5. Practice relaxation or mindfulness

21. Taking quality to the highest level Working together Caring safely Uncompromising integrity Valuing people Summary/Conclusions/Reflections Expectations - small steps Data v positive experiences - proof is in the pudding! The role of role plays (request to increase!) New cohort…commenced 25 th January 2016 Amendments well received to date Watch this space…

22. For more information or to get involved in the implementation process contact: Sarah.ashworth@ partnershipsincare.co.uk Natalie.brotherton@ partnershipsincare.co.uk Thank You