Personality: Disorder or challenge?
Final evaluation report for 2005 Surrey Sussex course
Introduction
The course was developed in response to the Health Policy Implementation Guidance ‘Personality Disorder: No longer a diagnosis of exclusion’, and the need for a theory and skills course relevant to all practitioners working with people with personality problems and disorders, as laid out in the NIMHE document ‘Capabilities Framework – Breaking the Cycle of Rejection’.
The course ran over a period of seven months. It included presentations on theoretical models, recent developments in practice and research outcomes. It also included reflective practice groups, which were designed to encourage the sharing of expertise and the development of personal practice. The Local Application Groups were a particular feature of the course and were designed to provide a basis for supporting multi-agency collaboration on local service developments, and from which participants could continue to develop their expertise beyond the time scale of the course itself.
Each of the six Trusts who provided mental health services in the Surrey Sussex area in 2004 provided a lead tutor for the course (list below). These six tutors developed the course based on the Thames Valley course model. They continued their clinical responsibilities whilst supporting the course and the Local Application Groups.
The service users group, Capital, in West Sussex, provided expert by experience involvement in the course. For funding and other reasons, this was rather limited in the 2005 course. This involvement proved to be highly valuable and a commitment has been made to seek full involvement in future.
Attendance:
Each of the six Trusts were given six places on the course and there was a strong desire to ensure that participants came from a wide range of organisations. A key selection criterion for participants on the course was that they would be able to use their learning to influence practice in the workplace. Of the thirty-three people who remained active throughout the course, eighteen were working in health services, five were social workers, three in forensic services, two police officers, two from community drop-in services, two from homelessness services and one Citizens Advice worker.
Course attendance was high given that everyone who attended the course continued working in services which often struggle to find adequate staff cover. Forty people were given places on the course, one never attended, the maximum who attended on any one day was 37, and 23 people attended at least 11 of the 13 sessions:
Evaluation process
Participants were asked to complete feedback forms for each of the sessions, and were encouraged to give oral feedback throughout the course. A final feedback form was mailed out just before the end of the course and participants were also asked for feedback on to what extent they had achieved their own personal objectives.
Session evaluations
Feedback on content of sessions
End of session feedback is of most value to the person who has provided the session, but is also useful to those responsible for the whole course. These were gathered up at the end of each session and the tutor team read them and considered whether any action needed to be taken before the next session. A summary of these sheets was then prepared and sent to the tutor team and visiting speakers. The highest number received was 30, lowest 11 (not everyone who attended handed in an evaluation).
Feedback on the presentations was very positive throughout the course. The first question asked participants to rate the content of the session from 1 to 5, with 5 representing ‘excellent’. Overall, 83% rated the sessions as very good or excellent:
In addition, participants were asked to comment on the presentations; overall the comments were very positive, but did reflect the very diverse nature of the group: participants came from a range of organisations and had varied backgrounds and experience. Some had no formal qualifications in mental health, whilst others had several professional qualifications. The diversity of the group was reflected in comments about the balance of theory and practice, level of material being presented, jargon and acronyms. In general there were many comments about the desire for more time to explore topics in greater depth.
One suggestion, that was also raised on the final day, was to try to increase the non-medical perspectives in the presentations, and to spend more time on the work of other organisations in the introductory sessions.
Feedback on handouts
Most of the presentations were supported by powerpoint notes and reading material. Participants were asked to rate the handouts and these received a 79% very good or excellent rating:
Again, given the diversity of the group, some handouts would have had little relevance for some participants, but there were also several comments from people who very much valued the handouts and planned to make them available to their colleagues. Participants appreciated having paper copies of powerpoint presentations to use for note-taking, and there were comments when these were not available.
Feedback on the debate
The penultimate session was a debate. The motion was suggested by one of the LAGs and raised with the whole group five weeks in advance. Individuals from each of the LAGs agreed to participate in the panel. The topic was:
This house believes that specialist day services for PD patients create an unhelpful clustering of PD patients that works against social inclusion, leads to stigmatising of PD patients and is not justified by research evidence.
Before the debate started a vote was taken and the overwhelming majority voted against the motion. After the debate, the audience was fairly evenly divided between those who agreed, disagreed, or abstained from voting.
The feedback sheets showed that this was a very popular session, and panel members commented on how useful the preparation had been.
Other general points from session feedback forms
Besides the comments above, some other issues were raised to consider in planning any future course:
The diversity of the group was also reflected in comments from some about the desire for more structure in group work; positive and negative comments on spending time talking about the dynamics of the course group; requests for a greater variety of training methods.
End of course evaluation
The week before the last day, a final course evaluation form was sent out to participants with a request to hand it in on the final day, or send it to the administrator. Eighteen forms were returned, out of a potential 33. These were compiled into one paper and sent out to the tutors and experts by experience. Key points made are summarised below.
Reflective practice groups
Closing session
Inclusion of experts by experience
Local Application Groups / support from manager
The Local Application Groups were an unusual and highly valued element of the course. During the final session of the course, each group gave a report on their activities during the past months. Projects included producing a directory of local services, research with service users and staff, outreach with community groups, providing training and supporting ‘interest groups’. Besides commenting on how much they had valued the groups, participants also expressed their desire to continue the LAGs, or at least local involvement in PD service developments. Some problems with drop outs/poor attendance and the linked issue of time pressure and demands of ‘day job’ were also noted. The course tutors appreciated the support managers gave participants both in attending the course sessions and in their Local Application Group activities.
Personal Objectives: only 11 of the 18 people returning the forms included the photocopied page from their application forms, where they had given their personal objectives, and their feedback on to what extent they had achieved these. All commented positively on what they had gained from attending the course, and several commented on how they plan to build on this for their continuing professional development.
Conclusion
Achievement of course aims
The feedback from participants indicates that all of the originally stated course aims were achieved to some extent:
· To provide a theoretical base to understand the nature and clinical features of personality disorder
· To develop, amongst the course group, a shared language and understanding of issues connected with PD
· To develop an understanding of effective ways of working with people suffering with PD, and the evidence base for specific treatments
· To develop some skills and strategies to help deal with the particular stresses of this work
· To understand the importance of attitude change and stigma reduction, and to be able to promote such change
· To create / revive the awareness of the importance of reflective practice, in ourselves and others
· To provide contact with a peer group of professionals from different backgrounds working with similar clients
· To create a basis for ongoing learning
· To create a basis for enabling different agencies to work together in a more co-ordinated way
· To support the development and provision of modernised services for this client group across Surrey and Sussex
The last four aims, through the Local Application Groups, have resulted in a strong foundation to build on in future. All of these groups plan to continue and/or join other local forums in order to contribute to the improvement of personality disorder services in Surrey and Sussex.
The tutors were gratified by the very positive response the course received. The participants’ feedback on the 2005 course has provided several useful suggestions which will be considered by the tutor team in planning future courses.
Tutor Team
Elisabeth Batty Chartered Counselling Psychologist, Surrey and Borders NHS Partnership Trust
Dr Jane Blunden Consultant Psychiatrist in Psychotherapy, South Downs Health NHS Trust
Renee Harvey Consultant Clinical Psychologist, West Sussex Health and Social Care Trust
Kate Hunt Consultant Clinical Psychologist, East Sussex County Health Care NHS Trust
Dr Metka Shawe-Taylor Consultant Clinical Psychologist, Surrey and Borders NHS Partnership Trust
Chris Vincent Principal Adult Psychotherapist, Surrey and Borders NHS Partnership Trust
Report prepared by Susan Suleski, Training Co-ordinator, August 2005
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