DBT STEPS-A: Inter-agency collaboration to promote positive mental health in adolescents

Introduction: A Vision for Change – Report of the Expert Group on Mental Health Policy1 highlights adolescence as a key stage of psychological development during which young people need to develop and acquire skills to cope with difficult emotions. Adolescence can be a time of increased risk of poor mental health with anxiety and depression, as well as an increasing risk of self-harm and suicidal behaviour. While there is existing knowledge about high self-harm and suicide rates in Irish adolescents (e.g. McMahon et al.2), there is limited research on effective programmes that teach skills to promote resilience against a variety of these health risk behaviours. Mazza et al.3 identified the need to provide young people in schools with problem-solving skills, and offer them a safe environment to practice those skills in order to build up resilience and prevent the development of poor emotion regulation behaviours. With this in mind, they developed a proactive and preventive curriculum, DBT STEPS-A, which is a social-emotional learning programme based on DBT.

Method: 16 teachers, three CAMHS Clinical Psychologists, six NEPS Psychologists and two Health Promotion Officers were trained to deliver the DBT STEPS-A curriculum in Cork, Ireland. A framework for inter-agency collaboration was also established. This school based intervention was delivered by teachers, and was supported by wider child and adolescent services across health and education (NEPS, CAMHS, Health Promotion).

Results: DBT STEPS-A was delivered to over 400 Transition Year students (15-17 years) across eight schools in Cork during the 2015/2016 academic year. Although implementation of the programme was complex and required flexibility across professional roles, outcomes and experiences are promising.

Conclusion: DBT STEPS-A represents a new way of working and demonstrates a model of successful inter-agency collaboration which facilitates development of a shared language from community level to specialist mental health services. It also provides an opportunity to build resilience, to normalise mental health discussions and potentially identify mental health issues in adolescents at an early stage. 

References:

1- Department of Health & Children. A Vision for Change: Report of the Expert Group on Mental Health Policy. Dublin: Stationery Office. 2006.

2- McMahon, E.M., Keeley, H., Cannon, M., Arensman, E., Perry, I.J., Clarke, M., Chambers, D & Corcoran, P. The iceberg of suicide and self-harm in Irish adolescents: a population-based study. Social Psychiatry and Psychiatric Epidemiology, 2014;49(12):1929-1935.

3- Mazza, J.J., Dexter-Mazza, E.T., Miller, A.L., Rathus, J.H., & Murphy, E.M. DBT skills in schools: skills training for emotional problem solving for adolescents (DBT STEPS-A). New York: Guilford Press. 2016.