Gale K A WARM Approach to emerging personality

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Transcript Gale K A WARM Approach to emerging personality

A WARM Approach to emerging PD
Kellyrose Gale, David Kingsley, Louise McKenna
Rebecca Murphy
Woodlands Unit
The Priory Hospital Cheadle Royal
WARM Approach (2015)
• Poor evidence base for effective treatment in severe emerging
Emotionally Unstable Personality Disorder in young people
• Risks often escalate in Acute Inpatient Units and they may get
‘stuck’ for months or even years making little progress
• In community settings, risks may be difficult to manage
leading to multiple placements and limited change
• Often risk behaviours lead to high levels of arousal in staff
who may over-protect or reject them.
• It is difficult to create an ‘emotionally safe’ context in which to
treat these young people
• Past trauma often impacts on symptoms and attachments and
makes therapeutic engagement more difficult
Defining the problem
Inexperienced, inconsistent, poorly trained staff teams
Difficult to hold several models in mind for varying client groups
Staff who “don’t want to work with PDs”
High incident rates / staff injuries / staff anxiety and turnover
Reactive high-intensity ‘fire fighting’ approach
Inpatient care may add to traumatic experiences for young
people rather than treating them
• Cautious management leads to long periods of enhanced
observations and ‘stuckness’
• Young people aren’t going to engage in difficult long-term
therapy if they think they might be discharged next week...
Woodlands Attachment Regulation Model
Effectiveness of WARM
• Incidents of violence and self-harm reduced in severity
and frequency
• Outcome measures (HoNOSCA/ CGAS)
• Qualitative feedback – Young people / staff / parents &
• Lengths of stay (average 10 months)
• Discharge to community placements / home in most cases
• Engagement in therapeutic programme / intensive therapy
• Positive & effective coping strategies
– DBT in practice not just in theory
• Able to reflect on impact of behaviour on self and others
Future Model Developments
• Collate the evidence for efficacy
• More detailed psychological assessment at admission and
• Which aspects of the model are most effective?
• Which PD domains change the most and the least?
• How might our model be adapted for use in more generic /
less secure / community settings
• Publication and Dissemination
Case Study
• 17 year old female with a history of significant overdose,
suicide attempts, disruptive behaviours, aggression, nonengagement on previous units, violence towards staff and
fellow young people. Prescribed enhanced observations
continuously for 12 months on another unit prior to admission.
• Admitted for 10 months using the WARM approach. Discharged
to community setting, applied for college course, voluntary
work, ability to reflect, use of positive distraction techniques,
ability to seek support appropriately.