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Improving care of vulnerable clients with personality disorder and addictions

We will develop e-learning modules to enhance staff confidence and competence in the management of the complex psychological difficulties presented by service users with personality disorder.

  • Proposal
  • 2022

Meet the team


  • Dr Jeffrey Fehler
  • Consultant Psychiatrist
  • Central & North West London (CNWL) NHS Foundation Trust
  • Clinical Director Addictions Directorate
  • Dr Dima Abdulrahim
  • CNWL Addictions Quality Manager
  • Dr Abigail Rees
  • Foundation Dr (trainee)
  • Dr Merfet Mohammed
  • ST in Psychiatry (trainee)
  • Dr Chun Yin Wong
  • CT in Psychiatry (trainee)

What is the challenge your project is going to address and how does it connect to the theme?

Our patients in Addictions services typically have complex needs impacting on their mental health. As clinical staff shortages across healthcare services remain a challenge, we are increasingly relying on staff (including unqualified ‘recovery practitioners’  and peer support workers) with limited knowledge and experience of managing healthcare comorbidities.
Patients with borderline personality disorders may be particularly challenging to manage, especially in times of ‘crisis’.
This often leads to suboptimal management (patients not being contained, promised medical reviews/medications when not always necessary), patient dissatisfaction (when boundaries not set/adhered due, lack of information about their condition, managing expectations) and risks KW from becoming burnout (due to anxiety, feeling out of their depths, not having skills to contain the client and often needing to spend a large amount of time dealing with cases).

What does your project aim to achieve?

Digital technology and electronic platforms provide a solution to this challenge, by providing high quality and timely training to the widest number of people, in a relatively short period of time. Research has identified the benefits of e-learning and mobile learning: For learners, it provides flexibility, choice, convenience, wide reach and appeal, control of own learning and best use of time. For NHS services,  it provides efficiency, consistency, cost savings, improved care.

Our project will develop e-learning and/or mobile learning modules to enhance the competence and confidence of our workforce, and particularly those with no formal clinical training.

In particular, it will focus on clinical challenges that are associated with the complex difficulties presented by patients, including mental health co-morbidities.

Although our modules are aimed primarily at addictions services, they will be useful to other practitioners who manage patients with addictions, including those in mental health and primary care settings.

How will the project be delivered?

The project team will include:

–        Clinical leadership

–        Clinical and non-clinical staff (including keyworkers/ recovery workers and experts by experience/ patients)

–        Expertise and experience in development of digital training, research and quality improvement

In order to deliver our project we will:

–        Build on surveys to identify gaps in keyworker knowledge

–        Convene a project group that includes staff and experts by experience

–        Carry out a comprehensive review of the research evidence on the topic

–        Summarise the evidence into learning modules

–        Test and evaluate the modules in a small number of clinical settings

–        Implement digital training in our services and learn lessons on implementation process and to identify barriers and enhancers to the uptake of training

o   Collect data on uptake of training

o   Collect data on pre-and post-training knowledge and data impact on learner (quantitative surveys)

o   Focus groups with staff and experts by experience

–        Dissemination within our services and beyond

How is your project going to share learning?

We will be sharing project learning in a number of ways:

1.    Locally, within care quality and performance management groups – within our Addictions directorate and in similar forums in other relevant services in our Trust (e.g. mental health services). We will also share our experiences more widely within other addictions services (the Alliance, Collective Voice, RCPsych Addictions Faculty).

2.     Our evidence-based e-learning and mobile learning modules will be available for use by clinicians and others in the UK and beyond. A dissemination strategy will be developed from the onset of the project.

3.     The Quality Improvement (QI) methods and QI coaching will allow us to identify the barriers to the uptake of training as well as the factors that maximise its uptake.

This should identity learning that is of importance to the Q community in general who are involved in the training and the improvement of staff competence and skill set.

How you can contribute

  • - Feedback on our idea would be greatly appreciated
  • - Tell us of your experience of working with/ or being a new staff group
  • - Tell us of your experience of developing online or mobile training
  • - Tell us of your experience of barriers and solutions to delivering training to busy staff, managing very large caseloads
  • - Do you know of any resources that can support our work?

Plan timeline

31 Mar 2023 April: Survey; May: Convene group; June: Literature review; August: Emodules.

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