The development of principles and guidance for service design, and the delivery of care to young adults (18-25 years old) with complex emotional needs

Introduction: Guidelines for borderline personality disorder (BPD) are often consulted by services. However, there has been a shift in the way that BPD is talked about and a move towards the term complex emotional needs (CEN). There has also been suggestion that adult services are not meeting the needs of young adults (18-25 years old) due to the absence of developmentally attuned support. This thesis aimed to develop principles and guidance for community services supporting this population to inform service design and delivery.
Method: A scoping review was conducted which informed a modified Delphi. The modified Delphi method consisting of three rounds was used to develop these principles and guidance. The first round involved a focus group to gauge panellists’ perspective and opinions. The subsequent rounds were online surveys used to allow panellists to review and make amendments to the principles and guidance being developed. There were 14 panellists in total, consisting of young adults, carers/family, and professionals. Data was analysed using a framework analysis and consensus agreement criteria as stipulated by Diamond et al. (2014).
Results: Fifty principles and guidelines emerged relating to service design and the delivery of care of young adults (18-25 years old) with CEN/BPD. There were some similarities with current guidance for the recognition and management of BPD. However, a variety of areas not included in current guidance were raised and included within the finalised principles.
Discussion: The principles and guidance give flexibility to services to define their clinical model using the available evidence, whilst noting key principles such as the need for a relational and formulation-based approach which should underpin service design. Furthermore, they indicate that 18-25 years old with CEN would benefit from additional developmentally appropriate care which is not current practice within community adult services. The principles and guidance are a supplementary resource and have the potential to influence the current community service delivery for those supporting young adults with CEN/BPD.