Steps for Stress case study




Steps for Stress Case Study for Well Scotland

How it started?

In November 2013 the national Steps for Stress Advisory Group was established to help support the implementation of Commitment 16 of the Mental Health Strategy for Scotland (2012-2015). Through discussions, NHS Ayrshire and Arran were invited to consider taking forward local 'test of change' pilots within services that they currently knew used the Steps for Stress (S4S) materials regularly.

We knew from linking with our local Health Information Resource Department that the S4S resources were the most commonly ordered, but we were unsure as to how they were being used by individuals and services.

An initial scoping survey showed that people were aware of the S4S resources, but they were just simply handed to clients or picked up by individuals and not used as part of an intervention. Initial feedback suggested that this was due to lack of confidence within staff about having a conversation about stress, as this may lead to a further discussion about mental health problems which they felt ill equipped to deal with.

Partners involved

Following the local scoping survey NHS Ayrshire and Arran approached Fresh Ayrshire and South Ayrshire exercise referral scheme and it was agreed that both services would begin to implement a small test of change pilot using the 'Plan, Do, Study, Act' model.  Through these test of change areas we wanted to see how we could increase staff confidence when having a conversation with a client about stress and mental health leading to better use of the S4S materials.


After agreeing the methodology and process, staff who agreed to take part were invited to attend a one hour workshop which aimed to give participants an overview of mental wellbeing and the risk and protective factors that can help support individuals experiencing mild to moderate mental health problems. To allow for NHS A&A to measure whether workshops had been successful in improving staff confidence a pre and post workshop evaluation questionnaire was issued 

As well as attending a workshop, staff were also provide with a local information pack which included a further information sheet details on where to order more resources, signposting to other local services and information on where they could access further mental health training such as the online North Lanarkshire 'Mindset' module.

Initial Findings

In total 4 workshops have been delivered to staff and initial feedback  have indicated that overall staff knowledge of the Steps for Stress materials had indeed increased and most felt more confident in having a conversation with a clients about mental health. However, some staff have also feedback that although they found the workshop useful, they simply do not have time to use this information with clients.

Further Evaluation

As well as the one hour workshop and the pre and post staff evaluation questionnaires some other tools were developed to help with evaluation of the test of change work. To try to begin to measure whether the S4S resources make a difference to an individual's mental health and wellbeing staff were asked to approach their clients and ask them if they would like to be part of some evaluation work, and if so a consent form was competed. Clients were then asked number of questions about stress and current coping mechanisms, which can be seen in client feedback sheet A. After this discussion the S4S materials were handed over and the client used these materials for a number of weeks. A follow up interview was then arranged and questionnaire B was completed which asked if the individual had found these materials useful and if whether their mental health and wellbeing had improved as a result.

The Ayrshire and Arran 'Steps for Stress' Evaluation includes the learning from the work of their test of change, how the Plan Do Study Act model was adopted, and key learning points for decision makers.

Barriers and Facilitators

Early findings have shown that although the work through the test of change areas has been successful, a few barriers and facilitators to implementation have been identified along the way, such as -

  • Having the NHS Ayrshire and Arran project sub-group on board from the beginning was important as this meant the value of this work was seen
  • Time to have a conversation with a client about stress, some service structures and processes can be tight.
  • A challenge of trying to cover all aspects of mental health training in a 1 hour workshop, it was felt more time was needed for this due to the nature of the subject.
  • Staff capacity - Need to embed this in staff time which is difficult, if there was financial support they can ask staff to work longer.

Next Steps

The new Ayrshire and Arran mental wellbeing strategy (2016) has a commitment to continue this work around Steps for Stress, therefore we plan to continue to gather information from both test of change sites but also look to engage with further partners who also regularly use the S4S materials with the hope to roll out this 1 hour workshop. For example there has been interest from the local Ayrshire College for sessions to run to academic staff.