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Open Access Highly Accessed Study protocol

Collaborative Care for patients with severe borderline and NOS personality disorders: A comparative multiple case study on processes and outcomes

Barbara Stringer12*, Berno van Meijel2, Bauke Koekkoek34, Ad Kerkhof5 and Aartjan Beekman1

Author affiliations

1 Department of Psychiatry and EMGO institute, VU University Medical Center/GGZ inGeest, Amsterdam, the Netherlands

2 Research Group Mental Health Nursing, Inholland University for Applied Sciences, Amsterdam, the Netherlands

3 Propersona, Centre for Education and Science, ProPersona, Wolfheze, the Netherlands

4 Research Group Social Psychiatry & Mental Health Nursing, HAN University of Applied Science, Nijmegen, the Netherlands

5 Department of Clinical Psychology and EMGO institute, VU University Medical Center, Amsterdam, the Netherlands

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Citation and License

BMC Psychiatry 2011, 11:102  doi:10.1186/1471-244X-11-102

Published: 24 June 2011



Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer) access to psychotherapy a Collaborative Care Program (CCP) is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP's as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder.


Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews) will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the 'black box' of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes.


The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen design we want to examine how and which elements of the CC Program could contribute to a better quality of life for the patients.

Trial registration

Netherlands Trial Register (NTR): NTR2763