The Community of Therapeutic Communities for Children and Young People

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Standards and Review Methods for Therapeutic
Communities for Children and Young People John
OSullivan and Kevin Gallagher
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Overview

• What is the Royal College of Psychiatrists
• Centre for Quality Improvement?
• What is the Community of Communities?
• What is TC?
• A quick look at TC Core Values
• Introduction to the Community of Communities
  Network for Children and Young People TCs
• Standards and the Quality Improvement Cycle
• The Bryn Melyn Experience
• Where Next?

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Royal College of Psychiatrists Centre for
Quality Improvement (CCQI)

• One of 4 Centres at the College
• Research and Training Unit
• Manages a range of national initiatives
• Engages directly with clinicians and other front
  line staff and managers
• Supports them to take responsibility for
  improving local mental health services
• More than 90 of mental health services in the UK
  participate in one or more of these initiatives
• 14 projects

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Department for Children Schools and Families
(DCSF)
The CAMHS Outcomes and Research Consortium (CORC)
The National Institute for Mental Health in
Englands National CAMHS Support Service (NCSS)
Association of Therapeutic Communities
Young Minds
Rethink
Forensic Mental Health Services
Her Majestys Prison Service
In-Patient CAMHS
The National Mental Health Partnership (NMHP)
The Charterhouse Group
Multi Agency CAMHS
Perinatal Quality Network
Community of Communities
NCB
Prescribing Observatory for MH
Accreditation for Acute In-Patient MH Services -
Older People
The UK Psychiatric Pharmacists Group
Psychiatric Intensive Care Advisory Service
Accreditation for Acute In-Patient MH Services
British Psychological Society
LD Accreditation
Self-harm Project
ECT Accreditation Service
The Royal Pharmaceutical Society of Great Britain
The Royal College of Nursing
Memory Clinics
Psych Therapies
Welsh Assembly Government
Mind
The College of Mental Health Pharmacists
College of Occupational Therapists
College of Emergency Medicine
The British Association for Psychopharmacology
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What is C of C?

• Started in 2001 and expanded in 2006
• Network of 80 TCs across sectors, mainly in the
  UK but with members across Europe and in New
  Zealand, Australia and India
• Systematic quality improvement process that
  incorporates peer-review, sharing of ideas and
  joint discussion
• Emphasis on learning and development
• Standards set by TCs for TCs and reviewed annually

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Adult Therapeutic Communities Main
Partners Association of Therapeutic Communities
(ATC) Reference Group Lead Diana Menzies
Therapeutic Communities for Children and Young
People Main Partners Charterhouse Group
(ChG) Reference Group Lead John Turberville
Addictions TCs Main Partners European
Federation of Therapeutic Communities
(EFTC) Reference Group Lead Rowdy Yates
Therapeutic Environments for People with Learning
Disabilities Main Partners Camphill
Communities Reference Group Lead Paul Abel
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What is a TC?

• Informal, casual environment with a distinct
  communal atmosphere
• Safe environment with a clear structure of
  boundaries and expectations
• Daily structure incorporating practical
  arrangements for maintaining and developing the
  community, as well as a varied programme of
  formal and informal therapeutic activity
• Everyone is expected to contribute to the life of
  the TC according to his or her ability
• Value based

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Core Values
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Core Values
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Children and Young Peoples Network

• 2006 - 2007 6 members
• 2007 - 2008 17 members
• Diverse network
• Large residential schools
• Smaller households with education and other
  services on site
• Core and cluster models with smaller households
  sharing common centrally owned facilities as well
  as local community facilities
• Day Therapeutic Communities

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Service Standards for TCs for Children and Young
People

• Developed by experts and practitioners in
  consultation with TCs and therapeutic service
  providers
• Provides consensus on therapeutic community
  practice in UK
• Informed by key documents for example National
  Minimum Standards and strongly with the Every
  Child Matters agenda
• Demonstrate the commitment of TCs to integrate
  with wider Childrens Services
• Do not replace minimum standards but support
  therapeutic providers to establish the added
  value in their approach and demonstrate it to
  others
• Allow service providers to meet key performance
  indicators in the new National Contract 2007

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Structure of the Standards

• The Core Standards
• Represent the basic requirements for being a TC
• Connects all members of C of C
• The Five Outcomes
• Being Healthy
• Staying Safe
• Enjoying and Achieving
• Making a Positive Contribution
• Achieving Economic Wellbeing

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Annual Cycle
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Types of Peer-Review

• Developmental Review for new and developing TCs
  or TCs experiencing difficulties
• A Full Review enables the TC to look at all the
  Standards with the visiting community and is
  ideal for a first visit
• Focussed Review looks at 3 sections of the
  Standards in depth
• Action Planning Review recurring themes for
  improvement in previous reviews and provides an
  opportunity to action plan for the future

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Working with the standards
A providers experience
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History of Involvement

• 2006/7 Bryn Melyn division took part in the 1st
  Annual Review Cycle along with 5 other providers
• All 12 homes and the school completed self
  evaluation workbooks against the standards.
• One home and the school were visited by an
  external peer review team
• 2007 Bryn Melyn restructured and merged 3
  divisions (Bryn Melyn, Mentors and Rubicon) into
  one structure
• 2007/8 All 30 homes and both schools completed
  self evaluation workbooks as part of the 2nd
  cycle
• 2008 One home and a school were visited by an
  external peer review team

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Benefits to practice

• Created a shared language and framework for
  practice across multi sites.
• Self review required house and school teams to
  review their practice against the standards
  asking why and how questions.
• Developed stronger links between Theory and
  Practice
• Supported more thoughtful care and placement
  planning
• Supports the process of integration and multi
  disciplinary working between care, education and
  clinical staff.

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Benefits to Quality

• Clear framework of added value above National
  Minimum Standards
• Has helped us develop the Training Programme for
  our workforce adding skills and knowledge.
• Has helped regulators and purchasers identify,
  define and qualify Therapeutic Residential Care
• Therapeutic Standards feed into KPIs for the
  National Contract
• Therapeutic Standards are being built into
  Outcomes Measurement tools building on the ECM
  outcomes.

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Additional Benefits

• Being reviewed and reviewing other specialist
  providers gives the opportunity to share best
  practice
• The standards provide an evidence base for
  practice both internally and externally
• It will provide a route for formal accreditation
  to assist purchasers in distinguishing between
  placements
• Ongoing review of standards ensures that practice
  is continually under scrutiny

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A brief practice example Boundaries and behaviour

• NMS 21 and 22 focus on Care and Control.
• Relationships based on respect
• Personal and professional boundaries
• Maintain boundaries of acceptable behaviour
• Staff training in care and control.
• Behaviour Management policy and practice
• Sanctions and restraint records and monitoring
• All registered care settings have to
  demonstrate they meet this standard.

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A brief practice example Boundaries (continued)

• (Part of) Therapeutic Standard 2 Staying Safe
• Young people experience consistent boundaries
  across all elements of the placement
• All staff in all settings have a working
  understanding of the notion of boundaries.
• As young people progress, boundaries can be
  re-negotiated.
• Young people are involved (individually and in
  groups) in addressing breaches of boundaries
• There are clear consequences which are followed
  through to an outcome that is meaningful
• There are non-punitive ways of resolving conflict

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Summary from practice

• Therapeutic Standards help evidence to regulators
  and commissioners/ purchasers where a theoretical
  model exists in practice.
• It allows fully integrated, multi disciplinary
  work to operate within a framework of common
  language and measurement .
• This allows for mutually agreed and understood
  goals and outcomes with joined up indicators
• Placements are more deliberately worked on, there
  is greater focus and clarity and young people
  experience a more stable, consistent and smooth
  environment.

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Where Next?

• End of Lottery funding 2009
• Increase membership
• Accreditation recognition by statutory bodies
• Enabling Environments to reach services who are
  not TCs

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Questions?