21/09/2016 Keir Harding Cheshire & Wirral Partnership Trust - - PDF document

21/09/2016 1

Keir Harding Cheshire & Wirral Partnership Trust @keirwales

Not the best service Not the best staff (I will ask you some questions as we go

• along. Type quick or I will feel

awkward!)

Have a think…. What might you expect to see? What might be the core features?

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10 Members 2/3 staff at a time All decisions made by voting Members run the group – Chair,

secretary, link, housekeeper, health&safety

Thursdays 10-3 All time spent together R&R – Extra time to reflect on actions that

worry people. Need to convince people you are thinking about it.

Assessment – Extra time to think about what

is stopping you getting here. Need to convince people you’re addressing it.

Participation – People feel you’re not using

the group ‘properly’. 4 weeks to address it.

 Links Meet

10.00 – 10.45 Business 11.15-12.30 Talk time

 Links Meet

1.15 – 2.15 Group 3 2.30-3.00 After group

 Links Meet

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Members are experts at living with their

difficulties.

We act based on discussion and

consensus.

We act as equals. Everything can be talked about. We balance caring for individuals and

each other.

• Group therapy
• Peers help you
• Other perspectives
• Safe
• Encouragement
• Doing things

differently

• Connection

(Remember this one!!!)

• Understanding
• Use our experiences
• Less alone
• Value for money
• Empowered
• We change things to

suit our needs

• Choice
• Equal with staff
• We are the experts
• Responsible
• Not ‘something that’s

done to us’. Lees, Manning, & Rawlings, 2004 Mitchell, Wilson, & MacKenzie, 2007 2002 Smith, Gates, & Foxcroft, 2006 Nice Guidelines BPD

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 The qualitative findings indicate underlying

changes in thinking that may account for some of the measurable changes in members' mental health and functioning

Services enable individuals to address two

main problem areas: relating to others and self-harm.

The study suggests that once-weekly TCs

provide an effective therapeutic approach to the problems associated with personality disorder.

Hodge et al 2010

 Significant improvements in both the mental

health and social functioning of service users. Changes in patterns of self-harm and service use were suggestive of possible underlying

• improvements. We also found evidence of the

possible offset of costs within 16 months of an individual leaving one of the services.

 Conclusions:

This study suggests one-day therapeutic communities may be both clinically- and cost-effective for people with personality disorder

 Barr et al 2010

What is a TC? Where is the magic? Who joins? Ethics? Evidence?

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Gask 2013 General principles of management

include consistency, reliability, encouraging autonomy, and the sensitive management of change

 A sense of belongingness is correlated with

improved self-esteem and overall well-

• being. The capacity for responsible agency

is central to behavioural change.

TCs are typically used in fields where

positive outcome requires both personal growth and behavioural change.

We suggest that TCs are uniquely placed to

demand such growth and change of their members

• Supported
• Understood
• Connection
• Connected
• Connected?
• Connected
• Need to share
• Get out what you

put in

• Support
• Understanding
• Friendship
• Connection
• Accepted
• Hard to accept care
• Liked for yourself
• Cant help everyone

all the time

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Graded Activity Focus on what people want and need to

do

Putting thoughts into words Using words to get what you want/need Keep client active in problem solving What will you DO to survive/get life more

like you want?

Think again… What would be the biggest challenges to

setting up a service like this in an area that has never experienced this way of working?

 A specialist personality disorder service A clinician who had worked in a day TC  A strong association with a formal,

structured therapy.

No money

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Conference with ex TC service users Highlighting that “doing things to

people” didn’t work for all.

Recruiting allies  Lower expectations Recruit staff Venue A good enough service is better than a

gold standard one that doesn't exist

Visit places that are doing it.

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Convince people to give you their time

for no immediate reward

Evangelise Secondment opportunities Working differently “If you build it they will come” Great facilities Vs Costing nothing Lunch Phone WE WILL TALK ABOUT IT!!!! What will you do if.... Learning that rationale decisions can be

made

Events are things to learn from rather

than to be avoided

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Rules that hammer home personal

responsibility

Structure designed with service users. A

failure?

Steering group – Reflect the reality that

we are hosted by the NHS.

Expectations Are we being tricked Old shoes are really comfortable Thinking hats on… What might a good enough member of

staff do in a service like this?

Role? Way of being?

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• Listen
• No judgement
• Question/Prompt
• Model something
• How to talk and

listen

• Explore things
• Question the usual

ways of doing things

• Don’t do things for

you

• Allow people to sit

with difficulty

• Slow things down?
• Step back?
• Increase

responsibility

Have you told...Vs ...is ****ing useless Direction Vs Learning what happens Being good Vs being neglectful Genuine Equal Silent Reflective

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Hearing a voice “kill your mum” Kill self to protect mum 3 days without sleep Told no one else “Do something!!!” Resisted being handed the phone Kept talking about it Noticed the fury “Make someone see her!” The group have set up a whatsapp

account

Initially very supportive Eventually fraught & terrifying Steering group Rules for the use of the app?

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Emphasised the ‘outside contact rule’ Noticed that relationships could also be

difficult

No attempt to control Is being on whatsapp compulsory? Anything can be talked about... Any thoughts? Views? Questions? Comments? Keir.Harding@cwp.nhs.uk @KEIRWALES

Keep the conversation going!