If you would like to comment on this document please contact the ATC Office at post@therapeuticcommunities.org.
In the last last year or so, ATC has agonised about "accreditation" of TCs. I have now decided to ban the "A-word" from my word processor as it conveys entirely the wrong meaning. People take it to mean a judgemental process by which individual TCs will be found satisfactory or wanting, and thus maybe survive or die. We have lived under a Darwinian tyrrany for some years now, with many TCs dying. ATC was not set up to be party to a process that wields an axe.
To survive, species need to adapt. Some surviving TCs have adapted, but with the profoundly hostile climate of the 80s and 90s, many didn't make it. But what we can do collectively to adapt, and survive, is to get organised and pass on the tips and tricks that we have learned in our own communities, and set up systems where we can more actively support each other. Then we might be able to work in effective and recognised ways without feeling under threat. There is strength in numbers, and we should be good at this sort of thing. Managerial buzz words for it include "sharing best practice"; "reflective audit"; "process benchmarking" and "quality network" - but I am going to start off by calling it a "community of communities".
Of course, it is where ATC started nearly 30 years ago - with David Clark and a band of others regularly visiting each others' TCs, getting to know what problems they had and how to tackle them, and generally sharing good ideas. I hope that the process we are now on will recast those ideas in a modern context, so that ATC itself can be seen to be adapting to the current environment.
ATC is a small professional organisation, run mainly on good will and spare time effort by a considerable number of its members. However, if it were to set itself up as the authority on complex psychosocial treatment programmes (CPSTPs - watch this acronym!) we would quite reasonably be asked what right we had to do so: I suspect we would be asked by our members as much as outsiders, for most of us do not take kindly to arbitrary imposition of authority. In parallel with this, most of the superordinate systems in which we work (such as prisons, NHS, council-registered voluntary sector) are demanding openness and accountability. So we need to set up a system of openness and accountability which adheres wholeheartedly to TC principles. And to do that, we need to plan it carefully and get help from those who are experts at such things, and recognised as such.
With this in mind, and particularly thinking about NHS TCs, we approached NICE (the National Institute for Clinical Excellence) in late 1999. They referred us on to our professional bodies, and we have now made a very promising contact with the "College Research Unit". This is a charitable foundation for undertaking organisational research, with links to the Royal College of Psychiatrists. The plans that follow are what we are working on with them.
The project to set up this "community of communities" is a type of action research (AR), and AR is particularly in keeping with the way TCs work. It is based on a critical, emancipatory and empowering paradigm, which brings about a continual process of development through feedback and democratic change.
One of the key features for this project will be it's fluidity: with nothing done "top down". All the ideas will be developed in consensual and democratic ways: which might include voting and other ways of resolving conflicts, but will never allow "whoever is in charge" to take decisions without following a collectively derived procedure. The downside of this detailed respect for the way decisions are made, is that it is laborious and time-consuming. Also, the destination is unknown until the end of the journey (if indeed, it ever ends). Just like TCs, perhaps.
Mark Morris and I want to put a proposal to the AGM at Windsor in September that "ATC bids for funding for this TC network project in collaboration with CRU". The plan will be for setting it all up over three years, and involving all TCs known to ATC (unless they want to opt out).
To do that, we are going to do some pre-protocol work with Adrian Worrall from CRU - which will be to write an outline proposal and investigate likely funding sources. When things are written, we will post them on ATCs website. Do respond if you wish, or discuss it on the psyctc.org TC-chat list.
We hope to have the full explanation of it all and a good discussion at the AGM. If it is passed and agreed then, we shall start bidding for funding.
Once it is funded, we will hold professional consensus seminars. These will be similar to the proposals in the previous newsletter, but with more planning and detailed consideration of who should be involved and why, and with more scope for exploring and using the differences between us. The aim will be to include TCs in all settings - not just the NHS ones.
Another initial activity will be holding stakeholder conferences which will bring in, for example, Government regulatory bodies and commissioners & purchasers of services. Again, this is about adapting to our environment, as well as lending legitimacy to the process. These people as much as any are part of those superordinate systems upon which we rely for survival,
From those activities will emerge content and process. The content will be the specific areas of interest to us (eg reflective practice; staff training; community decision-making - maybe like KLAC, maybe different) The process will be one that all those who are part of the network can sign up to - the whole "community of communities" will "own" it as it will have been developed by them.
Although nobody knows exactly what it will look like in the end - as that is the nature of AR - it could well be like a modernised version of how ATC started, with the main activity being visits between communities.
The 2000 version is likely to include users, professional experts and external scrutineers. It may be arranged in a pattern of visits so each community does and has done to them, maybe every 5 years. For example, user exchanges, staff visits, and meetings with external people plus professionals from other TCs. This is wide open - all sorts of other possibilities may emerge in the setting up process. In this way, people working in entirely different settings can develop their practice in conversation with others in TCs. Write-ups will be shared amongst the network.
There will be no judgement of "TC-ness" in the process - it is simply to be for sharing, describing and disseminating good practice, and helping tackle problems. We envisage it happening through newsletters, the visits, internet facilities and an annual network conference. A lot could well be incorporated into what we do already.
At the start, all TCs who are organisational members of ATC will be members of the "community of communities" network unless they want to opt out. We will continue to have individual membership open to whoever is interested in the work - but group membership only for TCs who are members of the network. But the details of this too are up for grabs in the whole setting-up process: I would simply want to guard against a "two-tier" system of ATC membership. Hopefully, it will develop so that those in at the beginning will be be keen to stay in, and new TCs keen to join. If some TCs want to stay out, then that will be equivalent to voting with their feet (a process of which most of us have clinical experience!) They would be welcome to stay in ATC, but through interested individuals and not as whole communities.
This is an important piece of work for ATC, and so far it seems to have gone well. The criticisms of our first proposals posted on the website and sent out with the last newsletter seem to be well answered by this scheme. It also seems lucky that we have made contact with a organisation to help us set it up, which well understands what we are trying to achieve and avoid. But the whole process has already started - nothing is set in stone, and at this stage everything is so open that we would welcome any ideas for shaping it up. By the time it gets to the AGM, we will have pinned some of it down and be proposing to follow a certain course: so get your say in now! Write to the newsletter, email responses to the ATC website, or discuss it on the psyctc.org email chat list.
If you would like to comment please contact the ATC Office at post@therapeuticcommunities.org.
See also
"THE ACCREDITATION OF THERAPEUTIC COMMUNITIES BY THE ATC: A Draft Consultative Document"
Robin Cooper: With The Best of Intentions,
an abridged version of a paper first presented to the Windsor Conference of the Association of Therapeutic Communities, on September 15th 1999.
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