WHAT IS A THERAPEUTIC COMMUNITY?
1. Culture of
enquiry
2. Treatment Programme
Structure
3. Treatment Process and
Community Living
4. Responsibility and
Decision Making
5. Staff Team Dynamics and
Relationships
6. Boundaries and
Containment
7. Physical Resources
8. Staff Resources
Italian Version:
- "KLAC 1": Italian Version
(Che cosa 'e' una comunita' terapeutica?, traduzione di Aldo Lombardo)
Item cluster |
Standard |
Evidence Required |
Evidence Obtained/ |
| 1 Culture of enquiry | |||
| 1.1 | All members (staff and clients) can question managerial issues, psychological processes, group and institutional dynamics. For example, client members can question why staff members are grumpy, why a staff member is leaving, why a meeting is cancelled, etc. | Direct observation of
community meetings and staff meetings Direct questions to staff and residents. |
|
| 1.2 | Solutions to problems are discussed and understood in the community before action is taken. The discussion is regarded as a learning opportunity. | Documentary evidence -
minutes of community meeting. Direct observation in community meetings. Questioning of staff and residents about the process of problem-solving. |
|
| 1.3 | Potentially difficult topics can be openly discussed (e.g. sex, drugs, staff misconduct) | Documentary evidence -
minutes of community meeting. Direct observation in community meeting. Direct questioning of staff and residents. |
|
| 1.4 | Managerial information and issues which affect the community are shared with the whole community. | Documentary evidence -
minutes of community meeting. Direct observation of community meetings. Direct questioning of staff and wing therapist. |
|
| 1.5 | Staff show awareness of ways in which issues may be avoided or denied within the staff team, or in the community as a whole. | Direct observation of
challenges to avoidance or denial in community meetings,
and staff meetings. Direct questioning of staff. |
|
Item cluster |
Standard |
Evidence Required |
Evidence Obtained/ |
| 2 Treatment Programme Structure | |||
| 2.1 | Information about the therapeutic community is available to referrers and potential members that gives a true picture of the community | Documentation - handouts/brochures sent to potential referrers and potential members. | |
| 2.2 | There are clear statements available of the philosophy of the therapeutic community, its treatment aims, and the current treatment programme. | Documentation - brochures,
mission statements, information given to new client
members and new staff members, and other statements. A current weekly timetable should be available. |
|
| 2.3 | The statements that are given to clients and staff are open to comment, change and development by any member of the community. | Direct questioning of staff and residents. | |
| 2.4 | There is a community meeting at the beginning of each weekday, attended by all residents, and all staff on the premises. | Timetable Direct observation. |
|
| 2.5 | There is a community meeting at the end of each day. | Timetable Direct observation. |
|
| 2.6 | Time each working day is spent in therapy groups, as well as community meetings. | Timetable Direct observation. |
|
| 2.7 | There is a structured daily programme of group activities. | Timetable Direct observation. |
|
| 2.8 | There are opportunities for informal interactions between staff and client members of the community, egg cooking together, playing games together, outings, socialising, etc, and members are expected to make use of these. | Direct observation. Direct questioning of staff and residents. |
|
| 2.9 | There is provision for crisis meetings, with a recognised procedure for calling one that can be used by staff or client members. | Protocol Direct observation Direct questioning of staff and residents. |
|
Item cluster |
Standard |
Evidence Required |
Evidence Obtained/ |
| 3 Treatment Process and Community Living | |||
| 3.1 | Discussions take place, which encourage members to learn from everyday living, including informal interactions with staff and each other. | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. Direct questioning of residents. |
|
| 3.2 | Discussions take place which encourage members to verbalise their thoughts and feelings rather than act them out behaviourally | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. |
|
| 3.3 | Members are encouraged to identify parallels between their behaviour and perceptions when they committed their offence(s) and similar situations within the therapeutic community. | Minutes of community
meetings and small groups. Direct observation in community meetings and small groups. Direct questioning of residents. |
|
| 3.4 | Members know details of the offences committed by members of their small group. | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. Direct questioning of residents, particularly in their small groups. |
|
| 3.5 | Members talk openly about past situations that made them feel angry or of low self-worth and recognize ways in which their present behaviour in the therapeutic community reflects the same pattern. | Minutes of community
meetings and small groups. Direct observation of community meetings and small groups. Direct questioning of residents. |
|
| 3.6 | Peer members offer supportive identifications and make suggestions on how to handle such situations more constructively. | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. Direct questioning of residents. |
|
| 3.7 | Members are given positive feedback by their peers to enhance their self-esteem. | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. Direct questioning of residents. |
|
| 3.8 | Members are given feedback about their anti-social attitudes, and behaviour, as they appear in the therapeutic community and the effects these have on other members. | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. Direct questioning of residents and staff |
|
| 3.9 | Members are given feedback about impulsive or self-defeating behaviour, as it occurs in the therapeutic community and the effects on others. | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. Direct questioning of residents and staff |
|
| 3.10 | Members provide implicit or explicit models for one another on constructive ways of coping with conflict and frustration. | Minutes of community
meetings and small groups Direct observation of community meetings and small groups. Direct questioning of residents. |
|
Item cluster |
Standard |
Evidence Required |
Evidence
Obtained/ Rating 4=standard is fully met 3=standard is substantially met 2=standard is partially met 1=standard is not met |
| 4 Responsibility and Decision Making | |||
| 4.1 | Client and staff members are involved in discussions about the selection and admission of potential new client members. | (Advance questionnaire) Direct questioning of staff and residents. |
|
| 4.2 | Client members are involved in the process of appointment of potential new staff members. | (Advance questionnaire) Direct questioning of staff and residents. |
|
| 4.3 | Staff members are involved in decision-making about the appointment of new staff members. | (Advance questionnaire) Direct questioning of staff. |
|
| 4.4 | Prospective members are involved in decision-making about their own selection and admission. | Documentation - information
sent to prospective members Direct questioning of residents. . |
|
| 4.5 | Client members are responsible for the day-to-day running of the community, e.g. administrative, domestic and social tasks, e.g. chairing the community meeting, shopping for food, showing visitors round, etc. | Documentation - information
about the therapeutic community. Direct observation of elections to community posts. Direct questioning of residents. |
|
| 4.6 | Client members are responsible for allocating community members to community roles, jobs, etc. | Direct observation. Direct questioning of residents. |
|
| 4.7 | The community can make decisions by voting on matters that are genuinely empowering, where everyone’s vote counts equally. | Documentation on the
constitution. Minutes of community meetings. Direct observation of community meetings. Direct questioning of staff and residents. |
|
| 4.8 | The consequences of decisions made in community meetings are discussed by the community. | Minutes of community
meetings. Direct observation of community meetings. |
|
Item cluster |
Standard |
Evidence Required |
Evidence Obtained/ |
| 5. Staff Team Dynamics and Relationships | |||
| 5.1 | There are regular clinical meetings to examine how the community is dealing with events. | Documentation - timetable. Direct observation. |
|
| 5.2 | There are daily handover meetings. | Documentation and timetable Direct observation Direct questions to staff. |
|
| 5.3 | There are staff aftergroups following all community meetings, therapy groups, and other activities, which are attended by all the staff involved in the preceding group or activity. | Documentation and timetable. Direct observation Direct questions to staff. |
|
| 5.4 | Staff are provided with regular supervision throughout the week, related to their therapeutic community work. Supervision takes place in all the above groups. | Documentation - timetable. Direct observation of supervision. Direct questions to staff. |
|
| 5.5 | There is a weekly staff sensitivity group. | Documentation - timetable. Direct questions to staff. . |
|
| 5.6 | The staff team examine their own roles, and relationships, and their impact, as members of the team. | Direct observation Direct questions to staff. |
|
| 5.7 | Staff members as a group are able to tolerate the expression of conflict among themselves. | Direct observation. Direct questioning of staff. |
|
| 5.8 | Staff challenge each others’ perceptions of events in the community | Direct observation. Direct questioning of staff. |
|
| 5.9 | Staff members regularly examine their attitudes and feelings towards clients. In doing this, they are able to disagree with one another, and to explore these disagreements as a source of understanding about the client, e.g. the way a client presents different facets of themselves in different situations. | Direct observation. Direct questioning of staff |
|
| 5.10 | Staff members demonstrate a knowledge and awareness of mechanisms used to avoid painful exposure or confrontation by individuals with psychopathic or personality disorder, including denial, rationalisation, and splitting. | Direct observation. Direct questioning of staff. |
|
| 5.11 | Staff members demonstrate a knowledge and awareness of group dynamics that can impair effective team functioning, including dependence, idealisation, and them-us splits. | Direct observation. Direct questioning of staff, particularly uniformed staff |
|
Item cluster |
Standard |
Evidence Required |
Evidence
Obtained/ Rating 4=standard is fully met 3=standard is substantially met 2=standard is partially met 1=standard is not met |
| 6 Boundaries and Containment | |||
| 6.1 | Staff members provide an emotionally safe environment for the work of the therapeutic community. | Direct questioning of staff
and residents. Direct observation. |
|
| 6.2 | Staff take authority and leadership, or share this with the community as a whole, in response to the needs and capacities of the community at the time. | Direct observation. Direct questioning of staff. |
|
| 6.3 | The tension between risk and therapeutic opportunity is managed by the whole community to keep the risks of harm to self and others very low, and is used as a learning process. | Records of incidents of harm
to self and others. Direct observation if opportunity arises. Direct questioning of staff and residents. |
|
| 6.4 | The community is able to understand, learn from and react appropriately to incidents of harm to self and others. | Records of incidents of harm
to self and others. Direct observation if opportunity arises. Direct questioning of staff and residents. |
|
| 6.5 | The community as a whole is responsible for making, maintaining and changing the community rules. | Documentation - about
community rules and/or constitution. Direct observation. |
|
| 6.6 | The community can discuss and question what decisions are made by the staff group, or the community as a whole. | Direct observation. Direct questioning of staff and residents. |
|
| 6.7 | The community as a whole is responsible for identifying, maintaining and changing community boundaries, e.g. time-keeping, and for discussing breaches in these. | Direct observation. Direct questioning of staff and residents. |
|
| 6.8 | Senior residents take initial responsibility for supporting and containing newer members of the community, and for transmitting the therapeutic community culture to newer members. | Documentation –
protocol Direct observation if arises. Direct questioning of residents – particularly new admissions. . |
|
| 6.9 | Client members are involved
in maintaining a safe physical environment for the
community, including managing the interface with the
external world. This includes: i. the safety and comfort of the building and environment ii. the physical safety and containment of all members iii. management of external disruption e.g. refurbishments |
Direct observation. Direct questioning of staff and residents. |
|
Item cluster |
Standard |
Evidence Required |
Evidence Obtained/ |
| 7. Physical Resources | |||
| 7.1 | There is a room large enough for community meetings, where everyone can see each other. | Direct observation. | |
| 7.2 | There are adequate facilities for preparing and cooking shared community meals. | Direct observation. | |
| 7.3 | There are facilities for creative and action therapies | Direct observation. | |
Item cluster |
Standard |
Evidence Required |
Evidence
Obtained/ Rating 4=standard is fully met 3=standard is substantially met 2=standard is partially met 1=standard is not met |
| 8. Staff Resources | |||
| 8.1 | Staff demonstrate personal values compatible with therapeutic community principles and practice. | Direct observation in staff
meetings and community meetings. Direct questioning of staff. |
|
| 8.2 | There are adequate levels of staff to enable the above standards to be met. | Direct questioning of staff. Documentation - rota. Direct observation. |
|
| 8.3 | There is a sufficient number of staff with relevant training and expertise present in community meetings and small groups to enable the above standards to be met. | Documentation - re staff
training and experience (Advance questionnaire) Direct observation of community meetings and small groups. |
|
PLANNED ENVIRONMENT THERAPY TRUST |
ATC HOMEPAGE
|
CHARTERHOUSE GROUP OF THERAPEUTIC COMMUNITIES |
||||
|
||||||
This page is hosted and maintained on behalf of
the ATC by
The Planned
Environment Therapy Trust
"Supporting, promoting, recording
and valuing therapeutic work in caring and healing
environments/communities/institutions...".