1 / 12

Reinvigorating the TC in the UK

Reinvigorating the TC in the UK. Diane Hilton. Why did we review our residential Therapeutic Community services?. 2009 Residential Strategy. Starting Point - what we found during the review. Retention vs. utilisation we were filling our beds, but people were then dropping out.

portia-roman
Download Presentation

Reinvigorating the TC in the UK

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Reinvigorating the TC in the UK Diane Hilton

  2. Why did we review our residential Therapeutic Community services? 2009 Residential Strategy

  3. Starting Point - what we found during the review • Retention vs. utilisation • we were filling our beds, but people were then dropping out. • We needed to be more responsive • The treatment we provided was not focused enough on individual need. • Inconsistent admissions/assessment process • we needed to have tighter, more consistent protocol in terms of who we admitted to service. Can we help and how can we help? • We could improve our continuity of care provisions and set up transitional care pathways (aftercare) • Staff competence- some staff showed negative practices/ bad habits and many needed more training opportunities to increase their knowledge and practice. • 10% share of the market

  4. What we changed:

  5. What we changed:

  6. Impact We have reduced the number of early discharges and increased our completion rates as shown in the graph

  7. Impact • From 10% - 12% share of market and rising • In 2009-10 we found we were allocating some people too long in treatment, and some not enough. • Average time funded for treatment has decreased from 184 days in 2009-10 to 161 days in 2012-13. • We have been tailoring our treatment to client need and have become better at matching time needed in treatment to the individual. • NOW our service users are receiving an overall better dosageof treatment.

  8. When is ‘unsuccessful’, successful? Is dropping out always an unsuccessful attempt at recovery?... • 13 early discharges phone-interviewed • A snap shot of those who discharged early from our UK residentials in the last 9 months Findings- • 85% of sample were actively accessing further treatment post discharge • All of the participants who entered treatment as heroin users were now abstaining from opiates…. In fact • 100% of sample Class A drug-free • 78% reported improvements in their psychological health (pre to post) • There was no difference in post discharge success between those who voluntarily dropped out and those who were asked to leave

  9. Conclusions… • Unsuccessful can be successful • Our TC’s are more responsive- • Welcome House • Markers of achievement • More caring response to early discharge • ‘Right treatment’, and ‘right time in treatment’ • Needs-matched, responsive treatment • Some people gain skills and make changes in a shorter time frame (NTA, 2012; Wexler & Williams, 1986; Wexler et al., 1990; Yates et al., 2010)

  10. Implications: • Changing views of drop outs- not everyone who leaves treatment early will relapse or return to old behaviours. Lets get rid of this stigma. • Early discharge policy- the study highlighted the importance of having appropriate early discharge policies in place for those who leave treatment early. • Funding lengths- Funding length does not need to be a year or 2 years and should be matched appropriately to the person- providing the right treatment for the right amount of time would make us a responsive and efficient service. • Regular client analyses/ assessment of programme design- This will allow us to keep up with changing trends in client psychology and need allowing us to modify and match our treatment programme appropriately.

  11. Discuss…. • Right treatment and Right time in Treatment?? What does this mean? How does your service do this? How can we get this right? • …….. ‘TCs are effective for those who remain in treatment long enough for treatment influences to occur’….(Yates et al., 2010:97) • Can staying in treatment longer be harmful? Is there an optimum treatment duration? Is this a strange concept to a TC…? (Wexler & Williams, 1986; Wexler et al., 1990)

  12. References • National Treatment Agency for Substance Misuse (NTA) (2012) DRUG TREATMENT 2012: PROGRESS MADE, CHALLENGES AHEAD. Retrieved from http://www.nta.nhs.uk • Wexler, H., & Williams, R. (1986). The Stay ‘n Out Therapeutic Community: Prison treatment for substance abusers. Journal of Psychoactive Drugs, 18, (3), 221-230. • Wexler, H., Falkin, G., & Lipton, D. (1990). Outcome evaluation of a prison Therapeutic Community for substance abuse treatment. Criminal Justice and Behaviour, 17, 1, 71-92. • Yates, R., De Leon, G., Mullen, R., & Arbiter, N. Editorial- Straw Men: Exploring the Evidence Base and the Mythology of the Therapeutic Community. In Therapeutic Communities (2010). International Journal of Therapeutic Communities, 31, 2, 95-218.

More Related