CHT model

Developmentally Informed Recovery Communities – ‘where relationships are the treatment’

 

CHT uses a model derived from therapeutic communities, incorporating the latest perspectives on Psychologically Informed Environments (PIEs) and a participative, democratic and developmentally informed recovery approach to enable people to achieve more of their potential and to fulfil more of their aspirations in life.

Each service has a dedicated fully-qualified psychologist/psychotherapist working with the Manager, staff and residents to create an individually-tailored but collective therapeutic experience. This supports the client in their recovery journey in both the individual and social domains in line with best psychosocial practice and the latest psycho-neuroscientific evidence.

CHTS’ approach emphasises individual recovery within a social community framework, encouraging participation in activities inside and outside CHT housing; support in maintaining and enjoying housing through reduction of social exclusion; a focus on reflection, learning and self-development through community groups, individual psychotherapy, and psycho-education; and a belief in the capacity of people to recover, and to achieve more of their potential and more of their aspirations.

CHT’s programmes focus on encouraging engagement in three distinct, but overlapping areas:

Community: we place a strong emphasis on helping residents to engage in activities, inside our communities and outside the service in the local community, to promote social inclusion. This includes the activities of day-to-day living, voluntary work, education, training courses and social and recreational activities that help residents to find structure and meaning in their day-to-day living.

Housing: the experience of living-together in the house is designed in line with the principles of Therapeutic Communities and Psychologically Informed Environments (PIE) within which there is strong encouragement to engage with others to take responsibility for the communal aspects of the social and physical environment of the house. This includes active participation in the Community meetings, cooking, cleaning, budgeting etc.

Therapy: we offer a range of psychological and social, individual and group, therapeutic interventions that are informed by best practice in PIE, psychotherapy and recovery, and are individually tailored to each resident. The clinical aim is both to enable residents to better understand the impact of their early experiences, particularly experiences of trauma, on their feelings, thoughts and behaviours, and to find more effective ways of managing themselves in their interpersonal, community and social relationships.

 

Clinical Model

All referrals are offered an Assessment which is undertaken either by the manager, the Psychologist, or a Senior Recovery Practitioner; at the Assessment the treatment programme is discussed and the expectations on potential residents made clear, and the resident is given information on CHT services written by staff and by other residents. Included in the Assessment is an Initial Risk Assessment and positive risk management plan.

If the placement is agreed, then the resident will usually come for one or more visits and perhaps a short stay before admission. On admission, they are supported into the experience of living together by an allocated keyworker and by a more experienced resident who acts as a ‘buddy’; they support the new resident to learn the ways of the community, and to explore what is available to them in the area.

We begin with developing a Formulation, outlining the resident’s relational style and history, including self-perception, and potential areas of psychosocial development: this is developed and discussed with the resident, and is reviewed regularly as treatment progresses. The Formulation informs staff interactions with the resident. Part of the Formulation is a more developed Risk Assessment and Management Plan, incorporating the understanding of motivations from the psychological and emotional perspectives of the Formulation.

Using the Formulation, the psychologist/psychotherapist and resident devise together a Treatment Plan – this is essentially what the resident hopes to achieve over their stay with CHT, and an outline of the psychosocial programme that we will put in place to support them in achieving it. The Formulation and Treatment Plan are dynamic documents that are refined with the input of the keyworker and other staff and residents over the course of the resident’s stay, and they are individual to each resident.

From the Formulation and Treatment Plan, the resident and keyworker develop a Recovery Plan: this is essentially a short-term dynamic document designed to support the resident in achieving day-to-day and week-to-week objectives that will support the achievement of the goals that are set out in the Treatment Plan. These are individual to each resident, and are revised frequently as the resident’s focus, challenges, aspirations and achievements unfold.

As part of the therapeutic model, residents also progress in terms of levels of participation, responsibility, and activity within and outside the community; for example, residents may learn to chair and facilitate the community meetings, or sit on one of the advisory committees of CHT on training or activities funding, or become part of interview panels or take part in presenting training, or becoming a ‘buddy’ to new arrivals and so on.

As the resident becomes more able to self-regulate, more able to manage all the tasks of daily life, perhaps engages in local voluntary work or a learning placement, and takes more of a leadership role in the community, so they move towards the Move-On phase of their treatment; they participate in the move-on group, their activities become increasingly externally oriented, and with their keyworker they begin to pursue move-on options. CHT offers ongoing psychotherapy to our residents who move on into more independent accommodation.

 

Pathways to recovery

CHT’s therapeutic programme provides psychosocial therapy, structure and support to empower people to make positive changes in their lives, acquire and improve daily living skills, seek and maintain employment, and integrate into their local communities.

Our services provide a complete pathway for our residents and range from young people’s transitional services, residential treatment and care settings with intensive staff support, less intensive ongoing treatment in shared supported living environments, and self-contained flats with therapeutic support where residents hold their own tenancies.

 

Residential Recovery Communities

Our CQC registered residential recovery communities provide intensive 24-hour staff support for adults experiencing mental health problems. An intensive therapeutic programme provides structure and routine to enable individuals to make positive changes in their lives. Each community is overseen by a Manager and a fully-qualified Psychologist/psychotherapist. All residents have a named key worker who works with them to manage their treatment programme, and to identify and address their daily-living and psychosocial needs as they work towards a more satisfying interdependence through active engagement with domestic, vocational, educational and social activities in the house and in the community.

CHT’s therapeutic programme is designed to be progressive and to move from the creation of structure and participation that support residents’ stabilisation and self-regulation, to engaging with psychotherapy, community groups and psycho-education that encourage development, and passing through increasing responsibility, participation and communal and external activities to eventual move-on.

These services typically support those who may have a history of multiple hospital admissions, placement breakdown, unresponsiveness to treatment, and who may have very complex needs, histories of trauma, and who may require a high level of support in many aspects of their life.

 

Supported Living

Our supported living services offer two tiers of support for adults with mental health needs who may require varying levels of support.

Therapeutic Supported Living

George Dooley House is a 24 hour, supported-living service in a 6-bedded shared house. Residents have their own private rooms and access to shared facilities, including a large kitchen and dining room. All residents have a named key worker who works with them to manage their tenancy, and to identify and address their daily-living and psychosocial needs as they work towards a more satisfying interdependence through active engagement with domestic, vocational, educational and social activities in the house and in the community.
As well as individual psychotherapy the project also offers supportive groups, and assistance in maintaining strategies for community inclusion, meaningful daily activities and developing social networks. This model of support continues the ethos of CHT which sees interdependence, rather than independence, as essential in a meaningful life.

Supported Living Move-on Flats

Fairhall Court Supported Living Flats offer single person self-contained accommodation with psychotherapeutic and practical support for previous users of CHT residential care services and for those who do not require the higher level of support that our residential care services provide.

CHT is also in the process of developing new move-on opportunities in small shared 2/3-bed flats/houses for people who want to move on from residential treatment services but who do not want the potential isolation of single-occupancy self-contained flats: they will continue to receive therapeutic support, with some practical assistance as required.

 

Young Person’s Services

CHT’s Young Person’s Service supports young people with complex presentations and histories of trauma to escape from or avoid the cycle of antisocial activity, unemployment, hospital and/or prison and move them towards employment or other pro-social occupation, their own housing, positive relationships, and developing the capacity to enjoy as near a normal life as possible, in line with the expressed aspirations of the young people themselves.

The service provides a 24-hour staffed therapeutic residential setting for young persons aged 16 up to 24 years, and operates as a psychologically informed therapeutic environment, delivering a structured therapeutic programme based around shared activity, group relationships, and individual key-working and psychotherapy. The service works in close collaboration with mental health services, education settings, social services, safeguarding and local partner organisations to provide an integrated network of support to meet the needs of the young person.

Through creating a community culture of personal development, shared experience and positive relationships, CHT’s unique specialist services engage young people with complex presentations and histories of trauma in a comprehensive programme of developmentally attuned psychosocial activities, promoting life skills, personal development, responsibility, empowerment and prosocial relationships.

 

Outcomes

CHT uses a variety of outcome measures including CORE 34, Honos, and the Warwick-Edinburgh Wellbeing Scale. We also measure ‘hard’ outcomes such as the percentage of residents moving on to less supported accommodation, the numbers taking up voluntary work or educational or training opportunities, and the number moving into paid employment.

We have regular surveys of resident experience, including ‘the friends and family test’, and regular resident feedback groups including regular resident meetings with the CEO. Our website features perspectives on our services written by people currently receiving them.