Day Democratic Therapeutic Community Network (DDTCN) – ‘The Network’ Origins Membership Function Developments

DDTCN Origins: Three, one-day-per week Democratic Therapeutic Communities (DTC’s) – satellite services established in Webb House era – planning meetings set up for staff & service user consultants. Set up evaluated by Dr. Barbara Rawlings (2003/4) Four DTC services involved in HaCCRU evaluation: ‘Evaluation of Day Services run by agency partnerships and Therapeutic Community Service North (TCSN) – Barr, et al - 2008 DDTC Network established - during the TCSN era, following closure of Webb House in 2004 ‘Day Therapeutic Community services for people with personality disorder: a new approach’ – Gopfert &Hellin, et al. – 2006 Network has grown & developed substantially since Origins: The precursor for the DDTC Network were the meetings set up at Webb House Democratic Therapeutic Community in Crewe during 2001/2. At this time, there were plans being developed by the Webb House Outreach Service and local mental health services in Liverpool, Leeds and Manchester to set up 3 new one-day per week TC services. These services eventually became The Rotunda DTC, Diverse Pathways and Fifteen, respectively. These monthly meetings were established as a part of the planning process for developing the Day Service model and involved current and ex-service users and staff from Henderson Hospital and Webb House, DDTCN meetings have a strong TC element to their structure from the start. Decisions are made democratically through voting. These meetings were supported financially at this time by the Bolton, Salford & Trafford Mental Health NHS Trust and this whole venture could not have been possible without this support. This model of collaborative working and sharing of experience and problem resolution worked well and was a vital component in moving from the planning phase into operational services. These meetings developed over time into distinct teams of clinicians and ex-service users working within each of the Day Service Developments. One of the most valuable benefits from these meetings was the support for ex-service users in learning new roles and ways of working alongside staff they may have previously had a therapeutic relationship with. The meetings were organised in such a way to provide a regular update about developments and to share experience and learning. The transition from Webb House Outreach service based meetings into the Network as we now it today happened during the Therapeutic Community Service North era,

DDTCN Membership: service user consultants & staff from 10 current DTC’s with 1 joining and 2 more in planning phase: Rotunda – Liverpool (est. 2002) Diverse Pathways – Leeds (est. 2003 - CoC accredited) Fifteen – Manchester (est. 2005) TaSTE – Tameside and Stockport Therapeutic Environment (est. 2007) The Orb – Oldham, Rochdale & Bury (est. 2008) 2 B – Burnley (est. 2008) Waterside – Birkenhead (est. 2008) Taith – Wrexham (est. 2009) Jigsaw – Chorley (est. 2010) TES TC – Trafford (est. 2011) Denton House TC – Northwich (est. 2012) - a new DTC service just started – in process of joining DDTCN Blackpool? A 3rd Lancashire Care DTC is being planned Chester ? Closed PiE (Personality in Education) – Manchester University 174 – Bolton Membership is for staff & service user consultants, the question of service users from DTC attending has been discussed on many occasions and concluded that for regular Network meetings this wouldn’t be appropriate, however some meetings have included service users – more about this later. 11 current operational DTC services: Rotunda – Liverpool (est. 2002) Diverse Pathways – Leeds (est. 2003) Fifteen – Manchester (est. 2005) TaSTE – Stockport (est. 2007) The Orb – Oldham (est (2008) 2 B – Burnley (est 2008) Waterside – Birkenhead (est 2008) Taith - Wrexham (est. 2009) Jigsaw – Chorley (est. 2010) TES TC – Trafford (est. 2011) Denton House TC - Northwich? (est. 2012) Blackpool – in planning stage Chester ? There were two other services set up during this time and attached to the Network: PiE – Manchester University which was set up specifically as a time limited pilot during 2004/5? 174 – Bolton which started in 2005 and closed during 2008 Alan and I will explain more about the DTC model of these services a bit later on.

DDTCN Function: “Not to re-invent the wheel” Meets quarterly – hosted in rotation Learn from each other & appreciate differences Share experiences & resources Develop services Determine, monitor and maintain standards Support forum for service user consultants and staff Identify unmet training needs and provide in-house training Developing a peer review system Identify and develop future evaluation of services As services developed it became clear that emerging and established Day TC services needed a space to meet together to learn from one another, develop joint standards, reflect on how communities functioned, how risk was managed, what structures worked well and which needed modifying, in addition to supporting ex-service users moving into a new role of working alongside clinical staff in running the services. The main function of the Network therefore was to share experiences and resources with each other so as not to “re-invent the wheel” – for instance the task of recruiting service users to the role Jean will describe shortly was and still is very complex in NHS Trusts, but made much easier by sharing experiences and things like role descriptions with each other. There is real value in appreciating each others different ways of working too. Network meetings are held quarterly and are hosted rotationally by it’s members, and crucially, to cover travel costs and people’s time, continue to be supported financially by their respective NHS Trusts. Occasionally other meetings are held for specific tasks, eg. Planning Inter-service Visits, two weeks ago 26 people attended – this involved service users from most of the DTCs too. Agreeing a way forward with these visits. This is an idea from CoC, Membership of which the Network deliberated over for several years, but concluded that it wasn’t viable for services run on a shoestring to be able to join. More about this later. One of the most important functions of the Network is as a support forum for service user consultants and staff HaCCRU suggestion for future evaluation was looking at why people left DTC’s early? This would be a really important area for further evaluation.

DDTCN Developments: Inter-service visits DDTCN planning for annual visits between services to monitor standards and offer constructive comments – representative group of service users, service user consultants & staff Annual Training Event 2011 – Unstructured time 2012 – The role of the service user consultant Inter – service visits - Purpose The purpose of DDTCN inter service peer reviews is to provide member services with supportive review by a peer service, to assist in maintaining standards, assist with difficulties and suggest areas for development. Process DDTCN has committed to 4 services conducting visits between now and September 2012 and then for this to be reviewed and hopefully developed further. The idea is that each DTC will either visit or host a visit by another service annually. The intention is to make the visits useful to both services while minimizing the amount of work involved. Visits will be on the main programme day of the host service. Visits should not usually be on the main programme day of the visiting service. The visiting team will consist of at least 3 and no more than 4 people, ideally including two members of the community, one service user consultant and one staff member. However, a maximum of 3 members of the visiting team will be involved in meetings with the host programme at any one time. A more recent development is the introduction of an annual training event for staff and service user consultants working in DTC’s, The first event last year was very well attended, with all DTC’s represented and focused on what happens in unstructured time, based on previous evaluation from Henderson Hospital that members attributed valuable learning from discussions/activities with others in unstructured time. This year the focus is going to be on the role of the service user consultant.

DDTCN The future ? Difficult to predict what will happen, but for looking at the way DTC’s have developed in recent years, bodes well - “The Network” has grown over the last 9 years & this is very encouraging. The “Network” is a fantastic resource! – Well supported by the various Trusts involved, and my hope is that it continues to develop. One possibility we have just started to discuss is the development of a website to hold lots of information centrally. A final plug is to thank Linda Cook who is: DTC Administrator Psychological Therapies Stepping Hill Hospital Pennine Care NHS Foundation Trust – for the fantastic job she does in disseminating information across the network.

DDTCN References: Barr, W. Hodge, S. and Kirkcaldy, A. (2008) – Evaluation of Day Services run by agency partnerships and Therapeutic Community Service North (TCSN) - HaCCRU Gopfert, M. & Hellin, K. et al. (2006) - A weekly day therapeutic community service for people with personality disorder: an innovative model. Psychiatric Bulletin Pearce, S. & Haigh, R. (2008) – Mini Therapeutic Communities – A New Development in the United Kingdom, therapeutic communities, 29, 2. Rawlings, B. (2004) Setting Up New Services: how service users were involved in planning therapeutic community day programmes, Therapeutic Communities, 24 (1), pp. 245-257. Rawlings, B. (2004) Interagency Collaboration: working in partnership to plan therapeutic community day services for personality disorder - unpublished An electronic copy of Dr. Barbara Rawlings unpublished paper can be obtained by contacting her on: barbara.rawlings@talk21.com HaCCRU = Health and Community Care Research Unit – Liverpool University. Particular attention to the bottom two references and the information and outcomes captured in Barbara Rawlings work, being particularly useful for new services to learn from.