1. Service Initiatives To Influence Therapeutic Milieu Dr Patricia Mooney, Consultant Clinical Psychologist

2. Introduction/ Context DOFMH&LD in NHS GG&C introduced two initiatives to positively influence Therapeutic Milieu (TM) –A Directorate wide TM training package –The implementation of Reflective Practice (RP) sessions through a service wide policy Premise that providing staff with right training and support helps provide right culture of care In line with Francis Enquiry Report and Forensic Matrix

3. Therapeutic Milieu Training - Aims Highlight influences on patient behaviour and the therapeutic environment Discuss nature of psychological interventions Raise awareness of communication issues and staff-patient interactions

4. Therapeutic Milieu Training – Content/ Topics What is ‘Therapeutic Milieu’ Importance of ‘Therapeutic Milieu’ Thinking about what it is like to be patient Reflection on how patients presentations and characteristics can make us feel Working with challenging and difficult behaviour Thinking about effective communication Promoting recovery whilst managing risk

5. Therapeutic Milieu Training – Training Model Delivery style encourages discussion/ reflection Uses multi media –Use of case studies, exercises, video clips Each session has two facilitators –One psychologist and one other discipline Targets multi disciplinary teams as a group Training calendar developed for the year ahead –One training session a month Names and numbers of attendees recorded as part of Directorate training strategy

6. Reflective Practice – Policy Aims Ensure that all staff have the opportunity to participate Set minimum standards Guidance on a standard model Guidance on what is manageable operationally –make such groups resource efficient and sustainable Promote maximum attendance at these groups Encourage multidisciplinary involvement Formalise responsibilities

7. Reflective Practice - Sessions Group format Multidisciplinary –All levels of training Recommended 2 - 6 participants Staff should have access to a session three monthly –Sessions should be offered at least once every four to six weeks to facilitate this Held away from the immediate ward environment or away from clinic space Sessions last 1- 1.5 hours

8. Reflective Practice – Sessions Several models of reflection Two considered most suitable for forensic settings –Gibbs’ Reflective Cycle/Model of Reflection (1988) –Johns’ (1995) model Tools developed to guide the reflection process Participants encouraged to lead discussions/ set agenda Sessions can be structured or unstructured Topics discussed will vary Content of discussions confidential

9. Reflective Practice – Governance No minimum standard of training for facilitators –existing competences of clinical psychologists sufficient Facilitators should receive regular supervision –integrated into existing supervision arrangements At least one identified lead person who can provide consultation Psychology service collate data on attendance and submit to Governance Group –quarterly –number of attendees by discipline

10. Summary/Conclusions Both initiatives designed to influence the therapeutic milieu Data collection regarding uptake of initiatives ongoing Impact on milieu due to be studied