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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.

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Reinvigorating the TC in the UK

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  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.

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