Our Approach

Enabling Recovery through Therapeutic Engagement

St Martins are committed to a Therapeutic approach that facilitates and promotes mental well-being, allowing our residents to return to a sustainable independent life in the community in supported accommodation or independent living. Our Therapeutic approach enables people to fulfil their aspirations, whilst providing the support they need to achieve this at their own pace and within a non-stressful environment.

Therapeutic engagement’ is based on recognised models of care, frameworks for practice and utilises a range of standardised outcome measures. It is the primary component of all our care interactions at St Martins and has the capacity to transform and enrich resident’s experiences.

We seek to provide a psychologically informed environment where the day-to-day operation has been designed to take the psychological and emotional needs of people into account, placing people and their individual needs at the centre of what we do.

St Martins uses the ‘Therapeutic Modules’ found in the illustration, which identify the main areas of need to enable successful mental health recovery and represent the elements that guide our care and therapeutic delivery. These elements are the building blocks towards recovery, independence and wellbeing.

It is our aspiration within St Martins to support people to recover and achieve the best possible state of health and wellbeing that they can; enabling them to live meaningful lives with or without on-going symptoms of their condition.

Therapeutic Engagement

St Martins approach follows three key principles of recovery:

  • Creating and sustaining a culture of hopefulness that is focused on the pursuit of personal goals and ambitions
  • Supporting people to take responsibility and maintain a sense of control over their own lives and symptoms
  • Opening up opportunities to build a positive identity and a life beyond illness

Person-centred Support

St-Martins recognise each person as being a unique individual with a personal set of needs and aspirations in recovery. We have formed a therapeutic approach to recovery that is committed to personalised support planning and programmes which enable service-users to relearn skills and develop new skills to aid personal recovery.

There are four underpinning principles to St Martins person-centred Active Support;

We work in partnership with service-users to identify their own goals and support them to achieve their aspirations.

  • 1. Every Moment Has Potential

    • Everyday there are countless opportunities for service-users to be engaged in a wide range of naturally occurring activities and interactions.
    • Using these real and naturally occurring opportunities for engagement reduces the need to create artificial activities.
    • The challenge is to find more and more opportunities for service-users to be involved.
  • 2. Little and Often

    • Everything that happens throughout the day is made up of smaller parts or steps.
    • People may be more willing to get involved in small parts of an activity rather than the whole thing.
    • Engagement for some people means initially joining for 5 minutes and then building up over time.
  • 3. Graded Assistance

    • Every person is an individual with their own support needs. Graded assistance is about giving just the right amount and type of support to enable a person to succeed in a task or social interaction.
    • Service-users need the right support at the right time.
    • Too much and they will be over supported and too little and they will be unsuccessful and less likely to try again or trust someone again to support them.
    • Most people will need more support initially in a new activity then less support as they learn new skills required to complete the activity.
    • There are many types of assistance: verbal prompts, hand-over-hand, verbal guidance.
  • 4. Maximise Choice and Control

    • Means supporting people to make as many choices about how they spend their day as possible. The more choices a person can make the more control they have.
    • Experience and choice go hand-in-hand. The more experiences a person has, the more alternatives have to choose from. When a person you are supporting makes a choice, it is important that, so fare as possible, you respect their choice.
    • Supporting people with complex disabilities to make choices can be difficult. Often people may not understand what choices are being offered or the word you are using.

    The level of support provided is matched directly to the person’s needs for support in each activity, always making it person-centred in practice. While the support provided has to be enough, the aim is to promote the person’s independence by giving only as much support as is needed. Assistance is gradually faded out as practice makes the person more skilled.

level of support

Active Support Plans (Task Analysis)

Delivering effective, engaging and personalised support plans are key to achieving the desired outcomes for each individual in our service.

The first step in a delivering a successful support plan is a robust and effective assessment. The St Martins Activities of Daily Living (ADL) assessment is divided into 20 areas of daily activities and provides a baseline of daily functioning in a wide range of areas of a persons life.

The information obtained from this assessment is then used to create meaningful individualised support plans aimed at increasing skills in areas of daily living where improvement could be useful for the service user.

Information obtained from the completion of the ADL Assessment is used to develop an Active Support Plans (Task Analysis) based on areas identified within the assessment indicating an area of need and requirement for ADL skills development.

Active Support Plans (Task Analysis)

Support plans are written in collaboration with the service-user and include the persons own recovery goals and clarify actions/responsibilities for staff and the person themselves. Plans are updated in response to any changes in the person’s needs and/or approaching move-on.

Task Analysis provides a simple structure to use when supporting the service-user in achieving a new skill, by breaking an activity down into smaller steps. The staff member works alongside the service-user to master each component part until the service-user becomes totally competent in the whole activity – or as much of the activity as the service-user is capable.

This part of active support works at the service-user’s own pace and celebrates achievement of each component part – rather than only celebrating total achievement and mastery. This way of working is highly motivating for the service-user and also for the staff who support them. It provides a genuine sense of achievement and helps the service-user to develop new independent living skills.

Our support plan follows the key areas of:

  • Managing Mental Health
  • Physical Health and Self-Care
  • Living Skills
  • Social Networks
  • Relationships
  • Physical Health and Self-Care
  • Addictive Behaviour
  • Responsibilities
  • Identity and Self-Esteem
  • Trust and Hope

Holistic care

St Martins recognises that all people we support are far more than their ‘mental illness’ and the support they receive must reflect this.

Adopting a Holistic approach to support and engagement goes way beyond the disability. It addresses an individuals needs in the context of their skills, ambitions, and priorities; maximising those strengths to enable them to achieve their desired outcomes and maintaining their wellbeing in a person-centred way with specific individual needs and preferences.

A Strengths-based approaches shift the focus away from deficits of people with mental illnesses and focuses on the strengths and resources they have. It concentrates on the inherent strengths of individuals, families, groups and organisations, deploying personal strengths to aid recovery and empowerment. In using this approach, we promote the individual’s independence, resilience, wellbeing and ability to make choices.

Identifying and supporting a person’s strengths can help address needs in a way that allows a person to lead, and be in control of, their ordinary and independent day-to-day life as much as possible.

Holistic care

Meeting Health Needs

  • Reduction in Symptoms

    It is recognised that service users will continue to have complex mental health difficulties which impact on their mood and ability to function in day-to-day activities. This may include a lack of motivation and other negative symptoms, or symptoms associated with psychotic and neurotic disorders. Service users will have support from a team of staff within St Martins and also externally from the NHS CMHT and other community services, as well as from an individually identified Consultant Psychiatrist who will provide support to lead a reduction in symptoms and improvements in the individual’s quality of life.

  • Management of Risk

    Our therapeutic programme helps the service user to manage their own risk more effectively. St Martins support our service users to recognise their own risk factors and take appropriate action to ensure a positive response to risk, which will help to protect themselves from vulnerability and exploitation and protect others.

    Our staff understand the balance between risk and opportunity and are skilled at encouraging/facilitating service-users to take positive, measured risks, which challenge their perceived capabilities and increase confidence, self-esteem and ability for self-sufficiency. All service-user activities are also risk-assessed.

  • Chronic and Long-term Physical Conditions

    St Martins provides care and support to people who have coexisting physical condition alongside a mental illness including those who may have diabetes, asthma, cardiac or respiratory conditions such as COPD. We work in close partnership with NHS primary care colleagues.

  • Psychological

    We continue to provide a range of interventions to meet the persons psychological support needs, including programmes for wellness, relaxation, stress and anxiety management. We work in close partnership with external NHS colleagues for support and guidance with skilled psychologically informed programmes.

  • Physical Health

    St Martins provides a psycho-educational approach to physical health which includes – diet and exercise, medication management, smoking cessation, management of physical health conditions, dental hygiene and the avoidance of self-neglect Service users are supported in having full access to a range of primary care and GP services.

    Staff work in collaboration with service-users to develop and oversee a physical healthcare plan as part of the ADL/Active Support Planning process, outlining and agreeing what actions will be taken, what areas will be monitored and setting goals where appropriate (e.g. stopping smoking or losing weight).

  • Medication Compliance

    The ability to self-manage medication within the community is an important part of relapse prevention. Using a psycho-educational approach and supervised administration we will support service-users to fully understand their medication, the need for compliance and through a structured approach we safely introduce a self-managed medication programme.

Meeting Social Care Needs

  • Preparation for Community Transition

    Achieving stepdown to supported/independent living is the ultimate aim of the St Martins services and therefore every effort is made to prepare the service user for life in the community, including, management of finances, budgeting and paying bills, developing social and family networks, citizenship activities and relapse prevention.

  • Education, Training and Employment

    The ability to live an independently fulfilling life and remain healthy in the community may be constrained somewhat by the persons’ ability to gain meaningful paid employment. We work with local employment and education partners to provide a range of opportunities to acquire educational qualifications, enhance a CV, gain interview experience and participate in voluntary and paid employment, for those for whom this is a realistic goal.

  • Building Recovery Capital

    We believe that recovery opportunities are further enhanced through greater integration of services in a range of related sectors and will ensure that service-users continue to access these via a wider partnership focus on the part of our staff team.

    Social inclusion and participation is important to us. We actively encourage and motivate service-users to enjoy full citizenship by accessing mainstream colleges, work placements, cafes, hairdressers, cinemas, gyms, swimming-pools and other leisure/recreational facilities. We offer support to access these opportunities, including initial accompaniment and risk assessment where indicated.

    We have identified those areas most likely to aid recovery including health and wellbeing, employment/meaningful activity, income and social networks. We are focusing on building links with these services, including links with Islington Recovery College, whilst in 2020 we agreed a formal joint working protocol with the Islington substance-use service Better Lives.

    Our Active Support Plans identify agencies that are/or should be involved in delivering interventions. Service-users play an active role, helping to identify agencies that are suited to meeting their needs.

  • Practical Support and Guidance

    St Martins staff are available to provide support and guidance including adopting a psycho-educational approach to helping service-users learn new skills which will help them to live a more fulfilling life in the community. Founded on a strengths-based assessment, the Active Support programme helps service-users to build on existing skills and develop new ones in preparation for living in the community.

    St-Martins supports people to develop a full range of practical skills including; problem solving, maintaining a safe environment, interpersonal relationships, physical health, cooking and self-care. Supported by our new Life-skills Facilitator roles.

Therapeutic Relationships

Therapeutically engaging actions refer to any endeavour, including routine ADL’s in which a service-user participates that is intended to enhance their sense of well-being and to promote or enhance physical, cognitive and emotional health. These include, but are not limited to activities that promote self-esteem, pleasure, comfort, confidence, education, creativity, independence and motivation.

All staff members within St Martins will encourage the development of a strong therapeutic relationship with service-users which encompass caring, supportive and non-judgmental behaviour, embedded in a safe environment. Typically, this type of relationship displays warmth, friendliness, genuine interest, empathy and a desire to facilitate and support.

Consequently, therapeutic interpersonal relationships engender a climate for interactions that facilitate effective communication. Building this positive relationship will commence during the transition phase and will enable the service-user to feel more confident and relaxed during the admission stage which can potentially feel quite stressful for the individual.

Successful therapeutic interpersonal relationships between care staff and service-users are associated with improvements in levels of satisfaction, reduction in incidents, adherence to care support, quality of life, reduced levels of anxiety and improvements in overall health and wellbeing.

St Martins expect all staff to display leadership behaviours in their interactions with service-users. Some examples of leadership behaviours include; guiding, supporting, nurturing, encouraging, creating opportunities for self-development, mentoring, coaching and celebrating achievement.

At St Martins we seek to use the principles of therapeutic engagement and leadership as a way to define how care staff spend quality time with service-users and aim to empower the service-user to actively participate in their care. We use therapeutic engagement to provide meaningful and purposeful structured activity which has been planned with the service-user and is based on meaningful identified aims and objectives.

Our staff are dedicated to ‘Making Every Contact Count’ [MECC], a CQC and NICE endorsed evidence-based approach to improving people’s health and wellbeing by helping them change their behaviour. MECC uses brief and very brief interventions, delivered whenever the opportunity arises in routine appointments and contacts (NICE 2016). Very brief interventions take from 30 seconds to a couple of minutes, often covering areas outside of the person’s main diagnosis and supporting well-being, e.g. diet, health, alcohol use, activity. The person is encouraged to think about change and offered help, this is a highly effective approach within residential settings where contact is frequent.

In developing this approach to ad-hoc recovery support, we have also adopted Every Moment Has Potential (EMHP). A person-centred Active Support Model, a way of working identifying moments of potential within the day-to-day, e.g. simple tasks or mundane communications. The approach teaches/supports staff to identify and build on these potentials in their work with individuals.

St Martins staff build on people’s strengths and encourage hope and optimism by:

  • Helping people choose and work towards personal goals, based on their skills, aspirations and motivations.
  • Developing and maintaining continuity of individual therapeutic relationships wherever possible.
  • Helping them find meaningful occupations (including work, leisure or education) and build support networks using voluntary, health, social care and mainstream resources.
  • Helping people to gain skills to manage both their everyday activities and their mental health, including moving towards self-management of medication (see the recommendations on helping people to manage their own medicines)
  • Providing opportunities for sharing experiences with peers.
  • Encouraging positive risk-taking.
  • Developing people’s self-esteem and confidence.
  • Validating people’s achievements and celebrating their progress.
  • Recognising that people vary in their experiences and progress at different rates Rehabilitation for adults with complex psychosis.
  • Improving people’s understanding of their experiences and the support that may help them – for example, through accessible written information, face-to-face discussions and group work.
Multi-Layered Engagment

Multi-Layered Engagment

The pyramid model illustrates the multi-layered therapeutic engagement strategy which is available in St Martins services.

The tiers represent five inter-connecting layers of engagement which should be accessible to all service-users and delivered by a range of internal care staff, LIkeskills Workers, NHS core services and Care Coordinators, and specialist community providers.

Specialist Programmes

Some service-users with the most complex behaviours, such as those service-users with treatment resistive conditions, Personality Disorder, or those with comorbidity or a dual-diagnosis of mental illness and Learning Disability may benefit from a programme of specialist treatment and engagement.

Examples of individual specialist programmes may include those provided through programmes such as: individual psychology or psychiatry provided via the NHS.

Treatment Programmes

Treatment programmes are not provided by St Martins but delivered in partnership with NHS and specialist Community Groups, including the Camden and Islington Recovery College.

Service-users will be referred to treatment programmes by our NHS CMHT partners or occasionally via a GP where there is an individual identified need.

Treatment programmes are deigned to positively impact on specific areas of the service-users presentation directly associated to the symptoms of their mental illness or diagnosis, which should be linked to the care plan and treatment goals.

Where there is an identified need these programmes will be facilitated by suitably trained and experienced clinicians through the NHS CMHT or links with specialist community providers/groups.

The focus of treatment programmes is on empowering individuals, developing confidence, and helping people overcome barriers that are limiting their ability to live full and satisfying lives.

We will support service-users to fully engage with treatment programmes and encourage them to attend and fully engage in sessions which are offered through the NHS.

Focussed Skills Development

From information obtained through the individual service-user ADL Assessment it is possible to provide focussed service-led engagement, facilitated using the existing skills, knowledge and experience of the Lifeskills Facilitators and care staff as role models.

The purpose of skills development is to either support the service-user to learn new skills which can improve quality of life and functioning or maintain existing skills or to relearn skills.

Individual ‘Interest-Based’ Activities

Based on information acquired through the completion of the Interest Checklist, Pre-Admission assessment, discussions with the service-user and information from other assessments and sources it is possible to build up an initial profile of the service-user’s likes and interests – this can expand over time as we learn more about the individual service-user and their list of interests increases.

At this layer of the pyramid it is possible to begin to explore the service-user’s own goals and aspirations in terms of improving their skills through activities which they already enjoy.

Focussed Skills Development

Generic Activities

At the most basic layer of the pyramid are non-specific, generic programme which are available to all service users on a weekly basis and are intended to provide baseline approaches to engagement. The activities do not require a high level of skill of the staff member to facilitate neither do they require great mastery of skills from the service-user to participate.

Programme Layers (Inward and Outward Focussed)

It is important to this strategy that opportunities are available for everyone regardless of mental state or ability. Generic baseline programme/activities, such as the one illustrated below can help to build motivation, engagement and therapeutic relationships. An example of a basic 25 hour generic programme may be constructed as follows:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning Breakfast Club Exercise Group Motivational Games Community Meeting Domestic skills Activity Model Making Creative Writing
Afternoon Current Affairs Healthy Living Daily Living Skills Computer Awareness Cooking and Baking Walking Group Gardening Group
Evening Exercise Group Mindfulness Relaxation Art and Craft Quiz Film Night Board Games Karaoke

Similar programme as above being offered to service-users in all St Martins residential service it demonstrates a commitment to providing inclusive unit-based activity as part of the overall recovery programme.

This baseline programme is then overlayed with individual person-specific recovery focussed intervention Interest-Based Activities (outward, community focussed) and Focussed Skills Development programmes to provide a comprehensive and meaningful recovery experience for the individual person.

Co-production and Service User Engagement

A key part of our recovery strategy is to ensure the service-user ‘has a voice’ and is central to the development of our organisation. St Martins recognises that users of our services are experts through their own experience. We regard service-users’ involvement as central to the delivery of high-quality services. We actively engage with service-users to encourage involvement in the design, planning, development and evaluation of the support and care they receive as individuals and the wider service environment that they are a part of whilst resident.

Each individual St Martins service will be able to provide evidence that service-user engagement and co-production is a high priority for the service. This engagement will be integral to the day-to-day functioning of the service and will include service-user engagement in many of the operational areas, which may include;

  • Appointing a service-user representative to the St Martins Service-User Council.
  • Buddying other Service-users.
  • Interviewing new staff.
  • Involvement in Staff Training.
  • Facilitating Service-User led audits.

This complements recovery focussed practice by involving service-users in improving policy, practice and service delivery, through a joint staff/service-user group.

The Co-production group is valued highly by the organisation and co-chaired by the Head of Service and attended by the Chief Executive, who provides feedback on issues raised by the group and proposed actions to the board.

We have implemented and are continuing to develop service-user involvement initiatives alongside our existing structures:

  • We have a co-produced newsletter.
  • We are exploring service-users being part of the interview panel for new staff.
  • We are developing service-user led audits of the care environment.

Psychologically Informed Environments

St Martins recognises that the quality of the living environment is a significant factor in the recovery of our residents and strive to provide psychologically informed environments across all our services.

We incorporate the thinking behind our Psychologically Informed Approach to service delivery into the built environment and our physical approach, creating Psychologically informed Environments in our services, considering noise, light, art, and colour when developing, renewing or maintaining our estate as the opportunity arises, aided by our status as an owning RSL.

We have created accommodation environments conducive to recovery, where service-users can develop tenancy and life skills to prepare them for move-on to more independent accommodation.

We ensure that our living environments are well maintained, appropriately equipped, and complement the core service delivery and support that our residents need.

We aim to use space to support developing social skills and appropriate behaviour and a non-punitive or ‘elastic tolerance’ approach to behaviour. In which avoiding cramped, cornered spaces and providing break out and safe spaces allows behaviour to be addressed innovatively and placements maintained.

Substance Misuse

We are acutely aware that, given our inner-city locations and incidence of co-morbidities amongst our residents, use of substances can become a serious issue and that we must remain vigilant, whilst continually working to develop our approach.

In response to these concerns we have implemented and trained staff in a redrawn organisational Substance Misuse Management Strategy and significantly increased joint-working with substance treatment services, introducing formal protocols.

The strategy outlines a person-centred approach in supporting residents, while following all legislative requirements.

In May 2021 the CQC said: “Risk assessments were thorough and potential risks that people faced whether by their addiction issues or by displayed behaviour were identified” and there “was clear evidence of how issues of addiction were addressed”

We will work in partnership with specialist substance misuse services to support people who have substance misuse problems. Substance misuse interventions aim to:

  • Support harm reduction.
  • Change behaviour.
  • Help people develop coping strategies.
  • Improve engagement with substance misuse services.
  • Prevent relapse.

Partnership Working

The overarching principle to partnership working in our services is ‘bringing together’; utilising the resources available to people, deploying staff to build networks & liaise/broker opportunities, in addition to partnerships within the Pathway.

We are committed to working in full partnership with other agencies, making joint decisions and delivering individualised, person-centred care through collaboration. This therapeutic strategy cannot be delivered in isolation by St Martins alone and to attempt to do this would be detrimental to the service-users outcome and experience.

St Martins is proud of our strengths, but we also recognise our limitations as an organisation and the strengths of a community based recovery approach.

Our external partners in the NHS, Local Authority and specialist community organisations are able to provide extensive clinical skills and experience and we value the contribution of our external partners in having a positive impact on the recovery of service-users.

Each person will be known to a Placement Review Team and any specialist clinical care should be provided via a multidisciplinary NHS CMHT who will also hold overall clinical responsibility for the service-users mental health while they are living in the community.

Ensuring Performance

We take pride in the model for engaging and working with service-users and the wider well-being programmes that we have introduced. But equally know we need to be able to observe and where necessary improve, the staff and management performance in delivery.

During the last 12 months we have made significant improvements to our quality assurance systems, introducing a comprehensive audit, more robust governance processes and individual unit service improvement plans.

The system includes very clear lines of accountability and oversight; from front line staff members, through Unit Managers, to Senior Leadership Team and the Board of Management.

  • Quality Record Management

    St Martins took the decision to improve and digitalise its care record system, following demonstrations by a number of providers, LogMyCare was chosen due to its functionality, its user-friendly applications and person-centred approach.

    LogMyCare allows us to have all of the information about our residents in one place including support plans, risk assessments, keywork sessions, physical health and prompts for staff such as community activities and medical/dental appointments.

    The system is app based and this allows staff to utilise it with residents during keywork sessions using a tablet. The system also has the functionality to allow care-teams and relatives to have remote access to records, subject to resident agreement.

  • Robust Training

    Core training is mandated for all new starters regardless of background, inductions are signed-off by managers and audited, they include initial development goals feeding into training and professional-development planning.

    Depending upon development goals and performance in key areas, training is provided for individuals based upon their appraisal process outcomes.

    Our programme has included:

      • Medication Training
      • De-escalation Techniques/Conflict Resolution
      • MCA/Assessment of Capacity
      • Working with Risk
Robust Training


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