Enabling Recovery through Therapeutic Engagement
St Martins are committed to a Therapeutic approach that facilitates and promotes mental well-being, allowing our service-users 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 service-user’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.
St Martins approach follows three key principles of recovery:
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.
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.
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:
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.
Meeting Health Needs
Meeting Social Care Needs
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:
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.
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 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.
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:
|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;
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:
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.
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:
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.
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.