Service Initiatives To Influence Therapeutic Milieu

Dr Patricia Mooney,

Consultant Clinical Psychologist

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

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

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

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

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

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

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

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

Summary/Conclusions

• Both initiatives designed to influence the therapeutic milieu

• Data collection regarding uptake of initiatives ongoing

• Impact on milieu due to be studied