Containment and therapeutic relationships in acute psychiatric care spaces: the symbolic dimensions of doors

Background There is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses’ experiences of open and locked working spaces. Results A sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be “invisible”. The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople’s crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users’ abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as ‘locked doors’ in the community (limited or no care continuity and stigma). Conclusions The impact of COVID-19 restrictions on people’s crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.

He Waka Eke Noa at Korowai Manaaki: A Process Evaluation of a Dialectical Behaviour Therapy-informed skills programme for young people in a secure youth justice residence

<p>Dialectical Behaviour Therapy (DBT) aims to help people live a life worth living. It has increasingly been developed and adapted to address a range of mental health symptoms across different ages, cognitive abilities and environmental contexts; however, its popularity in implementation has outpaced empirical research. The current study was a Process Evaluation which assessed professionals’ perspectives about a DBT-informed skills group called He Waka Eke Noa operating at Korowai Manaaki – a youth justice secure residence in New Zealand (NZ). The study involved 11 interviews with professionals across two organisations involved in facilitating He Waka Eke Noa and/or supporting the young people who participated. Thematic analysis was used to analyse the interviews and three overarching themes were identified. The first theme, ‘Factors influencing practical effectiveness’, explored areas which professionals highlighted as having a significant impact on how He Waka Eke Noa worked and had three subthemes: ‘Generalisability’, ‘Cultural Responsivity’, and ‘Criminal Justice Environment’. The second theme, ‘Theoretical application of DBT to young people in NZ’ investigated the compatibility of DBT with young people in secure youth justice residences in NZ. The final theme, ‘Motivation’, considered the role that motivation played in engagement and continuation of treatment for people involved in He Waka Eke Noa. The findings from this study shed light on how the group was operating and highlighted the importance of the relationship between facilitators and young people. It identified the challenges He Waka Eke Noa faced including the difficulty of balancing a risk-reduction approach with creating a therapeutic environment. Further developments are considered that would assist He Waka Eke Noa in maximising its effectiveness through increasing resources and ensuring diversity amongst the clinicians (e.g., increasing cultural diversity). The thesis concludes with recommendations for the future direction of operation, for example, rolling out DBT-informed skills groups in other residences and the community; and potential research avenues.</p>

He Waka Eke Noa at Korowai Manaaki: A Process Evaluation of a Dialectical Behaviour Therapy-informed skills programme for young people in a secure youth justice residence

<p>Dialectical Behaviour Therapy (DBT) aims to help people live a life worth living. It has increasingly been developed and adapted to address a range of mental health symptoms across different ages, cognitive abilities and environmental contexts; however, its popularity in implementation has outpaced empirical research. The current study was a Process Evaluation which assessed professionals’ perspectives about a DBT-informed skills group called He Waka Eke Noa operating at Korowai Manaaki – a youth justice secure residence in New Zealand (NZ). The study involved 11 interviews with professionals across two organisations involved in facilitating He Waka Eke Noa and/or supporting the young people who participated. Thematic analysis was used to analyse the interviews and three overarching themes were identified. The first theme, ‘Factors influencing practical effectiveness’, explored areas which professionals highlighted as having a significant impact on how He Waka Eke Noa worked and had three subthemes: ‘Generalisability’, ‘Cultural Responsivity’, and ‘Criminal Justice Environment’. The second theme, ‘Theoretical application of DBT to young people in NZ’ investigated the compatibility of DBT with young people in secure youth justice residences in NZ. The final theme, ‘Motivation’, considered the role that motivation played in engagement and continuation of treatment for people involved in He Waka Eke Noa. The findings from this study shed light on how the group was operating and highlighted the importance of the relationship between facilitators and young people. It identified the challenges He Waka Eke Noa faced including the difficulty of balancing a risk-reduction approach with creating a therapeutic environment. Further developments are considered that would assist He Waka Eke Noa in maximising its effectiveness through increasing resources and ensuring diversity amongst the clinicians (e.g., increasing cultural diversity). The thesis concludes with recommendations for the future direction of operation, for example, rolling out DBT-informed skills groups in other residences and the community; and potential research avenues.</p>

Good practices in Italian therapeutic communities. Outcomes 2020 of quality accreditation program “Visiting DTC Project”

Purpose This paper aims to present results achieved by the first, and to date only, Democratic Therapeutic Communities (DTC) quality improvement program developed in Italy, in the past 10 years, named “Visiting DTC Project.” Process of bottom-up identification, definition and evaluation of good practices of TCs for adult users with long term severe mental disorders will be described. In addition, a five-phase clinical care pathway will be presented for the same user category, developed by the “Visiting DTC Project” to comply with Italian National Health Service accreditation standards for TCs. Design/methodology/approach “Visiting DTC Project” involved 40 Italian TCs, since 2012 until 2020, in an action research on good practices developed throw a democratic and bottom-up methodology. Project’s methodology is the “Democratic Peer-to-peer Accreditation,” a kind of professional scientific quality accreditation and continuous improvement process for community mental health services. Scientific model for the definition of service standards and principles of treatment is the British “Democratic Therapeutic Community,” which the “Visiting DTC Project” is organizationally inspired by. Findings In the eighth annual cycle of the program for TC with adult users of mental health services a significantly effective good practice procedure (GPP), with good practical efficacy, was finally identified (for the first time after eight years), but still no best practice. GPP with the title “Multi-family Community Meeting” is the Good Practice of the year 2020. No Best Practice has yet been identified. An integrated clinical care pathway for Adult DTCs Users in five phases is also presented. This care pathway organizes advanced standards of Community Group Quality in a map, to support the description and planning of the five phases of the user’s clinical work in DTC treatment. Originality/value Cooperation with local community services, organizations and networks, as well as a therapeutic environment based on informal coexistence and cooperation between TC members, are thus, together with care of family relationships, the main characteristics of the Italian experience of implementing and developing the Italian DTC treatment model. These characteristics make it clear how fragile Italian DTCs are at this moment. They are still in an early stage of development. All the most applied and effective best practice procedures are dependent on a wide and dense network of relationships, formal and informal, which cross the therapeutic environment and interconnect TC members with all other stakeholders.

Metode de stimulare cognitivă a copiilor preșcolari

The study was conducted in 2019 over a period of 8 months in Ilfov County. The study included 148 participants (N = 148). The control group (GC) consists of 74 children, 34 boys and 40 girls. Of the 74 children, 17 are 4 years old, 22 are 5 years old and 35 are 6 years old. The experimental group (GE) consists of 74 children, 32 boys and 42 girls. Of the 74 children, 21 are 4 years old, 21 are 5 years old and 32 are 6 years old. The study aimed to examine the impact of cognitive stimulation of preschoolers in workshops with group and individual sessions on cognitive development. The results show the positive impact of the methods used on the cognitive development of preschoolers. The cognitive stimulation program proposes an innovative therapeutic environment, motivating and compatible with the reality of each child. The activities of stimulating the cognitive abilities of the participants in the experimental group included the Feuerstein working method, which proved promising preliminary results, which determines us to expand our studies in the future. The preschoolers in the control group received only the stimulation related to the educational activities and programs.

Co-Production within Child and Adolescent Mental Health: A Systematic Review

Background: Mental health services are currently experiencing much systemic and organisational change. Many countries have adopted a recovery approach to service provision through the development of national policies and frameworks. Within an Irish context, co-production has been identified as one of the four pillars required for services to become recovery orientated. However, there is a paucity of literature relating to the concept within child and adolescent mental health services. This paper aims to synthesise the peer-reviewed evidence on co-production within such services. Methods: A PRISMA compliant systematic review was undertaken. This includes how the reviewer retrieved, shortlisted, and selected studies for inclusion in the review. It outlines the inclusion/exclusion criteria and how these were further developed through the PICO framework. Finally, the methods also outline how the reviewer assessed bias and quality, as well as the process of data synthesis. Results: Two studies were included in this review, both focusing on co-production, but in different contexts within child and adolescent mental health. Two themes were identified: ‘road less travelled’ and ‘co-producing equality’. These themes and the associated sub-themes describe how co-production works in these services. Discussion: These results highlight the paucity of quality literature in co-production within child and adolescent mental health. Both studies scored poorly in terms of quality. Resulting from this review, a number of actions relating to the therapeutic environment need to be taken into account for co-production to be further implemented. Other: The reviewer has not received any funding for this paper. A protocol was not created or registered for this review.

PSYCHOTHERAPY METHOD OF THERAPY BY MEANS OF CREATIVE SELF-EXPRESSION BY M.YE.BURNO (TCSEB) IN TREATMENT AND REHABILITATION OF PSYCHIATRIC DISEASE PROFILE PATIENTS

Приводимые в статье данные об организационной структуре, методиках (направлениях) и основополагающих принципах психотерапевтического метода Терапии творческим самовыражением М.Е.Бурно (ТТСБ), как части Клинической классической психотерапии, Терапии духовной культурой, позволяют получить более точные представления о ТТСБ и овладеть навыками использования данного метода в лечении и реабилитации пациентов с психиатрическим профилем заболевания. Рассказывается о показаниях и противопоказаниях к использованию метода ТТСБ. О непосредственных алгоритмах и психотерапевтических методиках осуществления помощи. Затрагивается вопрос значимости личной — творческой роли специалиста в ТТСБ, осуществляющего Психосоциальную терапию и реабилитацию. Рассматривается феномен особого психотерапевтического эмоционального интимного контакта с шизофреническими, шизотипическими пациентами, являющегося существенным компонентом продуктивного терапевтического взаимодействия с данной группой обратившихся за помощью. Рассказывается об особой терапевтической среде психотерапевтического метода ТТСБ в Психосоциальной терапии и реабилитации. The data presented in the article on the organizational structure, methodologies and fundamental principles of psychotherapy method of Therapy by means of creative self-expression by M.Ye.Burno (TCSEB), as a part of Clinical classical psychotherapy, Therapy by intellectual culture, allows us to get more accurate understanding of TCSEB and master the skills of using this method in treatment and rehabilitation of psychiatric disease profile patients. The indications and contraindications for using the TCSEB method are explained. The direct algorithms and psychotherapy methodologies of helping mentally ill patients are mentioned here. We also talk about special personal and creative role of a TCSEB specialist who performs Psychosocial therapy and rehabilitation. We emphasise the importance of psychotherapeutic deep emotional contact, working with schizophrenic and schizotypal patients as an essential component of productive therapeutic interaction with this group of patients. The special therapeutic environment of the psychotherapeutic method of TCSEB in Psychosocial therapy and rehabilitation is described.

Experiences of the Non-religious in Psychotherapy

This study explores the experiences of non-religious clients in psychotherapy, specifically with regard to unwanted religious interventions. Because individuals who identify as non-religious often experience negative judgments of various kinds, they need a safe and accepting therapeutic environment. In the present study, clients expressed that 36 % of therapists reportedly engaged in either unwanted or unhelpful religious discussion, with 29 % explicitly suggesting a religious intervention for their non-religious clients, such as prayer or attendance at church services. For a small percentage of clients, these suggestions led to premature termination. Implications for professional practice, education, and public policy are suggested.

Further Developments in the Panel of Psychological Inquiry Method of Case Study Research: The Case of "Ronan"

In 2011 our research group published a pilot study—the Case of "Anna"—employing the Panel of Psychological Inquiry (PPI) Clinical Case Study Method. The present study—the Case of "Ronan"—is a second example of the PPI method in action. The Case of Ronan has a number of modifications in method compared to the Case of Anna. First, the Case of Ronan involves the evaluation of a more complex and controversial written case study of a 20-month old boy who was diagnosed with moderate to severe autism spectrum disorder (ASD), and who was treated in a comprehensive therapeutic daycare center program where the core approach was based upon Greenspan’s (2009) "Developmental, Individual-differences, Relationship-based" ("DIR"/ "Floortime") model. DIR/Floortime was originally developed for use by parents in their own homes, and the Case of Ronan demonstrates how a therapeutic pre-school environment can use DIR/Floortime as a model for most adult-child interactions in a pre-school therapeutic environment. In addition to the application of the PPI model to a radically different clinical diagnosis, there were modifications to the methodology itself including: (a) reduction in the number of judges from five to three; (b) having a key witness in the case testify remotely before the Panel; (c) the writing of a much more detailed judges’ opinion on the aspects of the case that most influenced their decisions; and (d) a further development of the logic of a quasi-judicial approach to clinical case studies in psychology. By examining how the civil law’s basic framework for proving causality in cases of personal injury (who did what harm to whom), the process by which knowledge claims that emerge out of clinical practice (who provided what benefit to whom) is further explicated.

The Application of Trauma-Informed Care to Substance Use Disorder

Trauma-informed care (TIC) has been described to apply to several groups of traumatized patient/families in the NICU. Trauma is multidimensional, including physical and psychological injuries with long-term effects on well-being and function. A newborn experiences the best outcomes when the mother also experiences the best outcomes. Thus, the TIC approach is applicable to the care of the infant with neonatal abstinence syndrome (NAS) and mother. Organizational adoption of this model is likely to provide a supportive and therapeutic environment for the infant with NAS and family.