- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Monday, December 02, 2019

iv RCGP’s 7th Health and Justice Summit ...

I've been working through notes, photographs and the summit programme hence the flip-flopping between days.

So, back to day one:

Megan Georgiou, Jem Jethwa and Dave Banks, Programme Manager for Royal College of Psychiatrists, Project Officer at Royal College of Psychiatrists and Lead Nurse for the Intensive Support Unit at HMP Durham and Tees, Esk and Wear Valleys NHS Foundation Trust
“Transforming the Care Programme Approach in Prisons”

The Care Programme Approach (CPA) has a history of being poorly implemented within a prison setting. The Quality Network for Prison Mental Health Services and Tees, Esk and Wear Foundation Trust have teamed up to review the process and develop new tools and guidance. The purpose of the workstream is to improve service delivery and patient care. The workshop will summarise the findings from the consultation event and present our work to date.

Late again and frustrated since as a former CPA Lead this subject is close to my heart. It is not a sacred cow, although the learning and values that it helps carry must be carried forward.

I got the immediate impression of a methodology being presented and sure enough we practised too:

Go M.A.D. Thinking ® Results Framework

Part of the approach includes the 10 possibility thinking areas as per the photo.

[There's an additional exercise that reveals the ability of Hodges' model to help prioritise, contextualise (or decontextualise) and assign the 10 areas.]

Dr Alex Acosta-Armas & Ms Sarah Hill, Consultant Forensic Psychiatrist & Service Manager for  North London Forensic Service presented “Forensic Learning Disability Pathways, from prison to the community: Less restrictive practices in secure care and the development of a specialist community forensic LD service”.
Pathways of care for people with learning disabilities, from prison with the establishment of assessment and detection services, followed by secure inpatient care, focussed on introducing less restrictive practice interventions. Development of a community forensic learning disability service aimed to facilitate transition into the community and to support community services.
Brian E Hodges who created Hodges' model was a Learning Disability Nurse and Tutor and designed the model with this population in mind.

I was not ideally placed for photos, but would encourage readers interested in Forensic Learning Disability Pathway to seek out the slides. There was a local history from 1997, improving quality, stating the case for a Community Forensic LD Team, eligibility criteria (referrals), progress since April 2019 and training delivered to date. This was informative relating autistic spectrum disorder, training for staff, assessment within prison and in-patient settings, attention deficit hyperactivity disorder,risk concerns - sexual offending, arson, stalking and FTAC - Fixated Threat Assessment Centres.

Whenever I see a slide, paper ... titled "New Model of care" my heart skips a beat. This model was CHOICES. I will try and obtain more information. 

Robert McEntree - Defining trauma
A workshop was presented by Michelle Osborne & Robert McEntree, Ward Manger & Staff Nurse for Arnold Lodge on “Trauma Informed Care in Forensic Health Care: Male Mental Illness”
How the admission ward of a Medium Secure Forensic Mental Health Unit in Leicester is introducing a framework for Trauma Informed Care.

There is frequent use of 'lenses' as a metaphor and this workshop was helpful as to me it presented 'trauma' as another lens, a potentially constructive metaphor upon an emotional - lived reality (with varying degrees of recall). Robert defined trauma with references and some texts:

The Polyvagal Theory, Stephen W. Porges:

The Body Bears The Burden, Robert Scaer:

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Book, Bessel van der Kolk:

Despite trauma's acuity (obviousness?) the slides were very informative:

What we talk about when we talk about "Trauma"
  • Pervasive
  • Impactful
  • Effects the most vulnerable in society
  • Self perpetuating
  • Negates potentially supportive relationships
Five core values of Trauma Informed Care and Environments

Safety  Trust  Collaboration  Choice  Empowerment

Barnett Brown, V., Harris, M., and Fallot, R. (2013) Moving toward Trauma-Informed Practice in Addiction Treatment: A Collaborative Model of Agency Assessment, Journal of Psychoactive Drugs, 45:5, 386-393, DOI: 10.1080/02791072.2013.844381

Fallot, R.D. and Harris, M. 2009. Creating Cultures of Trauma-Informed Care: A Self-Assessment and Planning Protocol, Washington, DC: Community Connections. [Google Scholar]

See also:
Becoming Trauma Informed:

In post iii I made (rather) a lot of 'transitions' and two major examples include veterans returning to civilian life and prisoners on release. The frequency of 'transition' was even raised at the summit. For example, if prisoners are recruited to a health programme and are then released that will be 'lost' so interventions are kept short for that reason. Alternately, reflecting cold reality there is acceptance in being able to re-enrol should someone arrive in custody once again.

Before closing remarks and thanks the summit's sessions ended with news of a transition:

Kate Morrissey, National Programme Manager - Mental Health, Implementation Lead for RECONNECT on:

The link provides background and details of this work. I will look to add more here to complete these four posts. Kate replied on twitter regards the summit and her presentation:

When I referred to the obviousness of trauma above, of course so often to the observer psychic trauma is not obvious. Is this why transition to stability, coping, staying well, recovery is so hard won? Is this why in housing, welfare and benefits so often the lens cycles through what is 'seen' resulting in doubt, denial and neglect?

These four posts reflect the main sessions and workshops I opted to attend. The summit's focus also included Women in prison, Transgender pathways and Children’s services.

Many thanks to Convenzis and other organisers, sponsors and supporters:
Great values, learning and job.