A citation of Hodges' model IN "Excellence in forensic psychiatry services..."

McLaughlin, P., Brady, P., Carabellese, F., Carabellese, F., Parente, L., Uhrskov Sorensen, L., . . . Kennedy, H. (2023). Excellence in forensic psychiatry services: International survey of qualities and correlates. BJPsych Open, 9(6), E193. doi:10.1192/bjo.2023.578

Background

Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development.

Aims

To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.

Method

A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire.

Results

Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score.

Conclusions

Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.

<>

As the second citation  for Hodges' model from ResearchGate this month, I hope this is a trend. If I can assist any researchers, please let me know. 

While welcome, I'm not interested in being a co-author; if I can help your understanding and application of Hodges' model this is what counts.

Delighted to add McLaughlin et al. to the bibliography.

Many thanks to Harry G. Kennedy and team.

CLOSE(D) CARE: Group climate in a secure forensic setting for individuals with mild intellectual disability

This morning ResearchGate alerted me to a new paper/thesis citing Hodges' model. 

I will add this to the bibliography and post again in the new year, relating selected conceptual content of Elien's thesis to Hodges' model.

Background

CLOSE(D) CARE

This study examines associations between group climate, aggressive incidents and coercive measures in adults with mild intellectual disability or borderline intellectual functioning (MID‐BIF) of a secure forensic setting.

Method Participants (N = 248) were interviewed about their perception of group climate utilizing the Group Climate Instrument. Data on aggressive incidents and coercive measures were retrieved from the facilities’ electronic database. A multilevel structural equation model was fitted in which variability in perception of group climate within and between living groups was examined.

Results An open and therapeutic group climate was associated with lower levels of aggression within and between groups. A higher number of aggressive incidents were significantly associated with a higher number of coercive measures.

Conclusions The findings have implications for the understanding of how group climate may play a role in reducing aggressive incidents at the living group in treatment of individuals with MID‐BIF in secure forensic settings.

Elien G Neimeijer (2021) "CLOSE(D) CARE: Group climate in a secure forensic setting for individuals with mild intellectual disability." Radboud University, ISBN: 978-94-6416-713-9
https://www.trajectum.nl/sites/default/files/proefschrift_e._neimeijer_pdf.pdf

Book - "Criminal: How Our Prisons Are Failing Us All"

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

LIFE CHANCES LIFE SKILLS (mental) health learning disability acquired brain injury post traumatic disorder ...	Personalised medicine: "If you use substance 'x' or this class of drugs, then there is a 'y' probability that 'z' will happen." ... ... future ...? Traumatic Brain Injury Screening
Collective Life Chances Society ...? Life Skills 'fit' for 21st C. EDUCATION EDUCATION EDUCATION Pre-School! Pre-School!! Pre-School!!! equity Social Justice

I heard Angela Kirwin being interviewed about her book on Times Radio earlier today.

Prisons have changed. Haven't they? Prison reform 'happened'. It is a fact of history after all - Elizabeth Fry et al.? At least according to Social and Economic History GCSE in the 1970s.

Mental asylums changed. They have closed. 

Prisons have (apparently) changed markedly since the 19th - 20th century.

With the 'asylum system' of institutionalised 'care' they share a few things in common..

The 'estate' was Victorian (Winwick Hospital is long gone - leaking, cockroach infested, red carpet at the main entrance - with frequent reference to custodial care and how to change - challenge this.).

Now community care, or care in the community (take your pick) holds sway. 

We are a fifth of the way into the 21st century - can you believe it?

Decades from now will they look at the prison system now and see it as archaic as we see the 'lunatic asylums' pre-20th century (terrible for much of the 20th in fact), and yet we often forget the rationale for their original establishment?

From a mental health perspective what do the social determinants (of health) mean?

Mechanistically speaking, it seems determinism is very much doing its work - too many enter the political system and it's not the one - to represent the community in Parliament.

I've viewed Hodges' model as a resource to highlight parity of esteem at an individual level (physical AND mental health).

Increasing in relevance, I can see its utility in the pursuit of collective parity of esteem.

The most troubling commonality here: care in the community is unfinished. It sort of got started. It fledged, but never took flight.

There were many compassionate, caring, professional staff in the asylums. Exceptional role models. They saw the theory - practice gap. Pointing it out. Aptitude - Attitude. They were the heart in the Victorian shell, even as science struggled (and still does) with the ghost in the machine.

Historically speaking the ‘workhouse’ is closer than we think.

The UK rightly lauds its National Health Service, created in 1948. The Poor Law was also abolished in 1948 (Hillam and Bone, 1999).

Prisons, mental health care, preventive health, health education and community care .. so much still to do.

This sounds an interesting new book too! :-)

Hillam, Christine., and J.M. Bone. THE POOR LAW AND AFTER: workhouse hospitals and public welfare. Liverpool: Liverpool Medical History Society, 1999. ISSN 1364-999x

RCGP Secure Environments Group 8th Health & Justice Summit: Communities of Practice in Secure Care

 

October 12-13, 2021 

Crowne Plaza Newcastle, Stephenson Quarter, Hawthorn Square, Forth Street, Newcastle upon Tyne, NE1 3SA

To address the complex health and social care needs of people resident in custodial settings, effective partnership work is required not only between health partners and the prison service but also with health and justice policymakers. PHE 2018-2019 Annual Health & Justice Review

Prisons and other secure settings can provide a unique opportunity to address a wide variety of health needs. These can range from infectious diseases such as HIV, hepatitis and tuberculosis as well as mental health issues, substance misuse disorders and long-term conditions.

‘Prison Health’ should be considered ‘Public Health’ as the vast majority of prisoners return to the community, and the investment in healthcare in these settings provides a wider overall benefit. The mission of this Summit is to share models of good practice, innovations in healthcare delivery and advances in treatment in order to best utilise the opportunity we have for our patients and for our society.

Following on from the highly successful 7th RCGP Secure environments summit in November 2019, and the 1st Virtual RCGP Health and Justice Summit in November 2020 the RCGP Secure Environments Group & Convenzis are very excited to share details of the 8th Annual RCGP Secure Environments Summit taking place on Tuesday the 12th and Wednesday 13th of October 2021 in central Newcastle.

This as always is ran with various key partners, this includes: Ethypharm, Mountain Healthcare, Spectrum Healthcare, Nottinghamshire Healthcare, Ashworth Hospital, Mersey Care, Merck Sharp & Dohme, Inclusion (Part of Midlands Partnership NHS Foundation Trust), Oxford Immunotec, SLD Training, Essex Partnerships, Public Health Wales and West London NHS Trust.

In recognition of the significant progress and collective contribution of our attendees, partners and sponsors, we are titling the 8th Summit:

Compassion, collaboration and continuity through the gate

We are now considering the next the next decade, and we look forward to receiving content on the following themes including:

• Clinical practice and teamwork
• Guidance, Research and analysis
• Innovation and technology
• Leadership and culture

As in previous years, the event will be held in partnership with a range of sector-leading strategic partners, more updates on this year’s partners will be disclosed soon.

Registration for the day is now open, and we look forward to seeing some familiar faces and new delegates across both days.

===

Having attended previously (in person) the knowledge and insights gained have proved invaluable working in Adult Community Mental Health Team, Early Intervention and START - Specialist Triage Assessment Referral and Treatment Team. So if you work in prison health, secure, forensic and related health, social and community services the potential gains should be even greater. The time invested also contributed to my revalidation. I plan to attend and possibly present Hodges' model.

The humanistic and mechanistic in patient transport & safety

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

Person - Identity 'Suspended personhood' ? Dissociation -> Alienation ? MENTAL - physical health Clinical assessment Mental Illness Mental Health Crisis Orientation - Mental capacity Anxiety - Distress - Stress 'Lived experience' Risk to Self / Self neglect Can person's needs be met? Trauma Individual sense-making "If I am in a cage ..." SUBJECTIVE - objective QUALITY - quantity Aesthetic (psychological) impact of conveyance

PHYSICAL - mental health Open - Closed Wards/Units Locked - Secure Clinical assessment Risk to Self / Self neglect Physical MECHANICAL restraint: Handcuffs Vehicle: Cage vans - confined space Logistics: Patient transport 'Transfer' local <---><-> remote Location of Specialist Units Number of places Data gathering Records OBJECTIVE - subjective QUANTITY - quality

Risk to Others Ability to cooperate Families - contact / visiting Shared lived experience: Treatment, Care Vs. Punishment Patient-Public Involvement Discourse Collective sense-making Perpetuation of stigma Blunted / Polarised dialogue:  Anti- Critical Psychiatry Barriers to dialogue: 'Service-users' - Services

Police & Policing Law Mental Health Act Mental Capacity Act Liberty Protection Safeguards Duty of Care Accountability - Liability Staff involved in transfers Policy Policy Instruments Data - Reporting: Commissioned Research? Employee safety Mental Health Services Commissioning: Private Sector - Public Sector Transport Services Standards Psychiatric Intensive Care Unit

I'm sure the vast majority of transport service providers - public and private, are of a high-standard, seek to assure safety of all involved and professional, but exceptions must be addressed.

See also:

Carli Brosseau and Alex Lang

Read more here: https://www.newsobserver.com/news/local/article230255979.html#storylink=cpy

‘How many have to die?’ SC mental health patients endure nightmare transport conditions.

https://www.newsobserver.com/news/local/article230255979.html

If I come across further information (esp. UK centred) I will add here.

h2cmng AT yahoo.co.uk

Read more here: https://www.newsobserver.com/news/local/article230255979.html#storylink=cpy

My source:

Cage vans are used routinely in the UK for patient transport between hospitals. There is currently no record of how frequently used. There is no requirement to demonstrate that this degree of imprisonment is proportionate, or that less restrictive transport is impossible https://t.co/jvVL2atSVe

— Alex Thomson (@AlexBThomson) July 25, 2020

6th Health and Justice Summit: safety with continuity i

Whilst I am using Hodges' model (h2cm) to 

reflect on the 1st day of this event no 

endorsement should be inferred...

My exposure to forensic - prison nursing is trivial in contrast to the emotions, policy, issues, contention and hence importance that just the word 'prison' provokes. This statement can can be summarised in one point that was made this afternoon. That is, how any duty of care to prisoners must be balanced with the public's perception* of what should and should not be done. The word important is a moot one when the the aim is to stress the risk of being forgotten. Prison health is surely in danger of being lost within the Russian doll of mental health. Mental health that was (still is?) also the Cinderella service of health care? I refer to history in celebration since while there was mention of pressure of staff, long shifts, not feeling valued, heightened risk there was no shroud waving. Attending today was refreshing in the expressed passion, pride and enthusiasm that I heard; even while some of slides showing older and newer prison interiors and rooms - cells - were sobering (as they are supposed to be*).

My forensic experience is limited to time as a student nurse, making numbers up, on Ward 17 at Winwick. Visiting a medium secure unit to liaise and 'communicate' about the National Programme for IT and co-writing a paper on the Hodges' model in forensic settings. I have long wondered about the model being used educationally with groups in primary care, looking at stress and vulnerability, resilience, staying well ... and perhaps more selectively with this population. A strength here is the model's use: explicit - explained and shared or used implicitly guiding the 'teacher' or (more properly?) facilitator. We invest in 'life story' interventions for people with dementia. What about the 'life stories' of prisoners? It not the matter of their life story, but their lack of understanding of that story? What tools are there to help make sense of their 'health career' the life chances encountered and experienced in their lives?

The keynotes this morning emphasised the facts and figures of the physical health of prisoners with severe mental illnesses [SMI] and the work of Equally Well. Amid many health problems the focus is upon obesity and smoking cessation.

Dr Alan Cohen from Equally Well, reported on surveys and analysis of national QOF data comparing the prevalence of people with SMI in ten long-term conditions. As per the summit website: “The physical health of those with a severe mental illness is held up as one of the last significant health inequalities. This presentation will explore some of the data that underpins that inequality. This will describe how it can be used to enhance services, through the development of a national learning network. Equally Well.”

There are plans for an evaluation phase of the work and other audits. Dr Cohen almost had me ask a question, with regards to some people having three health problems across least and most deprived populations. How can this be explained?

The second keynote c/o Stephen Watkins confirmed (for me) the history of mental health beds (below) and how ongoing studies and graphs can illustrate processes across prisons. How long do prisoners have to wait for mental health transfer and remission? Diagnoses, across gender, ethnicity and outcomes were also presented.

Today @NHSBenchmarking presented results from our national review of prison mental health transfers and remission. Findings include delays in the pathway in some areas, over representation of BAME groups, variations in prisoner location, & low remission rates

— Stephen Watkins (@SteveWatkinsNHS) January 31, 2019

Stephen Watkins NHS Benchmarking

Stephen Watkins NHS Benchmarking

I will post soon on the workshops I attended. As is often found with satellite sessions the choice is difficult at times.

Tomorrow I must ask someone about 'social care' input. I have had cause to liaise with palliative care and local hospices recently, dementia and cancers. A question concerning a very literal form of 'in-reach' was asked for me. With four people to follow up with tomorrow, great organisation and day 2 to follow it will be a 'breeze' getting out of bed - even if that breeze is chilly...

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

	primary care
::: Society: SOCIAL (care): Family interface :::::: :::	Prison Health --------------  INTERFACE ------------- Prison Service

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

personal autonomy	OPEN door CLOSED door Mechanistic: 'Lock' 'Up' Ability to step on the grass
Family involement (What do they know?)	prison experience in-validates the 'person' narrows - restrains - autonomy

Reflective exercises: define 'continuity' as per Hodges' model?

What is the bandwidth of autonomy across the domains of Hodges' model?

Contrast the return to society of prisoners and service veterans?

RCGP’s 6th Health & Justice Summit: Safety through Continuity

Perhaps I will see you in Liverpool, UK later this week? 
I will be taking notes and look forward to reporting here.

A 2-day summit organised by the RCGP Secure Environments Group in partnership with, Broadmoor, Ashworth, and Rampton high secure hospitals, Spectrum, Care UK, NHS England, Martindale Pharma, Nottinghamshire Healthcare NHS Foundation Trust, Betsi Cadwaladr University Health Board, HMP Berwyn, West London NHS Trust, Mersey Care NHS Trust.

Following on from our successful event in Glasgow in 2017, we are now focusing on ‘Continuity of Care – safety through continuity’ as this year’s theme. We recognise the need to embolden the links between primary and secondary care for people resident in secure settings and are looking to showcase examples of good practice on how we can improve on care transition to the community.

The first day will broadly address physical health in secure mental health environments, and the second day will address the health needs of people in other custodial environments such as prisons, immigration removal centres and YOI’s.

If you are registered as a delegate for the event, please register which workshop you would like to attend via the link below:

www.convenzis.co.uk/6th-health-justice-summit-safety-through-continuity-registration/

<>

n.b. There are two papers listed in the bibliography (please see the sidebar) that show how h2cm is applicable to this specialist field.

H2CM bibliography: New reference in "The Psychology of Arson"

I have only just caught up with a new addition to the bibliography for Hodges' model (please see the side bar).

Abstract: key points

• One in ten patients in secure mental health settings have a conviction for deliberate fire-setting.
• This chapter views the issue of inpatient care and management from a forensic mental health nursing perspective. 
• Hodges’ Health Career – Care Domains – Model (HCM; Hodges, 1998) is used to provide an overview of the political, biological, psychological and sociological aspects of care and management.
• Nurses can deliver and/or support all aspects of care and treatment and have particularly significant roles related to management of relational security and recovery-oriented practice. 
• The HCM can be usefully supplemented by a firesetting specific model to enhance nursing assessment.

Dickens, G.L. & Doyle, M. (2015) Mentally disordered firesetters in secure mental health care: a forensic mental health nursing perspective (Chapter 17) In, The Psychology of Arson, 1st Ed., (Eds.) Doley, R.M., Dickens, G.L., Gannon, T., pages 260-275. Oxford: Routledge. ISBN: 978-0-415-81069-2

Hodges model: indicative concepts in Substance Misuse Care

Hodges' model
in substance misuse services

psychological dependence vulnerable individuals, education, risk, assessment, review, motivation to change, harm reduction,  motivational interviewing, appreciative inquiry, life skills, education, advice, feedback withdrawal, aggression, hallucinations, change, drug use history, measures, care pathways, contract, rapport, empathy	substance profiles, abuse, signs physical dependence, health status, pregnancy, research methods, evidence, diagnosis, co-diagnosis, staff awareness, statistics, drug-treatments, triage, screening, scientific advice, dissemination models: stepped care, training, forensic science - mental health, classification, interventions, physical access, stepped care models
dependents, family, social network social attitudes, vulnerable communities, community projects, self-help, e.g. A.A., socio-economic depreviation, systemic - family, group therapies Advertising, housing, casual drug use, work, employment, benefit incentives, re-integration, inclusion, community, neighbourhood policing, drug culture, media	supply, cost of drugs - alcohol health & social care policy, service interfaces, statistics Drugs strategy, funding, X-agency working, funding, GP contract, commissioning, "client contract-plans", National Treatment Agency, NICE, Home Office, legislation, crime, offending, re-hab. / specialist teams / treatment facilities, Government data, community prescribing, employers

Can YOU add to the H2CM bibliography (now listed on W2tQ)...?

PJ

For readers not already aware, yesterday I started adding a bibliography to the blog. It is listed in the side-bar.

Links are included if applicable and these have been checked. I can supply electronic copies of most of these papers if you wish.

There are two publishing projects in process that are closely related to each other, covering substance misuse and forensic nursing.

On the forensic nursing front just over a week ago I met and greatly enjoyed speaking with -

Dr Michael Doyle
Nurse Consultant, Professional Lead & Honorary Research Fellow
Greater Manchester West Mental Health NHS Foundation Trust
Edenfield Centre
Prestwich
Manchester
M25 3BL

Apparently, Hodges' model is used and has quite a history at the Edenfield Centre. So Mike and I are working on a paper we will submit to a journal before the end of the year. More on this to follow.

In the hope that Erdos-Bacon Numbers might work for me, if anyone reading this has contact with community mental health nurses in the Isle of Man please get in touch. I understand they have used the model in the past.

Finally, should you be interested in applying Hodges' model in your nursing, social care, education or informatics theory / practice, do let me know h2cmuk @ yahoo.co.uk. I would be pleased to provide some paper - electronic resources and advice as needed.

August! Great Drupalcon soon!

Best regards everyone,

Peter J. (and yes that is me up there)

TEMSS - Therapeutically Enhanced Medium Secure Service for Women [II]

Dear Rachel (Ms Magee)

Delighted to help you and well done on picking out Hodges' model. It sounds like an exciting time for you personally being newly qualified and working on a new unit.

Apart from several occasions as a student (late 70s at Winwick Hospital) and more recent liaison through my Trust's NHS Care Record Service Project I have not worked in forensic/secure mental health services. So what follows is a very generic over view. That said Hodges' model is more than an out-liner - brainstormer tool. As your experience grows the model will grow with you and your clients if it is appropriate to share it with them. Anyway, here are some initial thoughts a real mish-mash running through the care (knowledge) domains in turn (with some repetition).

If you wish to develop and elaborate on what follows, casting a distinct TEMSS light on each care domain I'd be happy to place your prioritised version in a graphic (with you duly ack.)

intra-INTERPERSONAL
Screening on admission. Existing psychic 'injuries'.

An·a·gram: 'secure' = 'rescue' .....

Life history, experiences +ve/-ve (including hospital care), skills, strengths, beliefs, mood, expectations, RISK behaviour, personality, psychological reactions to situation (admission, secure environment, diagnosis, prognosis, treatment - psychotropics, locus of control, helplessness, motivation, family contact...), specific, individualised - person-centred care. Thought disorder? Attribution. Risk - self-harm, harm to others, self-neglect. Psychological dependence. Intelligence. Literacies: 3Rs, visual, social, information. Boredom, Mental capacity. Cognitive functioning. Religious beliefs. Personal skills, strengths, interests. Education - access to training. Response to stress - existing coping mechanisms. Sleep. Attitudes. Sexuality. Biopsychosocial influences PMT (sorry don't wish to seem sexist!)? Stress-vulnerability. Biases, prejudices. Orientation time, place, person (not just older adults).
(YOU as a nurse are also in this domain - your skills, control and restraint, anticipation of needs, observation, empathy, self-awareness, non-judgemental, bias etc....) Assessment tools. My care plan. 'personal' time. Quality - therapeutic time if used.

SOCIOLOGY
Family, pressure on existing - new relationships, spouse-boy/girlfriends, socialisation into the 'secure' environment, dependencies - children / pets. Observation. Group activities. Group therapies. Routine. Co-operation. Team work. Leadership. Status, stigma, respect. Communication. Social skills, Assertiveness. Media - papers, radio, TV. Qualitative research - client narratives. Demographic profiles - catchment areas - deprivation indices.

SCIENCES
Screening on admission. Existing injuries. Access to GP, emergency services if needed. Physical characteristics, height, weight - BP, temp, bloods, mobility. Evidence based care? NICE. Drugs, side-effects (+ substance misuse / alcohol), physical effects of addiction, physical environment - lighting (on-off [fade]), noise (acoustic) signature, colour, architecture (sharp corners vs curves), physical health problems, trauma. ADLs. Assessment toolkit - what's in yours? Nursing (care) process. Hygiene, Domestic services. Infection control. Physical space allocation. Multidisciplinary assessments - occupational therapy, physiotherapy, psychology, pharmacist. Unit viewed as a system - ecology. Complexity within TEMSS. Literature review. Site visits / conferences. Learners. Staff course study opportunities. Academic partnerships. Quantitative research. Triangulation. Statistics. Data gathering processes. Geographic profile of referrals.

POLITICAL
Human rights, policies, protocols, GP service provision, right of appeal as relevant, 'disciplinary constraints', compliance-concordance, 'offence' category. Client space - privacy / dignity. Access to therapies, rehabilitation, training opportunity, AUTONOMY, ability to exercise choice, institutional 'rules' make-up, clothing, bathing, kitchen, toilet facilities, dignity and privacy, 'unwritten' rules - bullying - vulnerable adults, abuse, financial, sexual, physical. Inspection - Commissioners - accountability. Referral process-pathway. Thresholds, waiting lists? Travel distance - regional resource. Transport links - visiting times. Cost of fares. Staff establishment. Health & safety rules. Disability. Care transitions. Learning disability. Early onset dementia. Ageism (other '-isms') RECORDS. CPA. Community Team. Qualified-unqualified staffing. Patient-relative groups. Service user representation on management. Academic links. Visiting. SAFETY - patients-staff. Serious untoward incident reporting. Translation. Advocacy - short-long term. Other agencies - Social Services, third sector voluntary partners? Philosophy of care, OUTPUTS vs OUTCOMES? 'contracts', Mental Health Act, appeals, hospital managers. Politics of care. Psychiatry in Dissent. Audit, data collection, IT systems. Access to REPORTS - INTELLIGENCE "How are we doing?" "Where are we going and is that the right way?" Your involvement - engagement - in these processes. Client - carer - public involvement. Finance budgets - (unit budget - resources), staff support / supervision. Energy use. Recycling. Client abilities with finances / debts. Homelessness. Re-housing. Existing tenancy. Opportunity for (regular) TEAM BUILDING ;-) Innovation and creativity. PDP - KSF. Targeted issues: Managed care. Personality disorder....? Professional associations, groups:
http://health.groups.yahoo.com/group/forensic-psychiatric-nursing/
No group for TEMSS for women? Over to you! .....

As you can see the model is high level. It does not DICTATE how your unit is run, what therapy is undertaken. It can help as an aide memoire prompting you and your colleagues to systematically consider all the care domains according to the context-situation and can help ASSURE an holistic assessment and evaluation.

The model can also be used to help explain problems, issues and their solution - or realistic outcomes to clients and their families. So the model doubles as an educational resource - very helpful to engage the INDIVIDUAL or a GROUP (family). You can do this EXPLICITLY using paper or flipchart for example, or implicitly with you using the model mentally as you go along...

By including a POLITICAL domain Hodges' model is ideally suited to your speciality - in fact POLITICALLY and SOCIALLY there are 'nested' issues within your 'secure care' context: gender, ethnicity, equality and equity, public attitudes, institutionalisation, citizenry, public involvement....

This blog includes many labels (on the right hand side) I will also add 'secure services'.

Rachel - I noticed on your organisation's website there are the names of the wards and address - there's a space to fill there...

Good luck, hope this helps and thanks again for your interest.

Best,
Peter

TEMSS - Therapeutically Enhanced Medium Secure Service for Women [I]

Dear Peter Jones

My name is Rachel Magee. I am a registered mental health nurse working for Bolton Salford and Trafford Trust at the Prestwich site. I work in a medium secure unit called The Edenfield Centre. We have recently opened a new department called -

TEMSS (Therapeutically Enhanced Medium Secure Service) for Women.

As I am a newly qualified nurse I am looking to learn more about this model and see if it would be a useful tool to incorporate into the women's service as part of my preceptorship project.

I am writing to you, to ask if you have any information or views on this particular area, which I could possibly use to help me in my research.

I look forward to hearing from you.

Many thanks

Rachel Magee (RMN)
----------------------
Thanks for your interest Rachel this sounds an exciting time for you -
response to follow....

[used with permission of Rachel Magee]