[Updated] AI Chat: Are the domains of Hodges' model comparable?

In drafting a future post: 'The Sciences: points, lines, angles and perspectives on domains', I thought I would ask Ecosia's AI Chat a related question, here is the (quick) prompt and reply:

PROMPT: 
In Hodges' model there are four care, or knowledge domains. The four domains are the sciences, sociology, political, and intrapersonal – interpersonal domain. In terms of potential content are these domains comparable, or is there an essential asymmetry? Please provide sources and references.

(I have saved the prompt for future reference and refinement.)

RESPONSE: [updated 21st June 2026]

Hodges’ model (also known as the Health Career Model or h2cm) is a conceptual framework that organizes knowledge and care into four quadrants, each representing a distinct domain of human experience and knowledge. These domains are:

1. Sciences (empirical, biological, and physical sciences)
2. Sociology (social structures, relationships, and community)
3. Political (power, policy, governance, and resource allocation)
4. Intrapersonal – Interpersonal (psychological, emotional, and relational aspects of the self and others)

Are the Four Domains Comparable or Asymmetrical?

The four domains in Hodges’ model are not strictly symmetrical in terms of their content, scope, or application. While they are presented as equal in structure (each occupying one quadrant of the model), their potential content, theoretical foundations, and practical implications can vary significantly. Here’s why:

1. Differences in Scope and Focus

• Sciences (Quadrant 1):
  This quadrant focuses on empirical, measurable, and biological aspects of health and care, such as anatomy, physiology, and pathophysiology. Its content is often highly specialized, technical, and evidence-based, rooted in natural sciences like biology and chemistry.

  • Example: The role of hormones in stress response or the pathophysiology of diabetes.

• Sociology (Quadrant 2):
  This quadrant addresses social structures, culture, and community dynamics. Its content is broader and more interpretive, drawing from sociology, anthropology, and social psychology.

  • Example: The impact of socioeconomic status on health outcomes or the role of family support in recovery.

• Political (Quadrant 3):
  This quadrant examines power, policy, governance, and resource distribution. Its content is highly contextual and often contested, influenced by political science, economics, and public policy.

  • Example: The effect of healthcare policies on access to services or the role of advocacy in shaping health priorities.

• Intrapersonal – Interpersonal (Quadrant 4):
  This quadrant focuses on individual psychology, emotions, and relationships. Its content is highly subjective and variable, drawing from psychology, psychotherapy, and ethics.

  • Example: A patient’s personal beliefs about illness or the dynamics of a therapeutic relationship.

2. Differences in Methodology

• Sciences and Political domains often rely on quantitative methods (e.g., experiments, statistical analysis, policy evaluations).
• Sociology and Intrapersonal domains frequently use qualitative methods (e.g., interviews, case studies, ethnography).
• This methodological diversity can create asymmetry in how knowledge is generated, validated, and applied.

3. Differences in Practical Application

• Sciences and Political domains  are often system-level and influence macro-level decisions (e.g., clinical guidelines, healthcare policies).
• Sociology and Intrapersonal domains are more individual- or community-level, focusing on personalized care, cultural competence, and therapeutic relationships.
• This can lead to asymmetry in impact, where some domains (e.g., Political) shape broad systems, while others (e.g., Intrapersonal) focus on direct human experience.

4. Theoretical Foundations

• The Sciences and Political domains are grounded in positivist and structuralist theories, emphasizing objectivity and external reality.
• The Sociology and Intrapersonal domains are influenced by interpretivist and constructivist theories, emphasizing subjectivity and lived experience.
• This theoretical diversity can create asymmetry in how knowledge is perceived and valued in different contexts.

Is There an Essential Asymmetry?

Yes, there is an essential asymmetry in the potential content of the four domains. While the model presents them as equal in structure, their content, methods, applications, and theoretical foundations are not interchangeable. The domains complement each other but serve different purposes in understanding and delivering care.

Sources and References

1. Conceptual Overview of Hodges’ Model:

   • Hodges’ Model: A Cognitive Periplus for - WikiEducator (PDF)
   • Hodges’ Model: Welcome to the QUAD
   • Hodges’ Health Care Model as a Framework for Quality

2. Theoretical Foundations:

   • Hodges’ Health Career Model and its role and potential application
   • Hodges’ model: the Sustainable Development Goals and public health

3. Discussions on Asymmetry and Complementarity:

   • The model’s holistic intent is emphasized in Hodges’ Health Care Model as a Framework for Quality, but its quadrants are not identical in content or application.
   • The differences in methodology and scope are discussed in Hodges’ Health Career Model and its role and potential application.

Summary Table: Asymmetry in Hodges’ Model Domains

Domain	Content Focus	Methodology	Theoretical Foundation	Level of Application
Sciences	Biological, empirical data	Quantitative	Positivist	Macro (systems, clinical)
Sociology	Social structures, community	Qualitative/Quantitative	Interpretivist, Structuralist	Meso (groups, communities)
Political	Power, policy, governance	Quantitative/Qualitative	Structuralist, Critical Theory	Macro (systems, policy)
Intrapersonal-Interpersonal	Psychology, emotions, relationships	Qualitative	Constructivist, Humanistic	Micro (individual, relational)

PROMPT: 
In Hodges' model there are four care, or knowledge domains. The four domains are the sciences, sociology, political, and intrapersonal – interpersonal domain. In terms of potential content are these domains comparable, or is there an essential asymmetry?

 

In Hodges’ model, the four care (or knowledge) domains are:

1. Sciences (biological, physiological)
2. Sociology (social, cultural, environmental)
3. Political (legal, policy, organizational)
4. Intrapersonal – Interpersonal (psychological, emotional, relational)

These domains are not strictly comparable in terms of content, scope, or function. Instead, they represent complementary perspectives that together form a holistic framework for understanding human health, well-being, and care. Here’s why there is an essential asymmetry between them:

1. Scope and Focus

• Sciences and Sociology are broad, well-established academic disciplines with extensive theoretical and empirical foundations. They provide generalizable knowledge about biological processes and social systems.
• Political is more narrowly focused on power structures, governance, and resource allocation. While critical for systemic change, it is less about individual experience and more about collective frameworks.
• Intrapersonal – Interpersonal is deeply personal and subjective, focusing on individual psychology, emotions, and relationships. It is less about universal laws and more about unique, context-dependent experiences.

This makes the intrapersonal-interpersonal domain inherently asymmetrical compared to the others, as it deals with subjectivity and variability rather than objective or structural phenomena.

2. Epistemological Differences

• Sciences, Sociology, and Political domains rely on external observation, measurement, and analysis. They are rooted in positivist or structuralist traditions, where knowledge is often generalized.
• Intrapersonal – Interpersonal is rooted in interpretivist and phenomenological traditions, where knowledge is co-created through subjective experience and dialogue. It resists universal generalization.

This creates a fundamental asymmetry in how knowledge is produced and validated across the domains.

3. Practical Application in Care

• The Sciences, Sociology, and Political domains provide frameworks for action (e.g., medical treatments, social policies, legal rights). They are instrumental in shaping systems and interventions.
• The Intrapersonal – Interpersonal domain is transformative—it shapes how individuals perceive, interpret, and respond to care. It is the domain where meaning is made and agency is exercised.

This means the intrapersonal-interpersonal domain is not just another “content area” but a lens through which all other domains are experienced and integrated.

4. Hierarchy of Integration

While the domains are conceptually equal in Hodges’ model, in practice, the intrapersonal-interpersonal domain often acts as the nexus where the other domains intersect. For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.

This integrative role makes the intrapersonal-interpersonal domain asymmetrical in function, even if not in formal status.

Conclusion: Essential Asymmetry

The four domains are not comparable in content or function. Instead:

• The Sciences, Sociology, and Political domains provide structural and systemic knowledge.
• The Intrapersonal – Interpersonal domain provides subjective and relational knowledge, which is essential for meaning-making and agency.

The asymmetry arises from the epistemological and practical differences between objective/systemic knowledge and subjective/experiential knowledge. Hodges’ model emphasizes that all domains are necessary, but they operate in fundamentally different ways.

INTERPERSONAL links: Holistic Bliss or Tristram Shandy ... III

The INTERPERSONAL domain links are to my mind (no pun intended) fairly obvious, at least that first row complements the SCIENCES top row opposite.

Basically, who needs a talking therapy and who needs a drug therapy?

The two uppermost care domains are intended to represent the INDIVIDUAL axis, so just as the SCIENCES [ANATOMY & PHYS] domain covers physical care; so the INTERPERSONAL domain encompasses emotional and mental health care.

Hodges' model is comprised of four care domains, but it is these two [INTERPERSONAL : SCIENCES] applied to the individual that even today we struggle to balance in theory and practice.

A key factor in Brian Hodges' early nursing career (and mine) has been the role of institutions, organisations and the formal policies and structures they represent. This can be depicted as:

EMOTIONAL HEALTH : PHYSICAL HEALTH (both 'individual')
OTHERS family, society : INSTITUTIONS (both 'group')

As to the INTERPERSONAL links themselves - I arrived at mental health through reading a psychology text on Wundt and introspection, then James..... PSYCHOLOGY being of central importance in this domain has two listings, with MENTAL HEALTH and closely related THERAPIES also sharing the top row. I may swap these around: PSYCH-OLOGY as a cognitive science should be placed rightmost, while MENTAL HEALTH and THERAPIES should be further to the left being more 'humanistic'. What do you think?

Do the sciences have to be corralled in the SCIENCES domain? I think I remember Bryan Magee and John Searle in conversation noting that many disciplines with science in their title are probably not sciences - in that upper right hand quadrant sense. Maybe it is just that -

cognitive science : "SCIENCE" (physics, biology, chemistry)
social science : political science

- are still running wild out there, untamed and as yet unbroken? Cognitive science has however, clearly come of age and the 21st century will undoubtedly be the century of the brain when anatomy, physiology and genetics are linked to thought and individual (and even social) behaviour.

Already the content here highlights cognition (thought). The inclusion of other link categories in this upper-left set can be explained with recourse to cogitation. After PSYCHOLOGY, PHILOSOPHY (with ETHICS) is the rather obvious 'ology'.

For better or for worse our culture is driven more by IDEAS and ideology than philosophy. Call it the informal philosophical engine that drives CREATIVITY.

COMMUNICATION lies at the heart of all things human-e. Given the millennia that the patient-physician relationship has been around, you might expect it to be perfected by now. Well health and social care workers and the public they serve are still trying to reach empathic nirvana (although that may be to take communication a bit too far).

Hodges' model has a role to play supporting reflection for all.

IDEAS, COMMUNICATION lead us to belief and a central component in psychological therapies. Belief is also a thread can be used by one individual to lead others positively or to subvert other individual's capacity to think critically. It is in this INTERPERSONAL domain that good and evil are so proximal they create heat, fanned by a culturally driven winds of history and media from the South. Be-life indeed. Here then - THEOLOGY is purposefully placed with TRANSDISCIPLINARITY. If it is to serve humanity Religion must be bound and integrated into the corpus of knowledge and that includes reconciliation with the SCIENCES. We cannot deny myth and yet myth cannot deny evidence - a debate that will go on......

The economic emphasis placed currently on creativity is quite remarkable, not just at a national level (cue ramble...). Cities recognise that their future development, sustainability and very survival depends on the generation and flow of ideas. Some things do not change. In myth a special place has been reserved for the isolated thinker, the one individual who takes themselves away for weeks-months, to be touched by the spiritual realm, to return to the community delivering insight, creative sustenance. Now creative individuals are needed more than ever. The isolation is virtual, the community potentially global. The energies of individuals are directed at solving problems concerning more mundane matters of cost, risk, flexibility and growth. Those creative outputs are distilled through team work and although they are then diluted they remain invaluable - such is the scale of the problems to be solved. Just as the great rivers that feed our cities have their sources - often remote and isolated in the high mountains, so ideas and creativity begin with one individual. That flow of personal knowledge now finally enters the ocean of KNOWLEDGE MANAGEMENT - EXPERT SYSTEMS (decision support systems).

I have a little mantra that I share with students. It's not perfect as there is much overlap; but I figure that what aptitude is to engineering so attitude is to caring.

HEALTH PROTECTION and PROMOTION, SELF CARE are all about attitude. Of course, money in the form of departmental budgets (those institutions do matter) and family income can make a huge difference, but if the right attitudes are not present then you may as well - "go fish!".

In light of the above STUDY SKILLS and EDUCATION and TRAINING speak for themselves - on this occasion at least. One of the original purposes of Hodges' model was to facilitate reflective practice (more to follow). We are familiar with the mechanical tools in use everyday to the extent they are taken for granted. Now the focus of training is more likely on the software tools that translate IDEAS into art, artefacts and conceptual frameworks.... ;-) These graphical and design tools must be learnt and the HUMAN-COMPUTER INTERFACE and its ACCESSIBILITY 'quotient' can prove to be either a brick wall or a leg-up for the individual user (even if networked or a collaborative tool - see SOCIOLOGY links).

If the SOCIAL domain reflects the worlds of the others, then the last INTERPERSONAL row REST & RECREATION reflects something of me and my family.

"Next!" - the SOCIOLOGY domain links....

Website & Content Review: Inter - Intrapersonal

While grappling with Drupal is an opportunity to learn new skills and put the website on a more professional and potentially dynamic-database-driven footing that is just one step. The other step is the need to evaluate the content and have a right sort out!

One thing that has bugged me for a long time is the name of the top left care domain - this junction of the HUMANISTIC - INDIVIDUAL axes. Being focussed on the individual - the label should read INTRAPERSONAL not INTERPERSONAL as reflected in the following definitions:

INTRAPERSONAL: Existing or occurring within the individual self or mind.

INTERPERSONAL:

1. Of or relating to the interactions between individuals: interpersonal skills.
2. Existing or occurring between individuals: interpersonal communication or conflict.

Source: Answers.com

This is not a mistake as such, it merely serves to highlight the way Hodges' model relies on the underlying continua. This domain from a health, social care and family perspective can readily incorporate INTRA-INTERPERSONAL. Today when I sat down with my clients and their carers it was not exactly SOCIAL, the emphasis was on INTRA - INTERPERSONAL interactions (situations).

So, from now on I will refer to both INTRA & INTER in any new content to follow.

Speaking of future content: the 1st NW England Drupal user group meeting on Wednesday night in Manchester is at the Cornerhouse. Eight attendees so far including myself, with six people 'watching' and yet to decide - I can't wait. Don't think we'll manage the Apple store too - another ti:me.

If you have any pointers regards future content please get in touch - h2cmng AT yahoo.co.uk.

Intra- Interpersonal in Hodges' model

As I'm sure I've already noted, the book reviews completed on W2tQ are not standard fare. They are applied reviews in that the reading informs my understanding of Hodges' model and demonstrates the scope, relevance and quality of the book for other readers.

I realised sometime ago that the 'interpersonal' domain also incorporates the intrapersonal. In the latest book for review which focuses upon the Person-centred Practice Framework and figure 10.1* supports this formulation. Unfortunately I cannot locate a graphic and will avoid resort to a photograph. Circular in form, there is a clockwise flow from intrapersonal emotions around to interpersonal emotions.

 

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

intrapersonal emotions perceiving  ::  controlling using    ::   understanding     (motivation) interpersonal emotions

More to follow with many thanks to the publisher for the review copy.

Previously  on W2tQ:

interpersonal

intrapersonal

My source:

Lynch, B., Barron, D., McKinlay, L., Chapter 10, pp.93-101, Connecting with others, In. Fundamentals of Person-Centred Healthcare Practice,  McCormack, B., McCance, T., Bulley, C., Brown, D., McMillan, A, Martin,S. (Eds.). ISBN: 978-1-119-53308-5 February 2021 Wiley-Blackwell 384 Pages. p.96.

*Barron, D. and Hurley, J. (2012). Emotional intelligence and leadership. In: Emotional intelligence in Health and Social Care: A Guide for Improving Human Relationships (eds. J. Hurley and P. Linsley), 75-88. London: Radcliffe Publishing.

 

 

'Proof' of the Four Quadrants

As I have read (and 'reviewed')  Lowy and Hood's (2004) The Power of the 2 x 2 Matrix in applying a matrix, it first has to be created and the process includes identifying and naming the quadrants of concern. The final step is similar to what I see as a key function of Hodges' model: assurance. They refer to proof, being finalising the matrix asking the question are these quadrants real. Are they correct in this (business, industry and commercial) context?

For Hodges' model the quadrants are predetermined. They are 'fixed' but in a way to reassure both those on clinical ethics committees and involved in corporate governance. Although fixed -

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

INTERPERSONAL	SCIENCES
SOCIOLOGY	POLITICAL

 - the terms used can vary as below:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

MENTAL HEALTH	PHYSICAL HEALTH
CULTURE & SOCIETY	POLITICAL

 

 'Culture and Society' was a suggestion and I've often wondered about the (meaning) scale and semantic synergy across the terms. Sociology is an academic discipline. As students 'produce' the model, I invariably have them wander about the library with Dewey. 'Politics' maybe a subject of study, but not 'Political'. The context for Hodges' model, however, is the situation in which the patient, nurse, carer, doctor, social worker, occupational therapist, physio ... find themselves. What is political about the situation. Even this is not the whole picture quadrant. What politics are evident? What political aspects should (must) be paid attention to? What is missing politically that is (further) injurious to this patient? (This patient (and carer) who is already helpless, hopeless and vulnerable?)

 In terms of proof, this is of course very important within healthcare. In mental health we often adopt a psycho-social approach and in psychological therapies from counselling to cognitive and gestalt forms in Hodges' model we can distinguish between one-to-one and individual psychology and group therapies and the psychology of a group. As soon as 'self' considers 'other' we also conjoin the model's vertical axis.

 

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

individual PSYCHOLOGY	SCIENCES
group PSYCHOLOGY	POLITICAL

 

When I write 'sciences' I'm looking at my school time-table (yes - really!). The sciences for me back then were biology, chemistry and physics (which had to include astronomy). Today, we refer to STEM:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

INTERPERSONAL	Science, Technology, Engineering, Mathematics
SOCIOLOGY	POLITICAL

 

 

In the summer on twitter ComplexWales asked a question and made a suggestion (I must find and copy the tweet). This set me to task to write during lockdown: so I've a good outline of a short manual for Hodges' model.

In the last post, this is why I'm grateful to Lowy and Hood. I can now also factor this into the manual,  future presentations and workshops.

 

Real proof as an evidence-base goes far beyond this. I can see an exercise with the above components, the axes, the domains and the research subjects being invited to construct something. Amid the quest for data and theory there should be a space for pragmatics too.

Finally, I will leave it to you to reflect on -

Personal, social, health and economic (PSHE) education

 

- in relation to Hodges' model ...

 

More to follow ('care architecture' still) ...

Alex Lowy, Phil Hood (2004) The Power of the 2 x 2 Matrix: Using 2 x 2 Thinking to Solve Business Problems and Make Better Decisions, San Francisco, CA: Jossey-Bass ISBN: 978-1-118-00879-9

 

ii Thoughts re. Ecosia's AI Chat 'answer'

The previous post has been updated, to the prompt is added:

 'Please provide sources and references.

[If you are new here, and too Hodges' model please see the bibliography in the sidebar.] 

A 'human' reading (still) makes me wonder if the 'answer' is what I want to hear (as a user)? Is it worrying that the first provides a 'Conclusion' the latest does not. The table is helpful as I believe that Hodges' model has a role across research (and political!) -isms through methodologies and methods. The model can also encompass ('eat'!) aspects of scale, or level.

The reply still gives me quadraphonic joy (if read out-loud). Not only are the domains recognised, but the LLM/agent ai takes the intrapersonal / interpersonal in its stride (from the blog?). Subjects related to each of the domains are given in brackets. 

There is of course a bias (several) in the prompt, as the care domains were never intended to be comparable. It is positive that each domain is seen as having its own specific scope and function. Over twenty years notes were started on a paper on Hodges' model and its role/function in helping to define 'scope of practice'. Significantly, in the UK the rise of associate positions across disciplines has provoked much debate, vitriol (on X and union and lobbying) and soul searching in certain professional groups. Given the increasing importance of the global health and social care workforce this trend is reflected globally. A situation set to be extended with uncertainties and tensions exacerbated by artificial intelligence in practice.

Before 'explaining' the asymmetries (in points 1-4) it seems the domains are complementary (for all their differences), and provide a holistic underpinning for the model as a whole (my reading).

1. Scope and Focus 

Interesting, how the science and sociology domains are described as broad. Perhaps I am underestimating the depth/density of sociology, after all folk theory is found there? Unfortunately, we can also add a myriad of conspiracy theories? Sociology can also lay claim to quite a few constructions of its own. Including aesthetics as a bridge to architecture and design(?).

On 'X', Hodges' model has been described negatively as inviting / fostering generalism. So, this is a bad thing? Is it not strange then that your Advanced Nurse Practitioner, Consultant doctors (all specialities) and students cross-curricula can all use Hodges' model? The fact that my own responses were never engaged has helped train my thought. Here the relevance of the model to students and continued professional development is made through generalizable knowledge.

The response to the political domain is supportive, acknowledging resource allocation and the distinction between individual and collective (see for example):

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model, Journal of Public Health Dentistry. 1–14, https://doi.org/10.1111/jphd.70034.  

I've seen tweets today regards IQ reductions in younger people. This is one reason for support of the top-left mental domain being designated as 'Intrapersonal – Interpersonal'. Our interpersonal skills and awareness are surely dependent upon our achieving a given level of inner mental life? Encouraging to see how subjectivity and objectivity is assigned too. Although, I think I'm in an echo chamber!

2. Epistemological Differences

In arguing for a model of health and social care that goes beyond:

• medical model;
• bio-medical model;
• bio-psycho-social model.

Reading 1-2 from the perspective of the Intrapersonal – Interpersonal domain you see how limiting this is, if an individual in a mental health/illness/mental capacity context can only point to sciences and sociological domains. Indeed, they may be relying guardians and advocates as they are unable to does this and raise the political matter of their rights. Without the POLITICAL domain (or as a result of it - neglect, structural racism) there is no law enshrining independent advocacy...

3. Practical Application in Care

To care is to act. Think about triage and emergency response.

Now in the 21st century 'care' must include self-care, health and social care, and (delayed or not you decide?) planetary care.

This necessitates a change of mindset at an individual and collective level. Consider the literacies that (again) young people must master to be effective, productive and happy citizens tomorrow?

So the following is a gift (in my eyes): 

"This means the intrapersonal-interpersonal domain is not just another 'content area' but a lens through which all other domains are experienced and integrated."

4. Hierarchy of Integration

'While the domains are conceptually equal in Hodges’ model' ..

This is interesting in itself.

[There does seem a emphasis upon the Intrapersonal – Interpersonal domain in this answer?]

This is quite a step, as the idea of a nexus and integration are picked up; and pointing to what are the determinants of health:

'For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.'

I'm pleased I did this, as long as I'm not being trapped in an epistemological cocoon: otherwise known as a circle. Apart from a few occasions, I have not used AI/LLMs, perhaps it is time to explore more? I'd like to preserve my naivety, especially were maths is concerned. I'm not sure of what baggage I may pick up and lack the knowledge to interpret?

Previous post:  https://hodges-model.blogspot.com/2026/06/h2cm-domains-symmetry.html

Reference [ii] "Practice in forensic psychiatry: A proposed interdisciplinary model"

Practice in forensic psychiatry:
A proposed interdisciplinary model

Expanding on the post about a further reference for Hodges' model:

Holmes, D. Perron, A. Jacob, J.D. Paradis-Gagné, É. & Gratton, S (2018). Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire. Recherche en soins infirmiers, (Practice in forensic psychiatry: A proposed interdisciplinary model). 134, 33-43. DOI: 10.3917/rsi.134.0033

Here, and on twitter I have sought to stress the limitations of the biopsychosocial model in healthcare, and I value Holmes et al. recognition of Hodges' model as politico-biopsychosocial. 

The authors also identify the structural nature of the model.

 

In comparing 'models of care' there is the question of whether Hodges' model is a model of care. As a generic conceptual framework Hodges' model can of course be used in the health care (as per its original design and creation) but it can be used to compare models of care.

Below, translated by Google are the models used in the paper.

I have altered the listing bringing the Tidal and Recovery model s together. Some I've 'mapped' in pairs, using formatting to indicate the differences.

Tidal Model

"The Tidal Model is a humanistic nursing model of recovery developed by Barker (12) with the premise that the person with mental disorder has strengths, abilities, personal priorities and a future ahead (13). This model of care, popular in forensic psychiatry circles, recognizes certain deficits of the hospitalized patient but it is especially interested in the meaning that the latter attributes to them. The sick person is the expert in his life and is therefore the one who contributes the most to his own recovery. This nursing perspective is therefore centered on the phenomenological experience (lived experience) of the patient and on the role of the staff, which is to allow healing and restore hope (12,14)."  

Recovery Model

"A popular model in mental health care, the recovery model is increasingly gaining ground in psychiatric care settings (28). The postulates of this humanistic model state that anyone, including those suffering from mental disorders, can aspire to a fulfilling future, participate in rewarding and inspiring activities, self-determination and finally, be able to live in an environment free of stigma and discrimination (29). The peculiarity of this model lies in the fact that recovery is part of a process where the person with mental illness can continue to show symptoms while being able to adapt to their condition (often chronic) and pursue their goals. life (30)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

recovery strengths, abilities, personal priorities deficits healing and hope phenomenological - (lived experience) personal responsibility fulfillment - life goals patient as expert personal adaptation living with x,y,z... coping strategies	place as context my future deficits signs - symptoms chronicity Institutional settings clinical - hospital
humanistic - human qualities social expectations social contribution participation - social inclusion free from stigma deficits	Institutional settings politics of recovery free from discrimination forensic deficits

<>

Integrated Practice Model

"This model was developed by Virginia Lynch, a pioneer in forensic psychiatry, and it guides the role of practicing staff in this care setting (15). There are three main theoretical foundations: 1) the fields of expertise involved (nursing, criminal justice and forensic science), 2) the health system (victim and offender, health care and forensic nursing ) and 3) the social impact (social sanction, human behavior, crime and violence) (16). According to this model, patients should be cared for using an interdisciplinary and holistic approach (15)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

nursing forensic psychiatry 2. health system interdisciplinary holistic OFFENDER	nursing theoretical foundations forensic science 1. fields of expertise 2. health system interdisciplinary holistic
VICTIM role of practitioners 2. health system 3. social impact (social sanction, human behavior, crime and violence)	criminal justice 2. health system

<>

Model of Nursing Interaction

"This model of care includes six categories of forensic nursing interaction with the goal of establishing a relationship with the patient: establishing and maintaining a relationship (relationship based on honesty, respect and trust), encouraging and support interactions (help the patient to recognize his qualities and use his resources), the learning of social skills (encourage the patient to do social activities and talk to others), reality orientation (help the patient patient to be aware of his way of being and of acting), reflective interactions (the perception of the patient and his problems) and the learning of practical skills (encouraging the patient to develop good lifestyle habits) ( 17,18)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

patient qualities, resources reflective interaction self-perception of problems reality orientation awareness of way of being and of acting	practical skills develop lifestyle skills
reality orientation learn social skills develop lifestyle skills encourage social activities talk to others	encourage and support interactions reality orientation perception of patient and problems

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Healthy Living Program

"This model was developed in response to metabolic syndrome and physical illnesses that may develop in people with severe mental illness (19). It includes programs related to health promotion activities such as weight reduction, smoking cessation, physical exercise, etc. It is a voluntary approach that not only improves physical health, but also independence and recovery. For the program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team."

[ PARITY OF ESTEEM ] 

mental health - metabolic syndrome physical illnesses

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

independence recovery voluntary approach	(physical) health promotion activities such as weight reduction, smoking cessation, physical exercise,
independence recovery	voluntary approach for program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team

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Holistic Model

"This model is used in forensic care in the assessment, health care and psychotherapy of patients with personality disorder (22). Holistic care includes the physical (diet and exercise), cultural, spiritual, and psychosocial needs of the patient. This model is based on problem solving, anger management and decision making. Caring is a central concept in the holistic model and is actualized in an emotional, psychosocial, constant and authentic caring response (23). It is for caregivers to be present for the patient, to respect his situation, to understand his experience and to demonstrate a desire to help."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

holistic care personality disorder [mental] health care psychotherapy assessment emotion problem solving, anger management decision making actualized psycho-	holistic care 'caring' assessment diet, exercise health care 'being present'
-social culture holistic care 'being present' constant and authentic caring understand person's experience respect person's situation desire to help	forensic care holistic care desire to help (also exemplified in the organisation?)

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Good Lives Model

"This model focuses on the offense committed by the mentally disordered offender, his recovery, the promotion of personal goals, the reduction of the risk of reoffending, and the treatment of mental illness (24,25, 26). The model favors an approach based on the strengths of the patient. In addition, mechanisms of change are present, that is to say that behaviors judged to be poorly adapted are replaced by adapted behaviors when the patient is equipped with the skills, resources and support provided by the nursing staff. This model contextualizes the offense, focuses on the symptoms of mental illness while conceptualizing both as inappropriate behaviors.This model helps to better understand the relationship between mental illness and crime in order to create an individualized plan of care."

Risk-Need-Responsivity Model

"This model (27) imported from the correctional environment was adapted to the psycho-legal context by the addition of the “mental illness” dimension. It was developed primarily to reduce the risk of recurrence. Care interventions are geared towards the identification and treatment of criminogenic factors. This model is based on three major principles: the risk principle (granting the highest level of resources to the group most at risk of crime), the needs principle (identifying dynamic criminogenic risk factors and targeting them in treatment) and the principle of receptivity (adjusting programs according to the characteristics of the person: learning style, motivation, strengths, etc.) (24,25)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

mentally disordered (diagnosis) recovery characteristics of the person learning style (evidence?) motivation, strengths 3. principle of receptivity treatment: skills, resilience personal goals “mental illness” <-> crime recurrence individualized plan of care	1. risk principle -> resource allocation recurrence treatment 2. dynamic criminogenic risk factors  support of nursing staff
treatment [social determinants?] mechanisms of change adapted behaviours inappropriate behaviours recurrence	offense reoffending correctional environment contextualise the offence treatment principles [policy] recurrence

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Hodges' Health Career Model

"This model has a politico-biopsychosocial structure which is consistent with contemporary interdisciplinary practice (20); that is, it relies on a multidimensional critical approach, incorporating writings in sociology and politics, in order to understand the person in context. It is based on four objectives: measuring learning, providing holistic care, supporting reflective practice and closing the gap between theory and practice (21). This model is applicable in various clinical situations in a psycho-legal context. When this model is used as a frame of reference, it emphasizes the role of caregivers who must meet the patient's needs and focus on their problems. It also serves as a guide to assess and provide assistance to the patient vis-à-vis their physical, psychological and social needs as well as with the justice system in order to promote their recovery. The theoretical foundations call on four sources of knowledge: interpersonal, scientific, sociological and political (21)."

The PERSON in Context 

(situated)

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

INTRAPERSONAL INTERPERSONAL reflective practice conceptual structure psychological needs measure of learning psycho-	SCIENTIFIC physical needs theory-practice gap
SOCIOLOGICAL reflective practice (develop self-awareness) social needs practice-theory gap	POLITICAL justice system (needs) -legal

[ all embedded within the SPIRITUAL ]

Not just 'problems' Hodges' model can incorporate any desired stance, perspective or philosophical approach - strengths, disease, skills, weaknesses or deficits, psychosocial for example.

I am not sure about explicitly 'measuring learning, but the model can be used by learners and teaching staff / mentors to demonstrate their understanding and justify their output - formulation.

There is an instrumental potential in Hodges' model as a whole. Hodges' model can illustrate the degree of holistic intent - whether this is realised could also be indicated using the model.

Once again I am grateful to the authors for their inclusion of Hodges' model. The reference is listed in the blog's bibliography (please see the sidebar for others) which includes:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.

See also on W2tQ (with overlap):

https://hodges-model.blogspot.com/search?q=forensic

https://hodges-model.blogspot.com/search?q=justice

https://hodges-model.blogspot.com/search?q=interdisciplinary