1. National Children’s Commissioning and Contracting Training Conference An Integrative Quality System for Positive Environments for Children and Young People Sarah Paget and John Turberville

2. Workshop Plan 1045-1100Introductions and Introduction to Positive EnvironmentsSarah 1100-1115Psychosocial Care, what does it look like; from EEs to TCs John 1115-1140 How do we recognise healthy environments? What should we be looking for? ALL 1140-1155 Standards and Methods for QI and QA Sarah 1155-1200Any Questions?

3. Who are we? Sarah Paget – Programme Manager of the Community of Communities and Enabling Environments John Turberville – Director of Residential Services at Mulberry Bush School and Chair of the Community of Communities

4. Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) Manages a range of national initiatives Engages directly with clinicians and other front line staff and managers Supports them to take responsibility for improving local mental health services More than 90% of mental health services in the UK participate in one or more of these initiatives 22 projects http://www.rcpsych.ac.uk/quality/quality,accreditation audit.aspx http://www.rcpsych.ac.uk/quality/quality,accreditation audit.aspx

5. Positive Environments: Draft Principles Staffing – Attention is paid to rates of staff sickness, and if this rises above national benchmarking action is taken to bring the rates down. – There is a stable staff team. – Staffing ratios conform to national minimum rates – Workforce development: staff are able to access graduate and post graduate courses, and professional development is encouraged. Staff are encouraged to consider the effects of the work on them Children and Young People are managed in the least restrictive environment possible to maintain safe practice. Risk management prioritises the thoughtful use of positive risk taking over defensive risk minimisation The environment is planned in order to promote the psychological health of Children and Young People Treatment/Care and management is psychologically informed and led by psychologically or developmentally trained staff, and focuses on relationships and the social context in which people live

6. Positive Environments (cont) Communication is prioritised Children and Young People are able to feed into the way the service is organised through a mechanism that is not complaint based Policies explicitly prioritise face to face contact over record keeping and form filling. The effects of the behaviour of staff and Children and Young People on others using the environment is regularly considered All staff and Children and Young People are encouraged to participate in how the service is run Staff and Children and Young People treat each other with respect and mutual concern Distress and/or behavioural disturbance are seen within the context of environmental and relational factors.

7. Positive Environments Quality Networks at CCQI Community of Communities Enabling Environments In development: Therapeutic Child Care

8. Enabling Environments / Therapeutic Child Care Settings or Therapeutic Communities Enabling Environments Therapeutic Communities Therapeutic Child Care

9. people feel safe enough to develop relationships and share experiences and ideas with others. everyone can get involved in deciding what matters and they are encouraged to try new things and test out new ways of working Leadership supports allows the taking of risks and is open to new idea's and relationships. 10 Standards set across 10 areas – Belonging, Boundaries, Communication, Development, Involvement, Safety, Structure, Empowerment, Leadership and Openness these can be schools, wards, day units, supported accommodation, working environments or neighbourhoods Enabling Environments There is a clear psychosocial model of practice that links recognised theory and practice delivery. Governance and leadership is appropriately qualified and functions to support the stated practice model, and staff are trained to deliver it. The therapeutic environment and programme delivered is in the stated practice model. The organisation evaluates its success in relation to delivery and outcomes and uses this information to improve the work of the organisation Standards set across 8 areas: Statement of Principles and Practice, Staffing, Therapeutic / Care Program and Framework, Care Planning and Transitions, The Physical Environment, Safety an Health, Governance and External Relations Therapeutic Child Care Settings Structured, psychosocially informed environments focus on the therapeutic value of social and group process. Models of practice are clearly stated linking theory and practice with staff and leadership being trained to deliver the stated Therapeutic Community model. Community members include staff and residents working together in the groups for the benefit of the groups and the community. 10 Core standards and then 18 standards across 4 areas: Staff, Joining and leaving, therapeutic framework, external relations and performance, Therapeutic Communities

10. Quality Networks Standards for Best Practice Peer review – Engagement not inspection – Encourage Shared Learning Networking Local Reports National Benchmarking

11. Quality Networks, Accreditation and Quality Marks

12. Benefits of Membership 1.Assists purchasers in distinguishing between placements: Standards provide clear framework of “added value” above National Minimum Standards 2.The standards provide an evidence base for practice both internally and externally 3.The annual cycle ensures that practice is continually under review both internally and externally 4.It allows fully integrated, multi disciplinary work to operate within a framework of common language and measurement 5.Helps develop stronger links between Theory and Practice

13. Community of Communities TCs for Children and Young People: 38 Accredited TCs: 7 In accreditation process: 2 Number full members: 22 Number of developmental members: 6 Number of associate members: 1

14. It felt very reassuring to have visitors come and recognise the good work we do. It gave us the feeling that what we are doing, we are doing well and that this is valued It was a tremendous experience being able to go on the peer-review. It felt very uplifting to see such a good service and see such fantastic techniques. Our visit to another TC generated an awful lot of discussion once we fed back our experiences to the rest of the staff team Doing the self-review workbook was great as it gave the whole staff team the opportunity to come together and reflect on our methods. We turned the day into a staff training day and everyone got involved

15. Enabling Environment 100+ Members Majority criminal justice, including YOI 3 Children's services Interest from schools and residential children's homes 14 awards EE = Healthy psycho social environment 10 Simple Standards and Criteria Methodology does not include peer-review

16. Therapeutic Child Care Recognising not all Therapeutic Environments are Therapeutic Communities Quality Improvement methodology and tools for services that provide a planned, psychosocial environment Standards for Best Practice Methods to support shared learning

17. Further Work Developing Enabling Environments relevance to services for Children and Young People Develop cohesive framework which integrates different theoretical and practical approaches to psychosocial practice Developing Integrative System linking networks and methodology QI tools to support quality improvement and service development

18. ?

19. Sarah Paget Programme Manager spaget@cru.rcpsych.ac.uk John Turberville Chair of Community of Communities jturberville@mulberrybush.org.uk www.communityofcommunities.org.uk www.enablingenvironments.com