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Article
Publication date: 12 December 2016

Simone Bruschetta and Raffaele Barone

The purpose of this paper is to present a model of democratic therapeutic community (DTC) for people with a diagnosis of schizophrenia and psychotic disorder, namely the…

120

Abstract

Purpose

The purpose of this paper is to present a model of democratic therapeutic community (DTC) for people with a diagnosis of schizophrenia and psychotic disorder, namely the Group-Apartment (GA). The authors will describe it in more detail, discussing the ideas which lie behind it, considering the relative cost of treating people in larger residential DTCs and in GAs, outlining findings from the first data gathered on a GA and looking at the usefulness of this model in post-modern societies, with particular reference to Sicily.

Design/methodology/approach

In brief a GA is a flat, located in an urban apartment building, inhabited by a small group of people. In this paper the authors consider an apartment inhabited by a group of three or four patients with the presence of clinical social workers who work in shifts for several hours a day on all or most days of the week (Barone et al., 2009, 2010). GA is also inspired by the pioneering work of Pullen (1999, 2003), in the UK tradition of the apartment post TC for psychosis.

Findings

GAs in Italy have become one of the main methods of support housing in recovery-oriented treatment, because it allows the empowerment of the users and fights against the stigma of mental illness (Barone et al., 2014; Bruschetta et al., 2014). The main therapeutic activities provided in the GA depend on the type of recovery route being supported, on the level of autonomy being developed and on the level of participation in the democratic life of the local community.

Originality/value

GAs appear better, cheaper and a more appropriate treatment for mental problems in the current financial and social climate than larger institutions. Where they have been tried out, they have been found to be effective, by users and by stakeholders. They exemplify the advantages of the DTC for encouraging recovery, but cost less to run. In accordance with DTC principles, the social democratic process is used not only to evaluate the clinical effectiveness of GAs, but also to build a network to support the development of innovative mental health services and new enabling environments (Haigh et al., 2012).

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 37 no. 4
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 7 December 2021

Simone Bruschetta

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…

110

Abstract

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.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 43 no. 1
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 15 March 2019

Cinzia Guarnaccia, Anna Maria Ferraro, Maria Lo Cascio, Simone Bruschetta and Francesca Giannone

The purpose of this paper is to present the Italian validation of the standards for communities for children and adolescents (SCIA) Questionnaire, an evaluation tool of…

113

Abstract

Purpose

The purpose of this paper is to present the Italian validation of the standards for communities for children and adolescents (SCIA) Questionnaire, an evaluation tool of communities quality standards, based on the “Service Standards for Therapeutic Communities for Children and Young People – 2nd edition” of the Community of Communities (2009), that enables an empirical, multidimensional and complex evaluation of the therapeutic community (TC) “system”. It is a self-report that sets out and measures variables that allow to get an overview of organisational models and the possible development areas to improve the effectiveness of the protection of child and adolescents in community treatment. The validation and a preliminary analysis to develop a short version of the SCIA are presented.

Design/methodology/approach

The questionnaire (composed, in the extended form, by 143 items) was administered to 101 community workers, 20 males (19.8 per cent) and 81 females (81.2 per cent) aged between 24 and 61 years (M=36.20, SD=8.4). The analysis of reliability (Cronbach’s α) and a series of exploratory factor analysis allowed to eliminate redundant or less significant items.

Findings

The short form of the self-report consists of 67 items, divided into seven subscales, which explore different areas of intervention in TCs. Despite the limitations due to the small sample size, the utility of this tool remains confirmed by its clinical use and the development of good operating practices.

Originality/value

The SCIA Questionnaire responds to the need to adopt empirical variables in the process of evaluation of the communities. The SCIA is also a useful tool for clinical evaluation, as it allows a detailed observation of residential community treatment with children and adolescents that allows to analyse and monitor the structural and organisational aspects and the quality of practices that guide the interventions.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 40 no. 1
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 2 December 2020

Jan Lees, Rex Haigh, Simone Bruschetta, Anando Chatterji, Veronica Dominguez-Bailey, Sandra Kelly, Aldo Lombardo, Shama Parkhe, Joāo G. Pereira, Yousuf Rahimi and Barbara Rawlings

This paper aims to describe a method of training for practitioners in democratic Therapeutic Communities (TCs) which has been used in several settings across the world over the…

137

Abstract

Purpose

This paper aims to describe a method of training for practitioners in democratic Therapeutic Communities (TCs) which has been used in several settings across the world over the past 25 years: the “Living-Learning Experience” (LLE) workshop. It goes on to consider the cross-cultural implications of the work.

Design/methodology/approach

Drawing on the experience of running exactly the same programme in different countries and cultures, the paper examines the cross-cultural adaptability and describes necessary adaptations for local circumstances. It also contains original ethnographic research in UK and Italy; further study is planned for other countries.

Findings

The workshops are readily transferable to different cultures and are appreciated for their democratic and relational way of working.

Research limitations/implications

The ethnographic study examines the workshops in some depth, in UK and Italy, and could usefully be replicated in other countries. No quantitative, outcome or follow-up studies have yet been done, and this paper could contribute to the design of useful quantitative studies.

Practical implications

The paper demonstrates that the LLE is a useful experiential learning tool in widely different settings. It could be developed in different ways, such as for developing relational practice or establishing therapeutic environments in different settings.

Social implications

The workshops' acceptance in widely different cultures indicates that the open and non-didactic format addresses essential and fundamental qualities required for therapeutic engagement and human relatedness.

Originality/value

This is the first description of the principles of democratic TCs being applied across different international settings. Its value extends beyond the TC field, to the use of democratic and relational principles' applicability in therapeutic pedagogy and training.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 42 no. 1
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 24 September 2020

Simone Bruschetta

It is argued that COVID-19 epidemic has critically affected, from many points of view, the hyper-modern economic system, dominant in the globalized capitalist societies. This…

94

Abstract

Purpose

It is argued that COVID-19 epidemic has critically affected, from many points of view, the hyper-modern economic system, dominant in the globalized capitalist societies. This paper aims to describe the point of view of therapeutic communities, basing my reflections on the Italian experience.

Design/methodology/approach

The author would like to share a critical thought on three issues that this pandemic crisis has made manifest in Italian society: the return of the removed bodies, the feeling of excess represented by therapeutic communities and the emergence of the need for a common thought.

Findings

Body become again an object of studies and with it also the group, as grouping of the bodies. Also the community become a now old-object of studies, as grouping of bodies and groups in a human environment. The objectives of this study are presented as the substance of the democratic vision of society, which therapeutic communities have a responsibility to promote scientifically and ethically.

Originality/value

Therapeutic community is presented as transformative and evolutionary for individuals and groups that compose it, as equally conflictual and destructive, both internally and externally. The author thinks this is the substance of the democratic vision of society, which therapeutic communities have a responsibility to promote scientifically and ethically.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 41 no. 3/4
Type: Research Article
ISSN: 0964-1866

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Available. Content available
Article
Publication date: 19 June 2020

Gary Winship

334

Abstract

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 41 no. 1
Type: Research Article
ISSN: 0964-1866

Available. Content available
Article
Publication date: 29 June 2023

Phil Willmot

214

Abstract

Details

Journal of Criminal Psychology, vol. 13 no. 3
Type: Research Article
ISSN: 2009-3829

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Article
Publication date: 15 November 2022

Rex Haigh and Jan Lees

This study aims to describe Italian and UK therapeutic community developments during 1960–2021.

118

Abstract

Purpose

This study aims to describe Italian and UK therapeutic community developments during 1960–2021.

Design/methodology/approach

Historical review and personal experience.

Findings

After significant divergence in the nature of “therapeutic communities”, mostly based on the different sociopolitical contexts in the two countries, areas of formal rapprochement have been emerging in the past 20 years.

Research limitations/implications

The details of how therapeutic communities developed in Italy, particularly in the wake of Law 180, deserves investigation and comparison to the UK and other countries.

Practical implications

The recent collaborative work in quality, training and research could support the future use of therapeutic communities and enabling environments.

Social implications

The underlying principle of “relational practice”, which underlies the therapeutic community approach, could have wider implication in public services beyond mental health.

Originality/value

Much has been written about the progressive intentions of Italian mental health with Law 180, but not with a specific focus on therapeutic communities – which were an important initial impetus for Basaglia and his equipé.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 43 no. 3/4
Type: Research Article
ISSN: 0964-1866

Keywords

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