Cove Care Transitions – Model of Care: The Therapeutic Spectrum

 

This model conceptualizes how we deliver care at CCT. It is envisaged that young people’s needs can be divided into the broad headings of their Safeguarding, Health and Success, and skilled CCT key workers, under the supervision of qualified mental health or therapeutic professionals, will assess these needs and devise specific care plans in each area.

This ‘Therapeutic Spectrum’ is applied to each care plan to establish the level of young person functioning – and therefore the level of staff care and support – that is needed for each of these care plans. For some young people, especially when they are first admitted to a CCT placement, the primary therapeutic goal might be that of maintaining their safety. Levels of staff intervention at this stage will be focused on more short-term approaches, where the young person requires higher levels of staff care and support to help them maintain their own safety of that of others. As this therapeutic goal is achieved, the young person moves ‘rightwards’ along the therapeutic spectrum, through the therapeutic goals of Recovery, Growth and ultimately ‘Achievement’, with more and more autonomy and independence, and a much greater emphasis on the longer term, being incorporated into their care plans.

 

The level and nature of formal therapy will also be informed by the therapeutic goal that the young person is currently at. Psychotherapeutic assessment, brief, supportive and problem-focused work will be delivered at the safety / recovery stages; while more exploratory work, which might include dynamic, Cognitive-Behavioral Therapy or work with a trauma-focus, will be delivered when the young person has successfully built up their resilience levels successfully through the Safety and Recovery stages and are in Growth and Achievement, and able to cope psychologically with such work. 

 

Therapeutic Goals: Operational Definitions

 

Goal

Definition

Level of Support

Therapeutic Modality

Timeframe

Safety

Young person is immediately at high risk of compromised safety involving themselves, others or the environment

Staff-focused, higher interventions e.g. supervising 1:1 / 2:1; supervised access to leave; restricted access to potentially harmful items; young person struggles to take personal responsibility for their care or engage in their multi-agency care plan

General Assessment stage; Supportive psychotherapy; Brief Solution / problem-focused work; critical incident de-brief

Immediate / short term; days – weeks

Recovery

Young person is able to demonstrate absence of compromised safety behaviors over short- medium term (weeks – month)

Reduced staff support (e.g. baseline 1:1 staffing) at 15 minute intervals; increased community time with potential for some free time; more young person responsibility and engagement in evidence

As above, with specific assessments; some areas for treatment / focused work identified

Short / medium term (weeks – month)

Growth

Young person has been successfully maintaining ‘Recovery’ behaviors over medium-term (e.g. 3+ months)

Baseline staff care and support; 30 minute intervals; free time in place and maintained without difficulty; young person takes high responsibility for their care and demonstrates good resilience; good involvement and engagement  with multi-agency care plan

Specific treatment areas; focused CBT / DBT

Medium term (3+ months)

Achievement

Young person has been successfully maintaining ‘Growth’ progress over medium- to long-term (6+ months)

High levels of young person autonomy; free time facilitated routinely; high levels of resilience in evidence and complete responsibility taken for the care and full engagement in the multi-agency care plan

Greater exploratory work, focused CBT / DBT; trauma-focus e.g. EMDR

Medium / long term (6 + months)