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Therapeutic communities (and many other residential services) have been effectively marginalised in recent years with the increasing popularity of community-based outpatient responses to a variety of social issues including addiction, learning difficulties, mental health issues, etc. The paper aims to discuss this issue.

This has inevitably led to a low profile and has resulted in a lack of knowledge about therapeutic communities and how the methodology differs significantly from other approaches.

This situation is beginning to change in a number of fields and it is important that the therapeutic community movement adapts its methodology to the needs of their respective client groups and clarifies its approach (and the efficacy of that approach) to funders and service commissioners.

This paper is a personal contribution.

The purpose of this paper is to describe the use and value of therapeutic communties (TCs) in services for people with intellectual disabilities (IDs) and complex needs.

A structured literature review of TC in ID services.

TCs have been used in a range of in-patient services for people with IDs. Although outcome studies are scarce, those that exist offer promising indications of such service designs.

TCs have seen a recent increase of interest in ID services. This paper provides an overview of these services and outlines the benefits that such a residential culture can offer for both service users and staff members.

The purpose of this paper is to investigate the views of young adult prisoners with emerging personality disorders (PDs), who were assessed as posing a high risk of causing serious harm to others, on the process of therapeutic change in a non-residential treatment service in a UK young offender institute. The treatment model utilises an integrated approach, specifically adapted for the developmental needs of young adults and combining therapies for PD with offence focussed interventions and regular keywork.

In total, 13 participants, who had completed at least one year of therapy, were interviewed about their perspectives about what, if any, change had occurred and how any reported change had taken place. The interviews were transcribed verbatim and analysed via thematic analysis.

All participants described having made positive therapeutic change. Three overarching change themes were identified: mentalisation of others, self-knowledge and adaptive coping. Relationships with staff were described as the key mechanism through which change was achieved. Specific treatment interventions were mentioned infrequently, although keywork and generic individual therapy and groupwork sessions were also described as drivers to change.

The findings suggest the possibility of positive therapeutic outcomes for this complex service user group. They also suggest that the domains of change and associated mechanisms may be similar to those reported for other service user groups and in other settings.

The purpose of this paper is to report on the point of view of architecture of an interdisciplinary research on housing and social integration of people with severe mental disorder (SMD) in Brazil after deinstitutionalization. It first aims to present the need for a qualitative evaluation of the way people with SMD deal with their living spaces (house and city); then to describe the method adopted to approach people living under control – in therapeutic residential services (SRTs) proposed by the State as the only alternative model for those leaving psychiatric institutions – and people living alone – with little psychiatric assistance and no dwelling support provided by the State. It aims to conclude with a discussion of the observed dwellings pointing towards the need to accommodate differences in any housing model adopted by the State.

The qualitative evaluation enabled the focus of participant observation on the way people interact with each other and with their living space. The authors followed the routines of chosen people with SMD in three different cities in Brazil and provided reports for the whole group to analyze them.

It was found that those living in SRTs are much more obstructed by institutional control than those living alone. Despite the difficulties and fragilities of those living alone because of the lack of support, they end with more possibilities for autonomy and social integration.

Most research on the subject approaches objective housing issues focusing on statistical results. This research evaluates qualitative dwelling issues, summarizing little pointers for future health policy on housing for people with SMD.

In the desire to improve outcomes for children in care, the issue of those individuals placed by local authorities in residential establishments run by external agencies has become especially salient. In addition to questions of quality and value for money, there are concerns about children becoming detached from local services, especially as many of the placements selected are outside the local authorities' geographical boundaries. This study looks at 262 children so placed in eight English local authorities. It was found that although there were common presenting problems, such as a need for specialist therapy or to reduce difficult behaviour, the children's circumstances varied and four distinct groups of children with common needs were identified. The use of such placements also varied across the authorities and did not mirror their numbers of children in care. The factors associated with the use of externally purchased residential placements and differences between those placed internally and externally are explored. A framework for developing new approaches for difficult adolescents and suggestions about fruitful service development are offered.

Developing therapeutic community (TC) programs in Australia for individuals on opioid substitution treatment (OST) has been a process spanning 16 years for the We Help Ourselves (WHOS) organization. Supported reduction of OST and stabilization services for those remaining on OST are offered to this population and continue to break down barriers of discrimination in offering the same services to all drug using populations. The paper aims to discuss these issues.

A number of research projects have been undertaken with the WHOS Opioid Treatment Program (OTP) TC services profiling clients accessing the services; looking at health benefits whilst in the programs; looking at retention and completion rates and conducting an evaluation post-treatment for one of the two programs currently being offered.

The excerpts from the research findings are presented identifying the complexity of individuals accessing WHOS services; highlighting the benefits for individuals on OST and assessing the effectiveness of the TC model for the client groups.

Working with multiple complex needs clients on OST in a residential TC environment offers many challenges and opportunity to work with an array of issues that present before during and after the residential stay. Provision of a history and overview of the WHOS OTP TC services and recent enhancements to these programs highlight a continuum of care for the individual on OST.

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.

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.

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.

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).

The purpose of this paper is to explore the applicability of the Australasian Therapeutic Communities Association (ATCA) Standard to Australian youth-specific modified therapeutic communities (MTCs). An Interpretive Guide for Youth MTCs and Residential Rehabilitation (RR) Services was developed and a pilot trial conducted with three Australian youth MTC services.

Using a mixed-methods design, this study included three components: a consultation process with residential youth MTCs (N=15), which informed the development of the ATCA Standard Interpretive Guide for Youth MTCs and RR Services; a pilot trial of the materials with three Australian youth MTCs (N=53); and an evaluation of the interpretive guide and assessment of applicability of the ATCA standard to youth MTCs through pre- (N=32) and post- (N=19) pilot trial administrations of the Survey of Essential Elements Questionnaires (SEEQ), and post-pilot trial focus groups (N=21).

Results indicate that the ATCA Standard is applicable to youth MTC settings when applied with the Interpretive Guide, although no significant differences were found between the pre- and post-pilot trial administrations of the SEEQ.

Future research is recommended to explore active mechanisms of youth-specific MTCs, differences between adults and youth MTCs, and the development of TC-specific training.

To date, no standard for youth residential substance use services in Australia has been developed, and this is the first study of its kind internationally to explore the efficacy of standards in a youth MTC.

The purpose of this paper is to improve current evaluation designs for Indigenous Australian residential alcohol and drug treatment centres, by understanding the context of treatment in this modified TC context. The aim of the research is to present an analysis of the key features of treatment associated with four Indigenous Australian alcohol and drug treatment centres, as expressed by staff working in these centres.

Ethnographic observations were made at each site between 2008 and 2009 with the first author attending treatment groups, education sessions, staff meetings and other events. The first author conducted informal conversational discussions with all programme staff and board members. In addition, 23 staff and 15 board members participated in a semi-structured interview with an emphasis on gaining views on the essential elements of residential alcohol and drug treatment, potential barriers to effective treatment delivery and “what works” in residential treatment.

A number of key themes emerged, including the importance of the flexibility of programmes to include a wide variety of treatment approaches, the importance of culture (although defined differently) in the delivery of appropriate service, provision of safe spaces that allow for clients and staff interaction, the potential for improvement in the provision of effective client case management, the need to reduce job-related stress through staff professional development and organisational culture change and the need to address the difficulties experienced in the provision of effective aftercare.

Currently, there is very little evidence related to Indigenous Australian approaches to the treatment of alcohol and drug misuse. The paper contributes to the understanding of the key features of treatment delivery, as identified by staff employed in drug and alcohol residential treatment. This understanding is vital so that government agencies can provide appropriate funding to areas of need for treatment services.

The purpose of this paper is to present an update on the Ealing Intensive Therapeutic and Short Breaks Service (ITSBS).

The challenges the service has faced are reviewed, including the service’s response to those challenges. Also provided is a more detailed analysis of the outcomes of the service.

The ITSBS continues to succeed in supporting young people with intellectual disabilities and challenging behaviour to stay at home with their families.

Despite considerable challenges and adaptations to the model, the ITSBS is still achieving successful outcomes for vulnerable young people and is considered nationally to be a best-practice model. Few prior articles have provided an account of how innovative service models are maintained and evolve over time.