Model of Care
At Care in Mind, our specialist model is designed to provide a unique, integrated approach to mental health support within a residential setting. The aim of our services is to:
- Promote independence
- Promote social inclusion
- Build resilience
- Support young people in rehabilitation and recovery
- Support engagement in community, educational and vocational activities.
Our residential staff teams undertake considerable training to support them in managing complex mental health issues effectively, with specialist support provided by our team of clinicians.
Every young person has an allocated clinical nurse specialist and clinical psychologist and is under the care of a consultant psychiatrist. Each nurse and psychologist works across two homes, with a maximum caseload of 10 young people. This enables timely, individually tailored interventions to be delivered to young people, whilst ensuring robust engagement and involvement with the wider MDT and residential team to ensure continuity and consistency of care for all young people.
This approach enables us to support young people with high levels of complexity on their recovery journeys, through safe and clinically effective residential care.
Structured Clinical Management is an evidence-based multi-modal intervention combining individual and group sessions. At Care in Mind have we adapted SCM for adolescents (SCM-A). SCM-A aims to support young people to learn and implement skills in relation to:
- Managing relationships
- Tolerating emotions and impulse control
- Self-compassion and soothing
SCM-A is underpinned by attachment theory, which supports young people in a framework that allows them to understand and change the way that they experience and manage their difficulties. In the first three months, the focus is on safety planning, building attachment in the therapeutic relationships and collaborative goal planning. This phase also includes psycho-education and socialisation to SCM-A. Ongoing work is multi-modal with group and individual sessions with highly trained clinical nurse specialists and clinical psychologists.
Group Work: Group sessions focus on developing the skills outlined above. Young people benefit from the shared experience in a group setting, supporting each other to problem solve and learning from each other as well as the clinicians leading the sessions.
Individual Sessions: Each young person has weekly clinical nurse specialist sessions that support the group work. The individual sessions aim to help young people to identify their current problems, encouraging a problem-solving approach using skills learnt in the group. The clinical nurse specialist also works with the residential team to reinforce and encourage the use of the skills learnt through SCM-A.
The Aims of SCM-A
The aims of SCM-A are to help service users to:
- Use services more effectively
- Develop better understanding of their internal states of mind
- Learn and practice skills to help them manage their emotions, impulses and relationships
- Develop vocational activities outside of mental health services and work toward independence
The psychology team work in an eclectic way drawing on a range of evidence-based approaches, working with young people on an individualised basis to find the best approach for them based on their needs and placement goals. All our psychological interventions are informed by individual clinical formulation and are delivered in line with NICE guidelines.
Our Staff Are Our Most Valued Resource
At Care in Mind, we recognise the value of all our staff in delivering therapeutic care to the people we support. We believe that it is by valuing our staff highly that they will, in turn, provide the high-quality care and support for young people that we expect them to receive. We also realise, however, that many of the young people we support have complex and often relationally based needs which make them challenging to engage with and to support. We, therefore, consider it essential that we provide a high level of support and training to staff, based on specific approaches that we believe will equip them to work with our complex and challenging clients.
The Boundary See-Saw Model
We use an approach called the Boundary See-Saw Model in a number of settings in supervising staff and during team reflections. The model helps teams and individual staff to reflect on relational boundaries, exploring the roles that staff, young people and carers can adopt in the difficult processes that arise around finding a balance between the need for care versus the need/wish to control (security). The model creates a shared language between staff and service users, to help everyone to understand the inevitable dynamics and boundary issues that arise all the time between carers and clients, particularly where there are significant risks and interpersonal difficulties.
The model helps individuals and teams to develop a heightened awareness as to when there are significant shifts away from the expected ethos of a comfortable balance between the Care and Control domains in relating positions between carers and young people. In turn, it provides a useful and non-threatening structure to support discussions and shared understanding and responsibility for shifts that may be identified and the development of collaborative plans to redress the balance in a healthy manner.
Team Support Structures
- Staff Support Groups
- Reflective Practice Sessions
- Post-incident Debriefs (with young people and staff)
- Clinical Supervision
CIM Training Academy
The Academy was developed to ensure staff are well equipped with the appropriate knowledge and skills to carry out their duties effectively and to support the aims and objectives of the Care in Mind Model of Care. All staff complete Mandatory and Statutory Training as a norm but are free to enhance their studies by completing NVQs which takes their training to the next level and supports their personal development and opportunities for career progression within the organisation. Successful candidates are invited to attend an annual Awards Evening when, along with members of their family as well as colleagues, we can all celebrate their achievements.
Effectively managing risk is essential to our model of care. Least restrictive practice and a therapeutic risk management approach are central in how we work with young people. We approach risk management in a collaborative way with our young people, co-producing risk assessments using the STAR risk assessment tool.
Our aim is to support young people when taking risks for a more positive long-term gain, helping them to learn the skills to control their own emotions and behaviour and ultimately develop the responsibility to manage their own risks.
Safewards is an evidence-based model that identifies factors influencing rates of conflict and containment and considers a range of mediating factors and interventions to support service users that may influence the dynamic. At Care in Mind, we have worked with the creators of Safewards to adapt it for the residential setting.
The model identifies ten key interventions to support staff and young people that are evidenced to have a significant impact on the reduction of conflict and containment:
- Soft words
- Talk down
- Positive words
- Bad news mitigation
- Know each other
- Mutual help meetings
- Soothing methods
- Clear and mutual expectations
- Discharge/positive messages