Simone Bruschetta's Lab
About the lab
Il Progetto Visiting DTC, un programma italiano di miglioramento e accreditamento di qualità scientifico professionale dei i servizi residenziali e abitativi per utenti adulti e minori della salute mentale, basato sul modello Teorico Scientifico della Comunità Terapeutica Democratica, e sulla valutazione di quello specifico aspetto metodologico dei Servizi definito consensualmente “Qualità Gruppale Comunitaria”. Esso è condotto con una specifica metodologia denominata Democratic Peer Accreditation basata su visite reciproche, gruppi di formazione e audit di controllo, e sull'attivazione di una circolarità virtuosa tra clinica, valutazione e formazione. I Servizi membri del Progetto vi partecipano aderendo a sub-progetti specifici di dimensione variabili dal locale o interregionale.
Featured projects (3)
Scenodrama is a group psychotherapy for young autistic, psychotic or hyperactive children, or those suffering from problems of emotional attachment or post-traumatic troubles. Scenodrama is designed for children of 4 to 8 years with pathologies of the psychic container. The method has been designed to ensure secure containment of the group favouring the process of symbolization. Scenodrama is also designed for single-parent families with young children, mostly in post-traumatic situations: separation, bereavement, abuse… Scenodrama was created in the 1990s at the Guillaume Régnier Hospital in Rennes, France, by Brigitte Baron-Préter, who is a clinical psychologist and a group and family analyst. The therapy was first used in outpatient clinics, then in a Medico-Psychological Consultation at the University Hospital Child and Adolescent Psychiatry Unit run by Professor S. Tordjman (previously by Professor Ph. Dardenne). L'Associazione Italiana Scenodramma è una Associazione di Promozione Sociale per la cura del disagio psichico in età evolutiva, essa è senza scopo di lucro, con fini culturali e scientifici, con intendimenti di solidarietà sociale per la tutela, la promozione e la valorizzazione della diffusione di pratiche terapeutiche e di prevenzione dei disturbi psichici. http://www.scenodramma.it
"Visiting DTC Project" is an Italian Scientific-Professional Accreditation Program which is aimed at those methodological aspects of the quality for Residential and Housing Services of Mental Health identified as a Groupal and Communitarian Quality. Visiting DTC Project is conducted through the involvement of the main stakeholders (Users, Family, Operators and Managers) and has the scientific professional patterns reference on the Democratic Therapeutic Community and on the Community Mental Health. The Program is composed of n. 3 Visiting Annual Cycles and n. 1 Conclusive Audit. Each Visiting Annual Cycle consists of two parts: the Accreditation Visits of the Therapeutic Communities and Personal Training Course. The two phases can be carried out simultaneously (in the same Annuality) or successively (in two different Annuality). The completion of the route of the three Annual Cycles determines a two type of Certification: 1) Basic Quality Certificate 2) Groupal-Communitarian Quality. Both are Scientific-Professional Quality Accreditation whit an annual validity. After completing the Three Annual Cycles, each Therapeutic Community can request the two type of Final Audit of Accreditation with External Commission. For Certification of Groupal and Communitarian Quality (second level of certification), the evaluation process of each TC participant, is descripted by the Emerging Setting from TC participating, the Compliance and Non-Compliance encountered, the suggestions and corrective actions proposed. The comparison of all the data obtained and the detected assessments (qualitative and quantitative), which took place through the work of the Forum of the “Terna” of TC, led to the identification and planning the exchange of Good Practices. For the consensual choice of indicators on which identify Good Practices of each TC, to be formalized in an Operating Procedure to transmit them to other TCs of the “Terna”, was based on the principle that each TC would build a Good Practice on an Area of Effectiveness (highlighted by statistical analysis, confirmed by the qualitative data collected and recognized in the comparison between all stakeholders) and transmit it to the TC that sees that indicator recognized as belonging to one of its areas of criticality.
Local Community Development constitutes a complex outcome of antecedent and concomitant processes that have to do with the possibility of citizens to access particular social resources which are primarily relational resources, as common goods. These resources, although often intangible, in turn convey other types of resources, of a positional, economic, symbolic, political and cultural type. The measurement of the development of these relational resources through macroeconomic indices that take into consideration all aspects of the quality of life contexts and social relationships of each individual today represent the frontier of modern psycho-socio-economic research. Lo Sviluppo Locale Comunitario costituisce un outcome certamente complesso e di difficile articolazione di processi antecedenti e concomitanti che hanno a che fare con la possibilità dei cittadini di accedere a particolari risorse sociali che sono innanzitutto risorse relazionali. Tali risorse, benché spesso intangibili, veicolano a loro volta risorse di altro genere, di tipo posizionale, economico, simbolico, politico e culturale. La misurazione dello sviluppo di tali risorse relazionali attraverso indici macroeconomici che tengano in considerazione tutti gli aspetti della qualità dei contesti di vita e delle relazioni sociali di ciascun individuo rappresentano oggi la frontiera della moderna ricerca psico-socio-economica.
Featured research (8)
Closure of the forensic psychiatric hospital (FPH) and opening of the therapeutic residential facility for execution of security measures (RESM). Ten years ago, on the Italian sociopolitical horizon, the need to complete the process of legislative reform that led to the closure of the psychiatric hospitals was delineated, which commenced with the ‘Basaglia’ law in 1978 ( Basaglia, 1982) , starting a process of transformation of legislation on security measures for those citizens with mental disorders, which led to the closure of the ospedali psichiatrici giudiziari (OPG). OPGs are old ‘forensic psychiatric hospitals’ (FPHs) reserved exclusively for the detention of psychiatric patients, previously called ‘criminal asylums for insane off enders’, created during the fascist regime, which have always remained separate from the NHS and under direct authority of the Ministry of the Interior. The years 2008– 2017 were referred by Italian civil society as the decade of the ‘gentle revolution’, to use a definition coined by the single commissioner for overstepping the OPGs, Franco Corleone ( Corleone, 2016 ). The political and social process of this ‘gentle revolution’ finally ended with the establishment of residenze per l’esecuzione delle misure di sicurezza (REMSs) for people with mental health disorders who have committed an offence, in which prisoners would officially become patients of the local community mental health department like all other Italian citizens, as institutionally assisted by the NHS. REMSs are therapeutic ‘residences for the execution of security measures’ (RESMs) for users with severe mental illness.
Nell'ultimo decennio le Comunità Terapeutiche, le strutture residenziali ed i servizi domiciliari di sostegno all'abitare stanno ricevendo una nuova e maggiore attenzione da parte di governi, delle organizzazioni senza scopo di lucro, come da parte delle società scientifiche e di tutti gli stakeholder dei servizi di salute mentale, comprese le organizzazioni di utenti. Con una maggiore consapevolezza dell'importanza di fornire cure e servizi centrati sulla persona, basati sui diritti umani e orientati al recovery, le Comunità Terapeutiche come tutti gli altri servizi residenziali, abitativi e domiciliari in salute mentale si stanno impegnando per fornire sempre maggiore assistenza e supporto di qualità. Per supportare gli sforzi di tali servizi nell'allineare i trattamenti erogati con i diritti umani e gli standard scientifici, negli ultimi anni sono stati sviluppati programmi di networking e accreditamento di qualità scientifica professionale basati sul modello metodologico dell'accreditamento tra pari. In particolare la tradizione inglese ed il modello scientifico metodologico della Democratic Therapeutic Community (DTC) e degli Enabling Environments (EE) hanno ispirato e contribuito a sviluppare programmi di miglioramento continuo di qualità che hanno fornito esempi reali di presa in carico terapeutica attraverso il così detto modello democratico, così come emerge e si va evolvendo nelle pratiche di cura e assistenza valutate bottom-up con la partecipazione di diverse tipologie di stakeholder.
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.
Democratic therapeutic communities developed from psychosocial models: they do not prioritise diagnosis, and they encourage drug reduction as much as possible. Mental health is seen as much as a social and cultural phenomenon as a biological one, with priority given to the interface between the individual and their social and cultural setting. Therapeutic communities involve user empowerment, and the development of a sense of agency; democratisation, through user involvement in the day to day running of the community, and shared decision-making; and peer therapy. Therapeutic communities, both democratic and substance abuse, operate all over the world, in diverse countries and cultures, and have had to adapt to local demand. Living Learning Experience workshops are a UK response to the need for training of therapeutic community workers, and are increasingly being used internationally to train local people to become therapeutic community workers, as well as providing an experience of group processes, and shared living. The purpose of this paper is to demonstrate how these trainings operate abroad, and how they have been adapted to fit with local and cultural conventions.
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. Keywords Therapeutic communities, Psychiatric patients, Groups, Inpatient, Residential, Sociology Paper type Conceptual paper
About Simone Bruschetta
- Simone Bruschetta currently works at 'Progetto Visiting DTC - Democratic Therapeutic Communities '. Simone does research in Mental Health, Social Science, Art-Therapy, Psychotherapy and Social Work. He works as Psychoanalyst in Catania (Sicily).