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Inspiration Model CARe journey July 2022
The CARe approach was developed in the Netherlands but now has spread all over the world. In English we call it CARe.
The CARe approach is alive in the Czech Republic. For example, trainers / coaches have been trained to teach and secure the Care approach. And every year a CARe Summer School is held: a multi-day event for the CARe trainers and practitioners to discuss the latest and desired developments together.
In addition, there have been several projects aimed to implement Model CARe into practice and improve quality of care. Within these projects employees of various facilities from the Czech Republic visited Nei Skoen from Helmond and other organizations and took inspiration for their own recovery sanctuary.
This year's Summer School was held in Ledce on July 14, 15 and 16. Dirk den Hollander (co-founder of SRH / CARe approach) and Luciano Mafficioli DelCastelletto, (CARe methodology Experience expert) were invited to attend the summer school.
Luciano and Dirk traveled to Prague on 11 July where they experienced a hospitable welcome at Jana’s place. The days preceding the CARe Summer School were used to visit initiatives that work with CARe and to exchange experiences and news from practice.
BONA o.p.s. July 12
On July 12, we visited several locations at BONA o.p.s. (https://www.bona-ops.cz/). BONA is an organization in Prague offering a wide range of services for people living with mental health issues, e.g. sheltered housing, supported living, community mental health teams, IPS, social entrepreneurship, and other recovery initiatives. BONA o.p.s. realized a 2 year comprehensive project to implement Model CARe systematically into practice across the whole organization.
- First we visited villa Alena. Spoken with an enthusiastic team. They already work with CARe Model.
In the morning there are participants in the context of vocational rehabilitation. For instance, by making beautiful articles by blowing glass. Besides that, there are regular working positions in social entrepreneurship.
In addition, a walk-in inspired by Nei Skoen is being worked on. The team is also working hard on contacts with the neighborhood/environment.
There is a garden that is maintained by several participants and creates a warm home atmosphere. Especially with Lucia´s dog, who welcomes everybody.
BONA (as a bigger umbrella) also organizes self-help groups and that's where Villa Alena participants also go.
- Then we visited Supported Housing.
Also here is a clear CARe environment. We spoke with employees and with clients. We got an insight into how the daily activities are organized and how participants play an important part in this. All this is housed in a large building that owned by the foundation and which looks institutional. But they are moving step by step towards recovery work: first you had 2 separate teams per location, now the employees follow the clients. All clients have a job outside the home. Some cook together and others just for themselves.
A development that is now being worked on: applying the CARe principles to the management team itself and in working with employees.
Finally, we visited so-called Social Community Mental Health Team. They work according to a FACT team format, including team support instead of individual support. There are 6 team members, mainly social workers and a psychologist (with addiction expertise) and a Peer Worker. Each worker cooperates with 10 clients.
There is a lot of collaboration with Sheltered Living and FACT teams and Psychiatric Hospital and other services. Due to this design, this is therefore not reimbursed by the insurance company: it is a BONA o.p.s. project currently supported financially by the Ministry of Social Affairs
http://www.bona-ops.cz/
Recovery College Prague:
In the afternoon we spoke with the team of the Recovery College in Prague at The Center for Mental Health Care Development. An entire afternoon sharing experiences.
For example, there are people present who are involved in preparing and realizing a Recovery college stage project, people who provide training in telling your recovery story and several trainings to support recovery, running self-help groups and a number of so-called Peer Lecturers, who teach at the universities and in different trainings. We have connected also with the colleagues from Jihlava, who recently started a project of Recovery college in this city in cooperation with RC Prague.
The whole afternoon was spent exchanging experiences and learning from each other. A rich meeting for all present.
https://www.cmhcd.cz/centrum/co-delame/skola-zotaveni/
https://skolazotaveni.com/
13 July visit Domov Na cestě, Předhradí - Domky
Morning:
We visited the organization Domov Na cestě, (2 hours by car:-). We visited in the morning a new built sheltered living facility, next to the castle Rychmburg (where the people lived previously), where we drank coffee and spoke with clients and employees of sheltered housing. This is a location that has recently moved. We were also here 2.5 years ago when people were still very hesitant about this and struggled with the question of how to use the CARe approach for this kind of service. It's great to see how far they have come. The CARe has been fully implemented. The clients are people with longer-lasting psychiatric disabilities and it is nice to see how they are physically (in the new space) and mentally attuned to this. A lovely quiet atmosphere in which residents get the opportunity to come out of their shell with these foreign guests. A very nice meeting.
The afternoon of the 13th in Domov Na cestě, Skuteč
We were surprised with an extensive homemade lunch with, among other things, 'moss cake'. Present more than 20 people mainly from various facilities of Domov Na cestě, but also other organizations. What immediately struck us: the warm atmosphere and the fact that there was a lot of laughter. Always a good sign.
There was no fixed agenda. In fact, here again: exchanging experiences.
It was very impressive to hear how a manager came out 'with his own experience' and can thus be an extra inspiration for his employees.
A very nice finding: an initiative for experiential expertise has been set up with the beautiful name: 'Space for souls'. Spontaneously also according to translation mistakes the name was shifted to “Space for beautiful souls”, how beautiful do you want it.
This meeting (just like the previous ones) was mainly about CARe and the use of experience expertise. The different methods and experiences. Great to be with. https://domovnaceste.cz/
Summer school CARe approach 14 and 15 July
The Summer School took place in Ledce in the home and recovery initiative of Martin Fojtíček. Martin and his wife have a large house where groups can also stay and with a large outdoor area. The meetings took place entirely outside.
The first part of the Summer School is primarily intended for the CARe trainers to discuss the most recent and desired developments and the second part is aimed to meet CARe practitioners and people interested in CARe to meet each other, share and discuss the topics from practice and encourage the workers to go on and keep CARe alive. Very nice that we could be here.
Meeting with CARe trainers
The CARe trainers currently developed a short training to support cooperation between community services and psychiatric hospitals based on CARe methodology. CARe model has become a part of the recommended methodology of the Ministry of Health for multidisciplinary cooperation and the demand to gain the knowledge and skills to work with CARe model is very current.
We have discussed this topic with CARe trainers and agree on the need to accent training on case studies and moving society from hospital to community.
Employees from psychiatric hospitals and community services can participate in the training together and there is very good experience with that.
We decided to discuss the set-up of a short training course based on the recent developments in CARe, because they make it possible to also make short training courses. See the Appendix at the bottom of this document.
We have discussed the situation in psychiatric hospitals in the Czech Republic and possible cooperation with smaller regional hospital. We made a suggestion to make it a 'best practice', because there is a great potential, so that large organizations can learn from it.
Basic CARe trainings are provided in many organizations, and we shortly discussed experiences from the trainings so far. We agreed on ongoing development of CARe basic training, and made a plan for next year to support a professional development of CARe trainers involved in the CARe team at The Center for Mental Health Care Development.
We have also discussed other trainings currently in preparations, for instance a training in de-escalation and safe wards, now only self-defense is trained.
CARe Summer School
Topics we have discussed:
Experiential knowledge and practice in acute care
• Peer Workers (how do we deploy them)
• Forensic psychiatry
• Recovery and acute admission wards
Dirk has written an article about recovery and acute care and was so great to share it with us. He has also found a few institutions in the Netherlands that work with peer workers in acute care (in case one wants to make working visits).
In addition, a question: deploy peer workers in all diagnosis categories or only with 'like-minded people'. In our view, all recovery processes have common characteristics and peer worker can use parts of his/her experiences in work with people in all diagnosis categories. There is contact with Norwegians (from Bergen), and they go a step further: peer workers always supervise fellows from a different diagnosis category.
We also were talking about ‘Housing First principles’ that are very important, such as first place then train. Honza from a Housing first project remarks that after 'first place' the 'then train' is no longer always necessary, many people have the skills to manage by themselves.
CARe approach and atmosphere
A question was to be discussed: how do you get such a nice atmosphere? Several suggestions are mentioned:
• Always start by creating a bubble (everything personal stays under this bubble) and: when a group comes together for the first time you make your own traditions. Traditions such as: The newcomer is the most important. And: expressing commitment. When the newcomer expresses his commitment, he is included in the group.
• Within the bubble we always start with a round to hear how everyone is doing and what wishes / needs there may be.
• Wearing silly hats helps.
• Assume a diversity of types of activities: just listening and looking at Power-Points does not work.
Our evening that day was related to joint making fire, music, singing, joy and connection:-)
Multiple topics on July 15:
• Much talked about working with Peers in psychiatric hospitals and especially admission wards
• Also talked about employees who share their experiences, struggles the worker might have in order to be in line with law and professional requirements, also in connection to culture and position in the team
• In the hospital: It is still 'she' and 'we', instead of 'us'. Recovery in the CARe approach is always about 'us'
• Many rituals are applied in the meetings of self-help groups: fixed components with an important character. Also apply this in training of CARe workers: create a bubble, hold personal rounds, make traditions for this group together, have participants read important passages, bring a round of 'sharing experiences in' etc.
• In your work, also start from your own passions: example of an accompanist who is interested in literature and has started a literature group, another works with cards, another takes his guitar, etc.
· Be aware of professional ground rules: these have been trained for so long and so internalized that we no longer realize them. Example: “professional distance”
In the afternoon we had a special opportunity to participate in a music therapy workshop led by Jana Fojtíčková, experienced music therapist focusing on recovery and music. Special experience, time with ourselves and with the group, healing for our souls.
There was also a place for moments of connection, quiet time, getting to know each other better, playing and small games (like withholding sticks together or finding something in common with everybody). Some had the opportunity to express the specialty in making the best coffee, others in cooking sweet apricot dumplings, some in singing and guitar playing, some in chatting or keeping balance while swinging on a tree branch.
We would like to thank all who participated in CARe Summer School and helped to create such a warm atmosphere full of commitment and shared experience. Special thanks belong to Dirk and Luciano for the inspiration, positive energy and enthusiasm they brought, to Martin and Jana for welcoming in their home, and CARe trainers for all preparations.
The World Health Organisation has published its 2022 World mental health report, entitled: transforming mental health for all. Committing to mental health is an investment towards a better life and future for all. Providing mental health care in the community is one of the important pillars of transformation.
WHO states, in line with the mission of the CARe Network: “Transforming mental health means strengthening community-based care for all in need. Community-based mental health care is more accessible and acceptable than institutional care and delivers better outcomes for people with mental health conditions. People-centred, recovery-oriented and human rights-based care is essential
We say good bye with a heavy heart to one of our respected college and friend Gábor Gombos. He was an independent expert of the UN Convention on the Rights of Persons with Disabilities, Adjunct professor (NALSAR Law University, Hyderabad, India; National University of Ireland, Galway, Centre for Disability Law and Policy) and a dedicated human rights advocate for the rights of people with psycho-social disability. Rest in peace.
