Paul John Griffiths
CLINICAL DIARY
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Back to Contents½Essays on Forensic Psychology ½ Home Page ½ [email protected]
This Clinical Diary was originally submitted to the University of Birmingham for the Master of Science in Criminological Psychology. This Clinical Diary describes the caseload carried by a Clinical Group Worker employed by the Ley Community, a drug and alcohol rehabilitation center in Oxfordshire. The average number of residents that would be Keyworked by the Group Worker, at any one time would be about eight. Therefore, as an example, three residents are highlighted.
To set the scene, the first section "Organisation Information", gives an overview of the Ley Community. This is followed by "Client Information", which is broken down into three records of: resident one, resident two and resident three. These record contact information, in the form of the Clinical Diary entries: each record includes a profile of the resident concern. The final section, "Conclusion", outlines personal opinions as to the progress made to-date. Due to the treatment language used throughout the diary a Glossary of Terminology, is provided as an Appendix.
ORGANISATION INFORMATION Back to Contents
The Ley Community is a drug & alcohol rehabilitation center, run as a therapeutic community and a ‘Concept House’. Dr Bertram Mandelbrote, a Psychiatrist in charge of Oxfordshire’s Regional Drug Dependency Service, founded it in 1970. It remains one of the first organizations to have treated drug and alcohol abusers within the local community, moving away from the "sick role" of hospitalization.
The model of "Concept Houses" was borrowed from the United States and began as an offshoot of Alcoholics Anonymous (AA). In 1958 Chuck Dederich, founded Synanon in California. He was a recovering alcoholic who broke away from AA because of his dislike of their rigid alcohol focus and their rejection of substance abusers, who were more likely to be poor and members of minority groups. The Ley’s first Director, John McCabe, was a graduate himself from Phoenix House another Concept House, in New York. The emphasis was ‘Self Help’ and based originally around Confrontational Group Work Techniques in order to challenge the very basis for individuals drug and alcohol use.
The Ley Community now occupies four houses on a seven-acre campus in the village of Yarnton, five miles outside Oxford. Facilities include woodlands, a small lake, an outdoor swimming pool and a sports field. It is registered as a Care Home with the local authority for 56 residents of both sexes over the age of eighteen. However, two of these beds could be occupied for individuals between the ages of sixteen and eighteen.
The majority of the referrals come via Individuals themselves: Families, Local Authority Social Service Departments or from within the Criminal Justice System. The Assessment Team deals with all referrals. In the first instance, an information pack is sent out including a detailed questionnaire. Normally, drug & alcohol abusers are already receiving some form of input from other agencies, e.g. Street Drug Agencies, Community Drug & Alcohol Teams, Mental Health Services, Probation Services or Local General Medical Practitioners; these agencies are then contacted for their advice. The second stage of assessment is to invite the individual to the Ley Community in order to attend a Formal Interview which will last approximately two hours and gain useful information about the individual family history education, medical, psychiatric, drug/alcohol use and previous/present offending behavior. Following this if the interview is successful and that the individual still wishes to proceed with their application, then a Day Placement will be arranged. This is where the applicant can experience a full day in a therapeutic community, talk to present residents and have a good fact finding tour of all facilities.
There is a period of assessment available to the courts, whereby defendants can be bailed to the Ley Community for a four-week period, in order to ascertain whether there exists a specific interrelationship between drug use and criminal behavior. If this is the finding of the assessment, then the individual and society’s best interests are met by a residential period in therapy.
The Program lasts approximately twelve months and is broken down into three treatment ‘phases’: Phase One, known as "Safety Net", covers the initial six to eight weeks. This allows the person to settle into their new environment, gradually be introduced to the community language and become educated in the community therapeutic tools. Perhaps the most important part of phase one is to establish and acknowledge some of the underlying reasons for the drug use and offending behavior, known as ‘Issues’. Phase Two, is where the ‘Issues’ are processed; these can utilize a number of therapeutic tools: Confrontation Groups, Support Groups, Skill Groups, Relating Chairs or One to One counseling with staff members. This phase last for approximately seven months, towards the end of which residents are encouraged to start to reintegrate within main stream society by using various methods: Voluntary Work, Socializing, Family Visits, Community Talks and Employment Preparation Studies, that includes Job Search, Interview Techniques etc. Phase Three, lasts for three months and commences when the resident is in full time employment. These residents live with the support of the community, in a detached house in the grounds, paying their own way, working and also completing one evening a week as an Auxiliary Staff Member, looking after junior residents. Transition between each phase is celebrated with a formal ‘Progression’, where the entire resident population comes together. The ultimate graduation, is where the resident completing the program ‘Stands on the Table’: they often invite family and friends to share such an event.
CLIENT INFORMATION Back to Contents
The Clinical Diary entries have the following headings:
Activity Back to Contents
These may record observations that have come about from either therapeutic evening or weekend activities.
Administration Back to Contents
Time spent with administrative tasks, either on the phone e.g. Care Manager, Probation or Solicitor etc or administering psychometric tests or paper exercises etc. All interactions with outside agencies are always conveyed to the residents concerned.
Confrontation Groups Back to Contents
These are the formal compulsory therapeutic groups that take place every Monday and Thursday afternoon and last approximately two and half-hours. They normally consist of eight residents and are facilitated by one Clinical Group Worker. The group sits facing each other in a circle on hard back chairs. The group process is Confrontation, Probe and Patch-up.
Diary Meetings Back to Contents
Each resident is issued with a ‘feelings diary’ and is required to be read by their Key Worker every morning. They record what happened throughout the day and the feelings that they have experienced any concerns or clarifications are sorted out face to face in Diary Meetings. They are not structured nor have any time constraints, they can last anything between a minute and an hour.
Initial Meetings Back to Contents
This is the first opportunity of introducing the Key Worker to the Resident. There are a few administrative tasks that must be performed: ‘Terms and Conditions of Residence (Treatment Contract)’; ‘Fire Procedures and How to Deal with Blood Spillage Procedure’. This normally takes about an hour for each document needs to be explained in detail and the treatment contract signed.
Key Working Group Back to Contents
Each resident is allocated a Key Worker on arrival. The Key Worker is one of the Clinical Group Workers assigned to one of the Therapeutic Houses, responsible for looking after a number of residents. These residents become his Key Working Group and usually number about eight. A formal Key Working Group meets twice a week, presently on Tuesday and Wednesday afternoons for an hour a time.
Requested Meetings Back to Contents
This is a meeting that can be requested by either party, for a variety of reasons, for example: talk about a visit; shopping trips; welfare needs, therapeutic input/direction; personal problems; medical/dental needs, etc.
THE RESIDENTS Back to Contents
RESIDENT ONE, born on XXth November 19XX in the South of England. His parents brought him up until they separated when he was seven years old. Being the only child he stayed with his mother, who had a number of boyfriends. One particular boyfriend was like a father to him and lived with them for several years leaving when resident one was about fifteen, for another woman. Back to Contents
He started smoking Cannabis at the age of twelve, gave this up for amphetamines at thirteen. It was about this time that he started using LSD and at fourteen started using ecstasy. At sixteen he smoked Crack Cocaine; although amphetamine is his preferred drug of choice he has ‘Chased’ Heroin on a number of occasions. When admitted into treatment he was a seventeen year old male, but is now eighteen.
He left school without any formal qualifications and has never worked. He has had several girlfriends since the age of fourteen. There was a period of time when he was drinking heavily and taking amphetamines when he says his natural father was abducted and the people involved threatened to harm him if anyone gave evidence against them. He lived in an acute state of fear and began carrying a knife with him. One evening when he thought his girlfriend was conspiring against him, he hid on a roof for four hours coming down only when it was daylight. It was at that time that he took overdoses of Paracetamol and Amitriptyline (Prescribed for his mother) and had short spells in hospital.
PREVIOUS CONVICTIONS: Back to Contents
00/00/95
Damaging Property Criminal Damage Act s. 1 (1)
Burglary & Theft, Dwelling
Burglary & Theft, Non-Dwelling Theft Act 1968 s. 9 (1) (b)
Supervision Order (SO) 12 Months.
00/00/96
Burglary & Theft, Dwelling Theft Act 1968 s. 9 (1) (b)
Robbery Theft Act 1968 s. 8
Attempted Robbery Theft Act 1968 s. 8
(Two other offences taken into consideration {TIC.})
Young Offenders Institution 30 Months, previous SO. Discharged.
00/00/97
Burglary & Theft, Dwelling Theft Act 1968s. 9 (1) (b)
Assault Common Law
(Twenty seven offences taken into consideration)
Three years Supervision Order, 12 months COR Ley Community.
CLINICAL DIARY ENTRIES Back to Contents
10/10/97 Initial Meeting
Admitted into treatment. Introduced myself as his Key Worker and explained the purpose of the relationship and advised him as to how he could utilize me to the maximum. Completed the Terms & Conditions of Residence, including Fire Procedures and How to deal with "Blood Spillage". Allocated him to the Housekeeping Crew (Work Department) and to settle in over the next couple of weeks.
16/10/97 Administration and Diary Meeting
Telephoned his Youth Justice Worker, in order to arrange an Internal Clinical Assessment for 10-12-97 at 11.00am. From his diary it appears that he is up half of the night listening to music and "Rapping". Explained the importance of sleep, he says that he is having difficulty turning his "clock" around, that he has always led a nocturnal lifestyle.
20/10/97 Confrontation Group
Confronted in-groups today about his negative friendship with another resident. Asked to explain why he feels more at ease with negative friendships rather than positive ones. Suggested that he look through the Concepts, especially the Bridge Concept.
22/10/97 Requested Time Back to Contents
Concerns over the relationship he is building with his roommate. Considers him an "Immature Prick", "sly" and play head games with each other. Asked him to identify the feelings the other person brings up in him and to write these in his diary.
24/10/97 Requested Time
Found out that his roommate has previously had same-sex relationships, something that Resident One feels uncomfortable around. Worried that something will happen to him during the night. Explained to him that these feelings have only came about after the knowledge was received and that he felt ok before this.
29/10/97 Requested Time
Resident One received a letter from an inmate of a Youth Custody Facility, full of obscenities and information concerning breeches of security within the Facility. I informed resident One, that this is something that he is trying to move away from and also that I would forward a copy of the letter to the Head of Security at the Facility. Confronted him about not using his diary yesterday and reiterated the importance of this. He has asked to be considered for education classes, he has been directed to see the Education Officer who will assess his needs. Youth Justice Worker phoned to say she would be on leave until 27-11-97 and that her colleague will cover the case until then.
30/10/97 General Meeting and Requested Time
General Meeting today, to explain that various substances have been discovered on site. Resident One went through several feelings about wanting to score a "Rock" and smoke it. I explained that this was a normal feeling especially during the first few months, when he is trying to find alternative ways to deal with the feelings he is going through.
31/10/97 Diary Meeting
Found out today that his father got married without telling him, went through feelings similar to when he was a child, when he felt left out of family things (Anger & Annoyance).
03/11/97 Diary Meeting
Feels as though nothing is happening in his personal program. Finding little things affects him and can not see the aim of pointless activities.
08/11/97 Activity
Came on a long walk with fifteen other residents and me. Enjoyed him-self, he felt that it was good to get out of the community.
11/11/97 Diary Meeting and Requested Meeting Back to Contents
He disliked having his request to send out for a Designer Label catalogue refused. Became angry, sat himself on the Bench to think about his feelings. Recently in his diaries he is talking about becoming "Pissed off" with people, how they talk to him as a child and becoming paranoid. Directed to take this to groups, in order to sort it out with the people concerned. Finding it hard to communicate feelings has started to use Relating Chairs. Realizes that changing behavior is going to be hard work.
12/11/97 Requested Meeting and Administration
Talked to Resident One, regarding his behavior of late, especially his immature attitude and the difficulties he is experiencing, with settling into the therapeutic regime. Completed the funding information sheet (SS27) as requested by his Care Manager. Gave him the Phase Two Papers, in order to gain some insight into his background history. Informed him that I will conduct a Case History tomorrow. Knows he has to open up more to people. Has written in his diary the following: "the whole point of this program is like "ringing" a car, you’ve got to strip it down, then put new better parts on then hope the police don’t ever realize what you used to be, to remain the new car".
13/11/97 Administration
Completed his Case History and gave him some direction on how to write his Feelings Diary. Looks very tired, says that he is struggling to stay awake during the day. Early bed and don’t listen to music late at night.
19/11/97 Requested Time
Went through the Phase Two papers. A good initial attempt asked him to provide some more in-depth information regarding several sections, especially concentrating on breaking down feelings regarding family and friends. Not writing his diary.
21/11/97 Administration
His Care Manager phoned to apologize for the SS27 as he had found the original one in the file. He would like to attend the Internal Assessment planned for 10-12-97, which was agreed. Working on Special Projects, looking after the wildlife, something he enjoys.
26/11/97 Key Working Group
During the afternoon Key Working Session, suggested that he needs to be spending more time in Relating Chairs (RC’s) with other people in his Group, as these are the people he needs to be building up relationships with. This he agreed to do. He is to start education classes today. States he is becoming very stressed of late, thinking that he is doing something wrong when in fact he isn’t.
03/12/97 Key Working Group
He completed his Personal Profile (PP), in the Key Working Group, did very well talking about some difficult personal stuff in quite detail, said he felt very nervous. Feed back from the Education Officer, he has settled into the group and is fully participating. Missing contact with the outside world.
06/12/97 Diary Meeting
Wrote two words in his diary "NOT MUCH". Asked him in future to complete at least a page a day.
10/12/97 Key Working Group
In the Key Working Group, he asked about getting some clothes as he only has the clothes he stands up in. Explained that we will make this a point of the internal assessment this afternoon with his Youth Justice Worker and Care Manager. Internal Assessment went well.
11/12/97 Administration and Diary Meeting
Received ‘Income Assessment Form’ and ‘How to Choose a Residential Home Form’ from his local authority. Having difficulty at the moment in dropping his Street Image, wanting to leave. Spoke to him about the difficulties of changing your life around and that this is something that he will have to work at, as it does not happen overnight.
14/12/97 Administration Back to Contents
Completed the new formatted, Terms and Conditions of Residence and went through each section in detail.
15/12/97 Diary Meeting
Following on from the conversation yesterday stressed the importance of completing his feelings diary. Perhaps he could write about his feeling towards authority, especially when I remind him that the Feelings Diary is one of the Community Tools. If he refuses to comply, then he could be seen to be in breach of the Terms and Conditions of Residence and he may be asked to leave. Asked him to write about the struggles he is having in the community at the moment. He agreed to write in his diary everyday. He is having difficulties in completing his Phase Two Papers, suggested that he will be able to get assistance from other residents, all he has to do is ask for help.
16/12/97 Key Working Group
Key Working Group today. At first, he was not very forth coming with information. Said he finds it difficult to identify, communicate and record feelings. He received good advice from other residents. He asked for some assistance from the group with his Phase Two Papers. His diary reads that he is quite down over loads of things at the moment, especially having "Crap Trainers". Asked him, to focus on himself.
17/12/97 Key Working Group and Diary Meeting
Completed his papers today and read the final draft to the Key Working Group. They asked him to complete Significant People (paper exercise) and complete his PP to the whole house. Diary reads that he is stressed, anxious and depressed today, especially when he is asked to go into the office. Worried that if he leaves, he will either end up killing himself, walking the streets or "doing big bird".
18/12/97 Diary Meeting
Working as the Kitchen Manager, with an interesting Crew. Read through his Feelings Diary. A great improvement, with consistent entries. Write two pages most days, identifying feelings adequately. Becoming anxious in the Kitchens, due to difficulties with another resident. Asked him to think about the situation and possible ways for him to deal with it. Directed him to either deal with it right away, or for him to use the Therapeutic Structure.
19/12/97 Administration
He received a ‘Talking To’ (TT) over the kitchens not being up to scratch. Completed typing up the notes from the Internal Assessment, into a formal report. Discussed the final draft with Resident One and gave him a copy (Appendix ONE).
22/12/97 Requested Meeting and Administration
Posted copies of Clinical Report and Care Plan to his Youth Justice Worker and Care Manager. Several emotional issues coming up in the kitchens. He needs to assert himself more and delegate responsibilities down to others. I explained how he could go about improving this. Using his diary to write about some of his early offending behavior. A lot of pain coming up about the period of time he spent in the Secure Unit, also remembering the good times.
23/12/97 Administration
Successfully completed all sections of the Phase Two Papers. Resident One, was Progressed into Phase Two of treatment.
24/12/97 Administration and Diary meeting
Received his Post Office Savings Account Passbook from his Mother today. Informed him that this would be placed into his Private Property. Diary work, suggest that he realize that for some people, time is running out. So therefore, he has no time to waste and must crack on with his issues.
27/12/97 Administration
Conducted the Hostility & Direction of Hostility Questionnaire (HDHQ), results as follows: SC 7; G 4; AH 11; PH 7; CO 9; TOTAL 38; IH 11; EH 27; DH –09. Gave him feed back from the results and also that he could benefit from participating in the forthcoming Managing Anger & Conflict workshops planned for January 1998.
30/12/97 Requested Meeting Back to Contents
Informed by colleagues that Resident One has been sick in bed since Saturday. Informed the Health Promotion Officer, who is unable to ascertain what is wrong with him. To give him Paracetamol, 2, 4 times a day and if this does not clear it up then to call the Doctor. Spoke to him, feeling very low remembering where he was last year, "out of his nut" and with friends. Encouraged him to join in with the various activities and not to isolate, as he will only feed into himself.
01/01/98 Activities
Participated with the evening’s activities and collected a prize in the Talent Contest supported very well.
04/01/98 Diary Meting
Feeling terrible and sad about one of his issues. Talks to another resident about this. Feels used, as the resident used this information to hurt him, by talking about this to other residents. However, he is determined to address these in-groups.
06/01/98 Diary Meeting
Talking about his past relationships being possessive, paranoia, insecure, sad, self-pity and inferior. Also feels that an ex-girlfriend used him for his money, drugs and to access his friends. Coming to terms with the way he is feeling about the past, in order to establish what he wants out of relationships in the future. Also taking in on him self to sort his Peer Group out.
12/01/98 Requested Meeting
Found out that over the holiday period some mail had gone astray once signed in and no body was taking responsibility. Informed Line Management, who will sort this out. Explained to Resident One that he was unable to have his money at the moment as the actual amount had gone astray, but that this would be sorted out straight away.
14/01/98 Diary Meeting and Key Working Group
Good diary work being produced. Working on drug use, his home life and the effect of his mother’s partners had on him. In the Key Working Group this afternoon asked if he could go shopping for a Jumper, informed him that I would discuss this with the staff team.
15/01/98 Requested Meeting
Spoke to his mother on the phone to day. She is concerned that she has not heard from him in a while. Confronted him over this, he said that he can not be bothered at the moment. Asked him to look at the possible reasons for these feelings. He is blaming his mother for his offending behavior. A Colleague contacted his mother to ascertain what was the amount of money she sent in over Christmas (£20).
16/01/98 Requested Meeting
Several concerns are raised as to Resident One’s inability to concentrate for more than a brief period of time and recently, apparently drifting off completely. Spoke to him about this with the Health Promotion Officer, possible concern over sugar levels. Asked him to monitor this over the coming week.
19/01/98 Requested Meeting
Observations over the weekend confirmed concerns over his behavior especially his sometimes-vacant expression. Confronted him over this. He says that he is missing drugs. It appears that he is experimenting with "Natural Highs". Not eating, not sleeping and overloading his system with ‘Refined Sugars’. Asked him to identify the dangers and possible medical and psychological damage in his diary.
21/01/98 Diary Meeting
Identifying feelings with regard to his recent behavior, good diary work. Attended a Special Group today on behalf of another resident. Good advice and participated well.
22/01/98 Diary Meeting Back to Contents
Working at the moment on his own previous relationship with his mother. Confronted on the fact that he was not recording his daily feelings in the diary and that this was as important as the other work at the moment. He is feeling run down, no enthusiasm and generally tired.
24/01/98 Administration
Continually putting himself down intellectually, believing that he is of low intelligence, having always being put down at school. I administered the Standard Progressive Matrices sets A, B, C, D & E. The results are as follows: Time 15 minutes, TOTAL SCORE 46, resulting in GRADE B. I gave feed back following the administration, which quite surprised him. Asked him to write how he felt in his diary.
25/01/98 Activities
Stayed in the house today as others went on a long walk, arranged activities for those that stayed behind. Working on Special Projects (SP’s) fixed the toilet in Admin. Watched a boring film "Stargate" in the evening, prefers to criticize it in order to get good feelings.
26/01/98 Confrontation Group
Heavily confronted by resident’s in-groups today, regarding his stubbornness, dieting, sleep deprivation and experimenting in natural highs. They highlighted that he has difficulty in communicating his needs and feelings effectively and the problems that this causes in others. Aware that he projects an image but sees this as harmless. Would like to firm up his interpersonal boundaries.
28/01/98 Key Working Group
Today’s Key Working Group was spent on Resident One’s image. He wore a collar and tie; very smart, also talked about what ideas he has for the future. Thinking about College, possible courses and that he would like the community to consider college instead of work when in Phase Three. He wants his intelligence on paper, does not want to be stuck in a dead end job.
01/02/98 Diary Meeting
Writing in his diary about his past, listening to "Rave" tunes and remembering the good times, seeing the present as very black and bleak. Spoke to him about this and reminded him that life was not always rosy in the past, especially when he was using drugs and serving time in various secure places. He sees the music of the street as being moody now and that depresses him "Its all fuckin serious, everyone’s dying, kill each other, robbing each other "darking" everyone off…. Its all gone sour." He gave me a rundown of his offending and drug history.
9-12years old: Shoplifting, Stealing from school, stealing from friend’s houses, stealing mopeds.
12-13 years old: Car Stereos, Indoor plants from porches, Shoplifting, stealing from peoples houses. Selling Acid, Amphetamines and Cannabis.
13-14 years old: Garden sheds, Garages, Mountain bikes and Commercial burglaries.
14-16 years old: Domestic Burglaries, Commercial Burglaries, and Shoplifting, Street Robberies, Till snatches and Creepers (Domestic Burglaries). Bootlegging cigarettes & Alcohol.
17 years old: Domestic, Commercial Burglaries, Street Robberies, Creepers, Shoplifting and Till Snatches. Cocaine, Methadone.
08/02/98 Requested Meeting
Feels that he is sitting on the fence at the moment want to get off but does not know how too. Went through the concept of "If not know, When?" Sees the house as one big "Neggie" click, nobody is doing what he or she should be doing and nobody is using the Community Tools. Asked him what part he is playing in all of this and what he is able to do about it?
09/02/98 Diary Meetings
Talked about him pleasing people, rather than asserting his own values and making people aware of his own needs. Asked him to work on this issue of ‘People Pleasing’ next and to use his diary.
10/02/98 Diary Meetings Back to Contents
Continuing on from yesterday re People Pleasing. He believes that in order to gain friendships, the best thing to do is anything that does not "piss them off" or annoy them. He has a fear of being without friends and of having double standards. He believes that he is negative, his friends are negative and that he is carrying a lot of guilt. Talked through establishing new friends, what is required and what he wants out of friendships in general, the basis is Trust, Honesty and Respect.
12/02/98 Requested Meeting
Informed Resident One, that the Community would not consider college in Phase Three, as gaining full-time employment is a crucial part of the program and something that all residents will go through. Expressed the benefits of him gaining gradual re-socialization into the wider community, rather than going from one institution into another. Also the fact that most Campuses have a strong drug culture and being away from that for an extra year before going to college would be for his benefit in the long run.
14/02/98 Activity
Did not enjoy the weekend activities at Motor-cross. Believes that he is a lot happier in himself at the moment and is using Community Tools a great deal to reduce his anxieties with regards fellow residents.
19/02/98 Administration and Diary Meeting
Contacted Care Manager and Youth Justice Worker, in order to arrange the second internal assessment on 11-03-98. All agree to date and time of 11.00am. Dislikes to Expedite in the evenings, as he sees this as a complete waste of time. Explained the importance of the position and the need for people to take turns in all areas. Says he feels comfortable in talking about all his issues.
20/02/98 Key Working Group and Administration
During the Key Working Group, he requested that the group does not form part of his Internal Assessment on 11-03-98. Resident One is complaining of chronic pains to his back, around kidney area. An appointment has been arranged for 17.40 hrs. with Doctor (B) at The Local Health Center. The Doctor was not able to identify the cause of the problem and suggested taking Nurofen or Paracetamol. If the pain continues, to see Doctor (A) when he visits the community on his weekly surgeries.
22/02/98 Requested Meeting
Talked to him about using pull-ups more, especially with people who he feels intimidated by and also those who he is in a negative clique with. Worried about his memory as he feels that he often forgets things. Talked about his interest levels and the need for him to remain focussed on tasks at hand. Back trouble again, asked him to see the Health Promotion Officer in the morning.
25/02/98 Activities and Administration
Went fishing with a group of residents and a staff member today. Found this an extremely boring hobby and something he does not wish to pursue in the future. His Care Manager phoned to see of he could bring some students with him on the 11-03-98, to have Professional Placements, whilst he is participating in the Internal Assessment. This was agreed.
26/02/98 Confrontation Group
Confrontation Group, good input to other residents. Attended the Radcliffe Infirmary today for blood tests etc. Disliked the fact that the Management Committee disrupts the house in the evenings, requiring an early Dinner and all evening’s activities to be held in Interphase.
28/02/98 Administration
Given some responsibility today asked to cover another resident at the hospital, everything went ok. Completed the second administration of the HDHQ. Results are as follows: SC 9; G 5; AH 12; PH 7; CO 11; TOTAL 44; IH 14; EH 30; DH –07. Gave him feedback from the results.
01/03/98 Activities
Came out for a long walk with fifteen other residents, to the Malvern Hills. He was able to lead part of the route, enjoyed himself and was able to have a good laugh.
04/03/98 Key Working Group Back to Contents
During the Key Working Group today, he asked about the possibility of attending evening classes at the local college. Asked if I would talk to the Education Officer about this, which I did. No problems in him attending college one evening per week. To sort out possible courses and Pass Up to discuss this in more detail. Stressed at the moment with his "SHIT" job in the Admin Department.
06/03/98 Diary Meeting
Confronted Resident One, regarding his attitude to work in his position of Admin Manager. Asked him to work on areas of Responsibility, Assertive Skills and Delegation etc. No diary entry for two days says he can’t be bothered.
09/03/98 General Meeting
Due to the low standards being produced by the whole house, a therapeutic House Ban has been imposed. Wake up at 05.30; structure most of the day, therapeutic content of all activities, no television, sweets, visits or socializing.
11/03/98 Administration
Conducted the Internal Assessment, together with Resident One, Youth Justice Worker and Care Manager. Has become attracted to a certain female resident, asked him to talk through this, to identify the feelings and to be aware of the dangers of exclusive relationships.
12/03/98 Confrontation Group
During the Confrontation Groups today, Resident One was confronted about his lack of interest in his own health, motivation and the long term effect of not changing or taking responsibility for himself. Starting to believe the House Ban will never end! "Leaking and Reacting" his feelings a little at the moment. During an RC, his family was brought up, he said that he feels like the "Black Sheep".
16/03/98 Key Working Group
Key Working Group, concentrated around Resident One. Anger, guilt, frustration and inability to get in touch with his feelings. Suggested several ways for him to go about tackling these by the group, communicating more with them e.g. RC’s.
18/03/98 General Meeting and Key Working Group
A General Meeting (GM) was called to address: his continually changing image, e.g. change of clothes and hair style five or six times a day; his preoccupation with designer clothes and his diet. He was placed on an Observation Contract and asked to wear orange overalls, his runner to observe behavior and food consumption. In the Key Working Group, gave out Anger Diaries and instructions on how to fill these in. However, in the afternoon, I was directed by the Team Leader to cancel the intervention and recall all the Diaries. I informed Resident One, of this who took it personally and saw that it was the staff trying to test his commitment. I was able to refocus him.
19/03/98 Requested Meeting
Explained to Resident One and his Runner what the objectives are of the Observation Contract and how they could go about gaining the most from it. Also that it is designed to focus Resident One, on areas that up to this point has found extremely difficult to deal with. A therapeutic contract was agreed and signed.
20/03/98 Administration
The Clinical Report and Care Plan agreed at the Internal Assessment on 11-03-98, was typed up and dispatched to his Care Manager and Youth Justice Worker. A copy was given to Resident One and discussed in great detail. Having problems with another resident who he feels intimidated by. Asked him to identify the feelings.
ANNUAL LEAVE FROM 23-03-98 to 07-04-98.
24/03/98 Administration
In my absence, the Staff Team decided to take Resident One of his contract, as they had ascertained that he was "eating and sleeping". They noted that he had become withdrawn and appeared to be going backwards.
26/03/98 Requested Meeting
The Team Leader spoke to him today about his being quite lazy and complacent. Attempted to get him to look at ways he can improve his self worth.
07/04/98 Requested Meeting and Key Working Group
Returned from annual leave to find out about the event of 24-03-98, and that this decision was given at the direction of the Program Director. Talked to Resident One, about what he felt he had gained from the few days he was on the contract. Discovered he disliked the feeling he was going through, felt uncomfortable without his Designer Clothes. Suggested he looked into the early years, when he first felt rejected and needed to look out side for good feelings and recognition. During the afternoon Key Working Group, Resident One talked about some feelings that came up out of a recent Confrontation Group. People do not seek him out for support, conscious of his age and size. Also, he is experiencing difficulties, in working through his issues. The group asked him to read through his Clinical Report tonight and to select just one issue to work on.
08/04/98 Key Working Group Back to Contents
In the Key Working Group today we discussed a Key Working Plan for Resident One. To work on insecurities, goals, communication, self-esteem and to gain self-confidence. Also paranoia and low levels of assertiveness. These following areas to be completed in the next week: five RC’s with Key Work Group members, four Special Key Work Groups and two seminars (topics to be chosen by the co-ordinators).
13/04/98 Requested Meeting
He has demonstrated a determined effort to complete the majority of the tasks set on 08-04-98. He also gave good input to the house over the weekend.
14/04/98 Administration and Key Working Group
He woke up this morning with a cold, informed the Health Promotion Officer, who advised him to stay in bed for an hour and then to get up. In the Key Working Group this afternoon gave up-date of requirements from 08-04-98. He has not completed everything, informed him that he needs to have two RC’s and a special Key Working Group this evening.
15/04/98 Diary Meeting
He was feeling very angry today wanted to smash up or smash somebody. He believes people (residents) are interfering with his program. He wants to run off, or run away because people consider him incapable of doing anything successfully. Asked him to speak to the person concerned with these feelings and to use the skills that he has developed in order to deal with them appropriately.
17/04/98 Diary Meeting
Went out into Oxford unsupported today, came back feeling very insecure. Talked about his feelings, about being in a new place, not knowing anybody and feeling alone. Worried about being institutionalized and not fitting in when he has the opportunity. Suggested ways that he can lower his anxieties and to relax.
20/04/98 Diary Meeting
Made up to Co-ordinator today. Aware of the areas he must put into practice in order to be successful in the position.
23/04/98 Key Working Group
Key Working Group, talked about the possibility of having a visit from his Mother. Discussed the benefits and risks of this. Asked him to forward a Request Memo as soon as possible, so that the staff team could discuss this in more detail. Working as a team with the other assistant co-ordinator. Handles situations of confrontation very well and demonstrates an ability to assert himself with residents. "I feel confident…and happy with myself for the first time in years".
25/04/98 Administration
Completed the third administration of the HDHQ. The results are as follows: SC 4; G 2; AH 6; PH 3; CO 6; TOTAL 21; IH 6; EH 15; DH –05. Gave him feed back from the results.
29/04/98 Key Working Group
Good input into the general discussion of the Key Working Group today. The evening course that was arranged has been cancelled; he took this news very well. Suggested he look for another. Realizes that the job of co-ordinator is 24hours a day, 7 days a week.
30/04/98 Confrontation Group
Confronted in-groups today, about not feeding information back, regarding a telephone call that he had covered with another resident. Attended College, but considers this too basic.
06/05/98 Key Working Group
In the afternoon Key Working Group, Resident One, talked about the problems he was experiencing as the co-ordinator; these were discussed and various suggestions from ex- co-ordinators were made. Overall, it is felt the he is making a good contribution to the house and that this position would help him deal with stress, assertiveness and responsibilities. Organized the evening activity put a lot of hard work into them, which people appreciated.
07/05/98 Diary Meeting
Learning to deal with other people’s moans and groans and not to become suffocated in others’ problems. Overcompensating during the evening activities, a way of letting of steam, explains the dangers of this in front of residents, especially when he may need to assert his authority the next minute.
11/05/98 Confrontation Group
Confrontation Group today nobody had any slips on anybody. General discussion on apathy and the role of the co-ordinator to be aware of problems and behavior from the floor.
14/05/98 General Meeting
GM for most of the day. Apathy, bystander apathy, lacks of communication, no respect and generally peoples doing whatever they want to do.
25/05/98 Activities Back to Contents
Bank Holiday today, Resident One stayed back in the community as the others went on a long walk.
28/05/98 General Meetings
GM this morning designed to see where the house was and what changes had been made from the last GM on 14-04-98. Nothing aimed at Resident One.
31/05/98 Activities
Resident One acted as the Phase Three cover, when the residents went on a walk to Symmons Yat in the Forest of Dean. Acted very responsibly, was able to take control of the group, pulled people up when needed asserted him-self as required. Good support.
02/06/98 Administration
Structured Memo for visit on 03-07-97 was received to day, discussed with the staff team and agreed.
08/06/98 Diary Meeting
Confronted about no diary entries for a week. Informed him that everything is on hold with regards visit, socializing etc. until this improves and he starts conforming to treatment. Says that he has little self-esteem and confidence. I will work on this with him and give him some exercises around ‘Self Esteem’.
11/06/98 Administration
Gave him some ‘Self Esteem’ paper exercises to complete. Contacted Youth Justice Worker and Care Manager, in order to arrange another date and time for an Internal Assessment. They will get back in touch with me in due course.
17/06/98 Diary Meeting
Resident One attended Earthwhatch (Conservation Foundation) today and has been selected for a Fellowship, where he will go on an expedition for two weeks and will also be given skills in job search, interview techniques etc. over a ten week period.
RESIDENT TWO (CASE STUDY ONE), was born in Scotland on the XXth March 19XX. He has four bothers one died in a car accident in 1988 and one sister. Early memories, father worked as a Watch Repairer and mother looked after the house. His mother became ill and eventually died when resident Two was six years old. His elder sister took on the responsibility of looking after the family. He believes that he did not receive the same affection he noticed his friends receiving from his friend’s families. However, as the youngest at the time he did not go without anything. He claimed that his father would drink and occasionally administer physical punishment but only following ‘bad behavior’. Back to Contents
He started using Solvents at the age of eight and drinking at the age of thirteen. He used Cannabis at the age of nineteen, Benzodiazepines at twenty-one and Heroin at twenty-five, "Temazipan" (Benzodiazepines) remains his drug of choice. His early offending behavior was mainly Alcohol induced. However when drugs became a problem, the nature of his offending also increased. He also claims to have dealt drugs in a big way. He has suffered severe personal injuries as a direct consequence to this, namely having both his legs broken and face disfigured by some of his criminal associates.
He was married to a childhood sweetheart in December 1986 and subsequently had three sons; unfortunately, one died in a car accident when Resident Two was serving a prison sentence in 1996. He served an Apprenticeship at a Garage in Scotland when he was sixteen and later became self-employed with his own garage. He dealt in second hand cars and built up a thriving business. However, greed and drugs, got the better of him and turned to "Ringing" cars.
After some problems in Scotland, he moved with his young family to London, where he again became involved in dealing and using drugs. He became registered and began a Methadone Maintenance Program with the local Drug Agency. It was via a referral from the Drug Agency, that the Ley Community became involved.
PREVIOUS and PRESENT CONVICTIONS: Back to Contents
00/00/85
Assault Common Law
Breach of Conditions of Bail Bail etc (Scotland) Act 1975 s. 338 (2)
Fine £60.00
00/00/85
Fail To Appear (after Summons) Crim. Proc. (Scot.) Act 1975 s. 338 (2)
Fine £20.00
00/00/86
Theft of Motor Vehicle Common Law
Admonished Disq. From driving 12 month, Lice. End.
00/00/89
Reset Common Law
Admonished, Deferred Sentence
00/00/91
Possessing Off. Weep. in Pub. Prevention of Crime Act 1953 s. 1
Fine £175.00
00/00/94
Theft Common Law
Theft by Shoplifting Common Law
Theft by Shoplifting Common Law
Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)
Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)
Nine months imprisonment
00/00/95
Driv. Whilst Disq. Road Traffic Act 1988 s. 103 (1) (b)
Minor Road Traffic Offence
Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)
Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)
Four months imprisonment, Disq. Driv. 3 years, Driv. Lice. Endor.
00/00/95
Theft by Shoplifting Common Law
Breach of the Peace Common Law
Six months imprisonment.
00/00/96
Poss. Cont. Drug Misuse of Drugs Act 1971 s. 5 (2)
Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)
Fail to Appear (Bail) Bail Etc. (Scot.) Act 1980 s. 3 (1) (a)
Nine months imprisonment.
00/00/97
Dangerous Driving
Driving Whilst Disqualified
Driving Whilst Unfit
Failing to Provide a Breath Specimen
No Insurance
Six months imprisonment.
CLINICAL DIARY ENTRIES Back to Contents
20/02/98 Arrival Meeting
Resident Two arrived late in the evening and was admitted into treatment by a colleague. He says that he could not stand it out there any longer. He is under no illusions that come Monday if his funding has not been sorted out; he will not be allowed to stay. There was a progression (Table) this evening and a few ex-residents from Scotland called to pay respects, so they introduced themselves to him.
21/02/98 Administration
My colleague allowed him to have a two minute phone call, to his family to let then know that they had arrived safely etc. Terms & Conditions of Residence were signed; also the Fire Procedures and Blood Spillage were read out, with copies given to him.
23/02/98 Introduction Meeting and Administration
I introduced myself to him as his Key Worker, explained my position and how we could work together. He made it quite clear that he had urgent Health & Dental needs, advised him to see the Health Promotion Officer in the morning via Pass UP’s. He spoke briefly about his children, who are presently being looked after by his sister in Scotland. Advised him to settle into the program before he starts to deal with his issues. Explained to him the nature of the program and how it was divided into various Phases. Probation Officer was informed of his temporary admission; he is on License until 04-05-98. Received faxed confirmation in writing of funding now regarded as permanent. Requested full medical notes, Care Manager to obtain these on our behalf.
24/02/98 Administration
Informed Probation Officer, that funding is in place and that his residence is now considered permanent.
25/02/98 Key Working Group
Introduced Resident Two, to the Key Working Group and explained the purpose and how to use it effectively. He says that he is settling in ok and working well on the Housekeeping Department as a crewmember.
27/02/98 Requested meeting
He appeared very upset. This was due to the fact that the anniversary of his son’s death was imminent and various feelings coming to the surface. He talked about how he had been in prison at the time, blaming himself and carrying a lot of guilt. Resident Two wanted to deal with the death, there and then. It was apparent that there was more to the episode than was known at this time. I informed him that he was in Phase One, which was about identifying the issues, in order to deal with these in phase Two. I allowed him to phone his sister in order to ask her to send the Disability Pension Book down so that this could be cancelled and a fresh claim for income support made in Oxford.
04/03/98 Administration
Resident Two asked about the work I was conducting with the other residents. I explained to him it was about the forthcoming Managing Anger & Conflict workshops. He explained that he has dad some problems in the past surrounding his anger. I conducted the HDHQ and the results are as follows: SC 4; G 3; AH 5; PH 5; CO 9; TOTAL 26; IH 7; EH 19; DH –08. I provided feedback from the scores, suggested that he could benefit from undertaking such a course and should give this some thought.
09/03/98 General Meeting Back to Contents
Due to the recent lack of respect in the house and general inability for residents to use the Community Tools, a House Ban was imposed. They wake up at 05.30; structure most of the day, therapeutic content of all activities, no television, sweets, visits or socializing.
11/03/98 Administration and Confrontation Group
In the morning I had a chance to talk to him about the Dentist and informed him that we would allow only emergency dental work at his stage of the program. This he agreed, so an appointment was arranged for 27-03-98 at 10.30am in Oxford. During the Confrontation Group today, the rules of the group was explained and the way to engage in conversation. It was noticed that Resident Two displayed bizarre body language, when he was asked to exchange seats with another residents. Very aggressive and intimidating image. He was challenged and reminded that this was not a prison landing and that sort of behavior is not tolerated here. Also, that this is the very behavior that he has come here to change. Once confronted, he was able to give good input to other residents.
14/03/98 Administration
He phoned his solicitors today to get an update of the outstanding court matters. I asked Resident Two for all information regarding the courts that he provided. There are two cases outstanding that must be dealt with in the near future.
16/03/98 Administration
He telephoned his other solicitors to see if the two cases could be brought together. The Procurator Fiscal will write to invite Resident Two, to a two-day trial and will be able to give four weeks notice.
18/03/98 Requested Meeting and Key Working Group
He is very concerned that other residents are not pulling him up especially when he is only too aware that he is doing something wrong. I asked him to look at the reasons for this and to look at the area of intimidation. I expressed that this is a two-sided situation, but that he needed to find out from other residents how they saw him in general. (Communication, Body language etc.). Handed over information to Team Leader due to my forthcoming annual leave. During the afternoon Key Working Group, I gave out Anger Diaries and instructions on how to fill these in. However, in the afternoon, I was directed by the Team Leader to cancel the intervention and recall all the Diaries.
ANNUAL LEAVE FROM 23-03-98 to 07-04-98.
30/03/98 Confrontation Group
Resident Two was confronted in the group today for being intimidating or taking the "Mickey", especially when he is pulled up. The group claim that he studies people and collects stamps on them. He informed the group that he held a grudge for twenty years over something petty and still managed to take it out on the other person. Directed to start to open up about himself to people, as in the person not the junkie or the criminal or the dealer.
01/04/98 General Meeting
GM today, he was placed on a hard works contract for his attitude and his general behavior.
07/04/98 Key Working Group
Returned from annual leave, received a hand-over from colleagues over Resident Two’s behavior. During the afternoons Key Working Group, he was asked to inform the group, exactly what he is working on at present. Commenting on enjoying the space on contract, using his diary to work on issues, feeling guilty over setting another resident up, playing mind games. Appears to be working well: addressing the main issues of why is behavior resulted in a Hard Works Contract.
10/04/98 Requested Meeting
Talked to him about wishing to go to the church around the anniversary of his son’s death, either the 19th or 22nd of April in order to light a candle. Permission was granted by the Team Leader for this to go ahead on the 22nd with a member of staff present.
13/04/98 Diary Meeting
Feedback to Resident Two the outcome of his request. He said that this was not good enough that he wanted to go on the 19th April. Reminded him of what he had asked for and suggested that he use his diary to write about his feelings.
14/04/98 Requested Meeting
Put on the Bench, for passing messages to a female Day Placement. Asked him why he had done this. He said he was not aware that this was not allowed. Reminded him that he had done this in a coveted way that would suggest, that he knew that he was doing some thing that was far from ok. It might also be true to say that this was not the first time he has acted in a devious way, asked him to write about being devious in his diary.
15/04/98 Key Working Group
Key Working Group was centered on Resident Two. They challenged him on his attitude in general, complacency and refusing to follow or use Community Rules & Tools. The group asked him to get on board, as his visit to church on 22nd April would depend on this. We spent some time talking about the mind games he plays with people and where this all started. Directed to work on these areas in his diary and work on getting in touch with his feelings.
16/04/98 Requested Meeting Back to Contents
Confronted resident two regarding some feedback. Apparently when he was at the Health Center in the village, smoking a cigarette with another young resident outside, he observed a young man come up to the young resident and give him a Joint (Cannabis Cigarette), which the other resident took and brought back to the community. When it was obvious that the evening staff member was aware that somebody had smoked cannabis in one of the Dorms and that the young resident was being questioned and searched, that Resident Two fedback. He informed me that he has not had any drugs but also, that he would not have feedback if had not "come on top". I asked him to explain his understanding of ‘feedback’. He said that in his eyes that it was the same as "Grassing". Time was spent re-orientating him around the therapeutic way of dealing with things. Asked him to use his diary, to write about what he would have to do to fully understand feedback, and to acknowledge the difficulties that he would go through coming to terms with regularly using it. Reminded him that he was on contract to have space in order, to decide whether this was the treatment center he wished to be in or not.
22/04/98 Administration
Feedback from other residents about an earlier incident. During the night a young resident was playing his music loud, being cheeky and ‘rapping’ loudly. Resident Two took offence to this especially when his requests to quieten down were ridiculed and rejected. He grabbed hold of the young man bent him over the bed and whispered in his ear "If you kept fucking around like this in prison, you would be bent over the bed and fucked, now fucking pack it in". As this amounted to an alleged physical assault, I informed my Line Manager who contacted the Program Director. I was directed to record the incident and do nothing until further notice.
23/04/98 Administration
The Program Director informed Resident Two that he is to stop making rude remarks of a sexual nature to residents, especially the young resident. If this behavior continues he would be liable to a complaint being made against him and that it may lead to Criminal Proceedings.
25/04/98 Administration
Completed the second administration of the HDHQ. The results are as follows: SC 3; G 2; AH 6; PH 4; CO 6; TOTAL 21; IH 5; EH 16; DH –08. Gave him feed back from the results.
29/04/98 Key Working Group
During the Key Working Group this afternoon, appeared very quiet, asked about the possibility of phoning his sister in order, to have regular contact with his children. Explained that until he is off contract phone calls will only be allowed on merit and at the moment his behavior does not merit it.
30/04/98 Confrontation Group
Confrontation Group today, good input with regard advice towards other residents accepted criticism.
01/05/98 Requested Meeting
Confronted Residents Two’s behavior the previous evening. One of the activities called "Kick the Can", an inter-group game; he apparently, placed a large stone inside the can, unbeknown to the person about to kick it. The other person sustained injuries to the foot. I gave him a "Formal Talking-To" and explained that this was his first warning that his behavior had to change, especially if he wished to stay in treatment at the Community. There are several areas that had to be improved upon and that his case would be reviewed in fourteen days time; he agreed to try to improve.
04/05/98 Activities
Stayed in the Community whilst the others went on a long walk. He has severe injuries to both his legs, received in a revenge attack in Scotland some years ago, where he was "Kneecapped".
05/05/98 Administration
Care Manager phoned to arrange a suitable time for a meeting. I explained that his behavior does not warrant this at the moment as we were reviewing his placement with us. Asked her to phone tomorrow, because I would be in a better position to discuss the individual and schedule an appointment.
06/05/98 Administration
Spoke to his Care Manager on the phone. She was able to give some background history: Alcohol has played a larger part in his life than drugs. Following his wife’s mother’s death, something that had a disturbing effect on the relationship, they went through a stable period. They were both vulnerable to outside influences. They were both consuming large amounts of Heroin and Crack Cocaine. They were Drug Running, however this was only thought to last a couple of months. Both his children now reside with his sister in Scotland; she has a residing order, although Resident Two has visiting rights whenever possible (Ruling made by sister). His older son was run over in the High Street. Social Services say the child was without boundaries, wandering around at 10.00pm. The child is very traumatized, doubly incontinent at night. His son witnessed his father being Kneecapped. His wife is no longer on the scene, last heard of in London, with possible "Drug induced Psychosis". A visit was arranged for Wednesday 27th May, requested travel details to be sent.
08/05/98 Requested Meeting
Resident Two has been selected to participate in the Managing Anger & Conflict workshop due to start on the 27th May 1998. Introduced him to the Anger Diary, and explained what is required.
11/05/98 Administration
Contacted the Dentist to arrange two appointments. These are booked for Wednesday 03rd June at 11.00am and Wednesday 17th June at 10.45am.
14/05/98 Requested Meeting Back to Contents
Gave Resident Two his phase two papers and explained how he should go about filling them in.
15/05/98 Administration
Received a letter from his solicitor in Scotland, requesting an updated report of his progress to-date.
18/05/98 Administration
The staff team feels that he has done sufficient work to justify taking him off contract. We discussed the areas that we need to be concentrating on with him: boundaries, deviousness, selfishness, criminality, lying and intimidating behavior.
20/05/98 Administration
A Police Officer from Kidlington Police Station phoned to say that they had received a Warrant for his arrest. I explained the situation at present: He was in treatment on a twelve month program; just starting to deal with some heavy issues; crimes related to alcohol and drug use. The Officer agreed not to proceed further with this until the appropriate documents were received from Scotland, in approximately four days. Sufficient time to contact his solicitor and get this matter sorted out. Immediately contacted the Solicitor via Fax. His Solicitor phoned back to say he has taken the document to the Procurator Fiscal's office and is considering the request not to action the Warrants for Arrest, but to grant bail to the Ley Community is being considered.
21/05/98 Administration
The Local Police contacted by phone to say that they have been asked to send back the Warrant, as it is no longer going to be actioned.
22/05/98 Requested Meeting
Completed Case History, very detailed insight into his behavior and family and social issues.
27/05/98 Administration
Conducted the Internal Clinical Assessment today, this was attended by his Care Manager. Good input, several areas highlighted, especially concerning his behavior. The next assessment to be conducted in three months time.
31/05/98 Activities
Came out with the rest of the house for a long walk in The Forest of Dean. A few blisters on his feet but proved to himself just how far he has come in a very short time. Enjoyed him self, worked well with the team. Asked if he would agree to participate in my College studies and allow me to use his resident information for a Case Study and Clinical Diary. This he agreed.
01/06/98 Administration
Received a formal letter from his Solicitors in Scotland, explained to him the present position. The Procurator Fiscal will formally request a report in three months time.
02/06/98 Administration
Went through the Solicitors letter in detail with Resident Two explaining to him the significance of the future report. Completed EPQ, Locus of Control and The Cultural Free Self Esteem Inventory, explained that my Clinical Supervisor, would score these blind and furnish the results after the last session of the Managing Anger and Conflict Workshops. Progressed into Phase Two this evening. Gave a good speech, hoping that the residents would give him a chance to change.
14/06/98 Administration Back to Contents
Put on Contract for the day by a Colleague, due to his poor behavior and possible threat to another resident.
15/06/98 Requested Meeting and General Meeting
Was spoken to by Program Director this morning regarding the previous days behavior: Incident of deviousness in the Kitchen over sausages; going to bed, falling asleep during a tea break. To go on Contract (Dish-Pan) for a week, to be reviewed on Friday. He needs to address his behavior because at the moment he is doing nothing to address his attitude. If he does not pull his socks up, he will be asked to leave. Agreed and signed a "Final Talking To".
17/06/98 Managing Anger and Conflict Workshop
Attended the Managing Anger & Conflict workshop today, good participation. However, does not see the need to complete an Anger Diary. Explained that that was his choice.
RESIDENT THREE was born in Oxford on XXrd August 19XX and has one sister. His early years are full of very happy memories. However, his parents divorced when he was aged seventeen, this came as a complete shock. He remains in contact with them both, but gets on better with his father than his mother. He attended the local secondary school and gained several qualifications. He states that this was not an enjoyable experience, because he was often bullied. He left and gained a College place in Handsworth, Birmingham, which he completed and gained NVQ’s in Flooring and Construction. This was when he started using drugs namely Cannabis. He met and fell in love with a woman and fathered a son. This relationship has now ended, although he has contact with his son. On returning to his hometown, he began using heroin, initially on an occasional basis then becoming a daily user. He has had several Casual jobs, working in everything from Construction to the Food Industry. Back to Contents
I initially met Resident Three in October 1997, whilst temporarily working in the Assessment Department. I was the person who conducted his Assessment Interview. The interview lasted for two hours and include family history; history of drug/alcohol use and criminal behavior; education; employment history; relationships; past interventions and reasons for wanting to change. He presented as an extremely chaotic young man, who was very restless and used disjointed levels of speech to communicate. It appears that the motivating factor for his presence today at the interview, was his Father without whom, he would not have arrived. His levels of drug use at the moment were of an occasional basis and managed via the local Hospital and Drug Agency. Assessment Outcome, to be offered a date in order to attend for a Day Placement (unless this young man receives input as soon as possible, then his immediate short term prognosis is extremely poor).
From October 1997, to his admission into treatment on 26th March 1998 was dealt with by the assessment team and I played no further significant part in his application for treatment. His domestic situation had deteriorated, his drug use, became a concern to the Health Authority, due to him intravenously administering Heroin directly into his groin area. He was considered at risk, by his local Social Services Department and became a priority client.
CLINICAL DIARY ENTRIES Back to Contents
ANNUAL LEAVE FROM 23-03-98 to 07-04-98.
26/03/98 Arrival Meeting and Administration
Admitted into treatment by a colleague. Received a letter from his Solicitor, with information concerning his forthcoming court appearance on 07-04-98 at 09.30am at Cheltenham Magistrates Court and that his advice is for Resident Three to plead guilty.
07/03/98 Introduction Meeting and Key Working Group
Returned from annual leave today, to find a new resident allocated to Key Working Group and that he was at court. When he returned to the Community, I introduced myself to him and explained the role of the Key Worker and what sort of relationship we should try and build. He informed me that he is due to return to Court on 05-05-98. I explained to him that I do not work on Tuesdays, but a colleague of mine will be available to take him on that date. During the afternoon Key Working Group, he introduced himself to everybody. He appeared to be comfortable talking and listening to others in that setting.
08/03/98 Key Working Group
Resident Three completed a mini Personal Profile to other group members this afternoon. For a new resident, this is quite a feat, which he accomplished very well. He spoke about his family, parents divorce and how this affected him. Attending College in Birmingham and started using drugs.
10/04/98 Diary Meeting Back to Contents
Talked about the benefits of completing a diary. States that he finds it difficult to identify feelings and does not know what to write about. Explained to him that he can break the day down into three parts and write about each separately, e.g. what happened? what he did?, How he felt?.
13/04/98 Requested Meeting
Asked to speak to Resident Three, about some of the feedback that came in from the morning staff hand-over, concerning his behavior over the weekend. He has taken a dislike to another young resident also from his town. We spoke about the difficulties of being in treatment with other young people, who know each other "on the out" and how these feelings can be overcome. Suggested he use his diary, to write about how he feels.
15/04/98 Key Working Group
Asked him to talk about how he was settling into the "Therapeutic Regime", he say ok. The group, thinks that he does not listen to people, does his own thing and talks continually, not letting anybody else get a word in. The Group talked about these issues and how he could become isolated from the community and we asked him to suggest ways in which he could overcome them. He is going to have "Relating Chairs" in the evenings with group members.
17/04/98 Diary Meeting
Talked about how his diary entries have improved over the last couple of days and how he appears to be identifying his feeling more. Appears to be taking things on board although, he has problems over the idea of "Feedback". Explained to him that this is an important therapeutic tool and he best discuss this with other residents, in order to find out how they overcame the same subject.
23/04/98 Administration and Key Working Group
Phoned his Probation Officer in order to arrange a suitable date for a visit, not available, left a message to return my call. Returned my call in the afternoon, a visit is booked for Wednesday 06th May 1998 at 11.00am. In the Key Working Group he was asked to talk about the ongoing problem he has with another resident and suggest ways that this should be sorted out, once and for all. A "Support Group" is planned for this evening, to talk through the problem.
25/04/98 Administration
Conducted the Hostility & Direction of Hostility Questionnaire (HDHQ), results as follows: SC 7; G 6; AH 8; PH 4; CO 10; TOTAL 35; IH 13; EH 22; DH –02. Gave him feed back from the results and also that he could benefit from participating in the forthcoming Managing Anger & Conflict workshops planned for May 1998.
26/04/98 Requested Meeting
There was a situation between Resident Three and the young person he has been having a few problems with. It appears the other resident accused him of stealing some "Coke Cola" cans from his locker and an argument followed. I spoke to the two individuals concerned. Went through this immediate issue and also their underlying relationship with each other and how they had to turn this around. If they were unable to work something out together, they might be asked to leave as they could jeopardize the whole of the Community. They both agreed to talk to each other in a Relating Chair that evening.
30/04/98 Administration
Received a phone call from his Solicitor and also his Probation Officer (same information). Court date has been put back to the 12th May 1998. As this is also a Tuesday, my colleague will convey to court.
04/05/98 Diary Meeting
Has enjoyed the Bank Holiday weekend. Decided to stay in the community instead of going on a long walk. Talked about wanting to leave asked him to write about the positive and negative consequences of leaving in his diary.
06/05/98 Administration
His Probation Officer arrived this morning only to find that resident three was at the hospital (blood-test results). Was given a tour of the community by another resident whilst waiting for his return. Confronted him about not informing his Probation Officer of his hospital appointment, said he "could not be bothered as he had forgotten all about it".
07/05/98 Confrontation Group
Confronted about his attitude of late, especially yesterdays confusion over his Probation Officers visit and being at the Hospital. He has difficulty in taking on responsibility for his own actions and behavior. The group kept him in the "Hot Seat" for most of the time. He does not see that he has any problems, can not get to grips with the Community Tools or see the purpose of the Community Rules. He was told explicitly by the group either to get on board or make the decision to leave. He explained that he is having difficulty conforming to the Ley Community as he was due in Court on Tuesday next week and that he did not know whether he was going to be sentenced here or to Prison. The group talked about his anxieties about the Court date and how this was affecting his behavior.
11/05/98 Requested Meeting
He was given several "talking-to’s" over the weekend and was awarded a "Further Action (FA)" of a "05.30am bomb Squad", which he failed to complete. He says that he unable to get up without a clock at that time. Explained to him that there were plenty of Community Clocks around, which he had better find one of these and repeat the "FA" on Wednesday morning and also to spend the time thinking about why he received the "FA" in the first place.
12/05/98 Administration Back to Contents
In court to day Resident Three received a twelve-month Probation Order, with the conditions to reside at the Ley Community or wherever his Probation Officer thinks fit.
15/05/98 Diary Meeting and Requested Meeting
It is apparent that his behavior has become a concern since he received his sentence on Tuesday. It was mentioned this morning during the staff hand-over that he is setting a very bad example to new residents. I expressed our worries to him that he was setting himself up to leave and that he must talk about what he is going through before it is to late. He said that he is finds it very difficult to be here at the moment because he is continually thinking about his son. Explained to him the dangers of this and he could benefit from speaking to other resident with children and actually write about this in his diary.
16/05/98 Administration
Resident Three, "Split" (left treatment against advice) at 09.30am this morning, actually ran down the drive. Later on in the day his Father rang to ask if we would have him back. I requested that he ask his son to phone us in person. An hour later he phoned asking to come back. At 09.00pm Resident Three, returned to the community, having used Heroin and without seeing his son, the actual intention when leaving. He was placed in Palmer House on a "Dish Pan Contract".
18/05/98 General Meeting
Resident Three was asked to stand in front of the General Meeting to day to explain his behavior over the weekend, especially the feelings that led to him Splitting on Saturday morning. He was given ample opportunity to talk by the Community who asked questions to try to elicit answers, he remained quiet. However, the residents were given the opportunity to vote: they decided to allow him to stay. He was offered a "Dishpan Contract", which he accepted. Whilst, he was upstairs with his runner, he asked to go to the toilet. After twenty minutes, his Runner became suspicious and when he emerged, challenged him. He handed over some "Works" and a small "Wrap" of Heroin. The Runner immediately notified staff. The Chief Executive gave permission for me to discharge him for violating the Community Rules, namely ‘Using Drugs’; this was dully done at 04.55pm. On escorting him from the campus, he apologized for letting us down. I explained to him, the only person whom he had let down was himself. On returning to the office I contacted his Probation Officer and Care Manger, to inform them of the fact that we had Formally Discharged him for breach of Community Rules.
The information held within the Clinical Diary represents a total period of fourteen months of therapy divided between three residents. Therapy within the Ley Community and any residential therapeutic community does not just occur between the hours of "9 to 5", but consists of twenty four hours a day, seven days a week. The role of the Clinical Group Worker (Key Worker) includes welfare, social and legal issues as well as the therapeutic nature of the work. The therapeutic purpose of the role is to facilitate change, this may not always be face to face, but often includes arranging support/confrontation groups or setting paper exercises and monitoring entries in their Feelings Diaries.
Resident One has currently completed eight months in treatment. He arrived via the Criminal Justice System, on a Probation Order with the Condition to reside at the Ley Community for a period of twelve months. Since his arrival he has not only settled into treatment but has become a respected member of the Community. He presented, as an extremely immature young man that blamed the whole world for his behavior, especially his mother. Several underlying issues were identified as to his drug use and the interrelationship between drugs and his criminal behavior. From having no positive self esteem, to the extent of disliking his own mirrored reflection, he has now started to like himself and through this, other people. Initially we helped him to almost relive his missed childhood, coping with a variety of mood-swings and personal identity criticizes. It was also identified, that he had a high level of intelligence, something that was quite a shock for him to comprehend, as he was always considered dumb and a "no hoper". He has worked consistently on all areas that have been asked of him. He is in the process of preparing for a visit from his mother; they have both worked on building their relationship over the eight-month period. They have asked for some therapeutic input on the day to discuss some painful areas, as water has gone under the bridge from both sides. Resident One’s prognosis looks quite promising. It is unfortunate that he will not be able to start full-time college on leaving the community, as there is a need for him to gain a supportive peer group of individuals of his own age. However, he is now full of confidence and looking forward to a drug and crime free future.
Resident Two has completed four months in treatment. Although he is a resident on a voluntary basis, there are several court cases outstanding, which suggest motivational issues. However, his behavior over the time has been extremely interesting. He remains very devious, selfish and spiteful, especially with regard relationships he builds with other residents and often keeps potential friends at bay by continually playing head games with them. He is currently on a Final Warning, for his intimidating behavior and general attitude to treatment. It will be unfortunate if Resident Two is unable to make the decision to turn his life around. I believe that the external image he has developed over the years is cleverly designed to protect a vulnerable core. It is this core, which he is reluctant to expose. He is presently half way through a Managing Anger and Conflict Workshop, which is giving him alternative skill to use at times of crisis. However, he complies with any request made, but given the option will do his own thing. The most positive thing, is that he continues in treatment, as long as he is a resident, then we will give him the opportunity to change his behavior but we have to remember, that we are unable to force individuals to change against their will. He has to want to change, failing this; his prognosis will only be quite poor.
Resident Three was in treatment for approximately two months. It is always the reality of this work that some individuals would prefer to keep their dysfunctional lifestyle, than to risk the unknown. This young man had probably not experienced the lows of the other residents and with the continual financial support of his father, will not for a considerable period of time. He has the taste for Heroin. He is presently living in Oxford and using on a daily basis. Unless he chooses to turn his life around, his prognosis is extremely poor.
APPENDIX
Glossary of Terminology Back to Contents
Auxiliary Staff Member This is a Senior Resident, who takes on additional voluntary duties, in order to hand down information to junior resident, and also become responsible for the house during the evening. Works along side an Evening Group Worker.
Community Tools These are the Therapeutic Tools that are used within the community on a daily basis: PULL-UP’S, making people aware of their behavior; BENCH, a place of sanctuary to think about behavior (Time Out); PASS-UP’S, a way of request for something; SLIPS, a way of dealing with feelings in preparation for groups; CONFRONTATION GROUPS, see below; STRUCTURE, a frame-work for daily tasks etc.
Confrontation Group These are the formal compulsory therapeutic groups that take place every Monday and Thursday afternoons and last approximately two and a half hours. They normally consist of eight residents and are facilitated by one Clinical Group Worker. The group sits facing each other in a circle on hard back chairs. The group process is Confrontation, Probe and Patch-up.
Crew These are the ‘Work Departments’. On admission each resident is allocated a Crew: Housekeeping; Kitchens, Administration or Special Projects. Usually a resident will start off as a crewmember on a particular department and progress through various responsible positions until finally becoming the Manager. Each Department will enable the resident to experience varying degrees of responsibility and associated stress. The ultimate position is that of the co-ordinators, these are the residents who are in charge of the house and are directly responsible to the House Staff Team.
Family Visits These are not normally considered until a resident has been in the Community for a minimum of six months. The first visit is not allowed on a group day and must be taken during Monday to Friday. The second visit can be an overnight stay and the third visit is allowed at weekends, it is only on the third visit that the resident and leaves the Community.
Internal Clinical Assessments This is a formal assessment that is normally conducted every three months, in order to ascertain the progress made to date and identify those areas that need to be dealt within the following period of treatment
Key Worker The Clinical Group Worker assigned to a group of residents, normally numbering about eight.
Key Working Group The group of residents assigned to a particular Group
Worker and meet formally twice a week on Monday and Thursday afternoons.
Phases The Program in separated into three distinct phases; One; Two and Three. Each has a distinct purpose of Assessment, Education and Identifying underlying issues for drug use; Dealing with those issues and Relapse Prevention (Preparing for the future).
Phase Two Papers These are a set of paper exercises that are designed to enable the resident to think about a Varity of contributing factors to their drug use. They include Significant People; Significant Events, Strengths & Weaknesses and Goals for the future.
Progression These are formal celebrations to mark the progress of a resident from one Phase to another. This is where the entire resident population comes together. The ultimate graduation, is where the resident completing the program ‘Stands on the Table’, they often invite family and friends to share such an event.
Support Groups Informal Therapeutic Groups, residents organize these as and when requested, not normally staffed.
Terms and Conditions of Residence This is the formal Therapeutic Contract the Resident signs prior to commencing treatment and completed on admission.
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