Help for the Quatra-Diagnosed: The Fourth Moment in the Evolution of the

Therapeutic Community

Democratic TC in the psychiatric context (UK: Maxwell Jones)

Concept-based, hierarchical model (US: Charles Dederich and Synanon)

Research-practice/evidence-based (Europe: EFTC, EWODOR; later US)

Holistic: e.g. serving quatra-diagnosed persons

Builds on evidence-based practices Emphasizes community as method Based on ecological dysfunction model of

behaviour and the “…reciprocal influence of personal and environmental variables instead of a disease model…” Broekaert, 1999 p. 33

Reflexive to diverse populations and problems in one therapeutic context

Research shows MTC success ranging from 30% -- 70%

Interweaving of homelessness, substance abuse, mental illness and criminal behaviour implies a holistic modified therapeutic model

Four problems lay on a continuum from less to more serious:homelessness->substance abuse->mental illness->criminal

MTC can serve the quatra-diagnosed persons starting with the least serious

Vision: To enfold our neighbours-in-need back into community, by giving them the support and the tools needed to reclaim their self-worth and gain self –reliance

78 hectare farm located15kms north of Victoria, BC Canada

Anticipate accepting clients in November, 2009

Approximately 800 people in the area fit quatra-diagnosed criteria (Cool Aid Society)

Existing services cannot cope with demands This population “troublesome” to business

and tourism Community support for Woodwynn strong

(63-80%), but some NIMBY issues

Administered by Creating Homefulness Society

Non-profit, primarily funded by non-governmental sources

Starting with 12 males but have capacity for 96 mixed gender residents when fully operational

Implementation of quatra-diagnosed model to occur over three stages starting with homeless and addicted persons

WF is loosely based on San Patrignano Several modules

◦ Organic fruits and vegetables Production of secondary goods

◦ Animal care/training◦ Production of hay

In addition to the City Effect WF will also provide a comprehensive therapeutic structure

Common TC structure◦ 24/7 attendance◦ Highly structured regime ◦ Meetings, education, therapy◦ Peer work structure/farm duties◦ Emphasis on reliability, responsibility,

accountability, consistency◦ Mutual positive regard (staff and residents)

Emphasis on the development of an Oral Culture

Acceptance of individuals’ unique biographic path (Guidicini & Pieretti, nd)

Long term residence anticipated (3+ years) Stages of treatment

◦ Affiliation with community◦ Primary treatment◦ Line-in re-entry◦ Live-out re-entry◦ Independent living (DeLeon, 2000; Sacks et al.,

1997)

Category 1◦ Daily meetings

e.g. morning, evening…◦ Seminars

e.g. health…

Category 2◦ Group activities

e.g. conflict management, gender-specific…◦ Individual treatment

e.g. counselling, relapse prevention…

Category 3◦ Community and clinical management ◦ e.g. personal boundaries, substance testing,

relationships, cardinal rules…

Category 4◦ Vocational training◦ Farm work

Promotion in the hierarchy based on evidence of successful treatment

WF is unique, particularly in Canada◦ It engages residents in the ongoing operation of

the farm and emphasises community as method and also provide individual and group treatment modalities

◦ Its holistic approach is well-suited to quatra-diagnosed persons

◦ Residents have the chance to regain or gain a healthy and self-reliant identity, and to help others to do the same

◦ An ongoing evaluation research program is being established

Thank YouPlease visit: creatinghomefulness.org