Artwork: Anthony Maccini - CHT

Peer Reviewer Handbook

Contents

Welcome ................................................................................................. 1 Order of events ....................................................................................... 3 Code of Conduct ...................................................................................... 4 Service Standards and Peer-Review ........................................................ 5 Example Timetable .................................................................................. 5 Types of review ....................................................................................... 6 Preparation checklist .............................................................................. 8 Workbook Guide...................................................................................... 9 Role of the peer reviewer ...................................................................... 11 The Review Day: ................................................................................... 11 Troubleshooting .................................................................................... 13 Community of Communities Contact List ............................................... 16

1

Welcome

This guidance is for Peer-reviewers attending peer-reviews on behalf of the Community of Communities (CofC). The handbook will guide you through how to prepare for attending a peer-review and what your role is prior to the review

day, on the day and after the visit.

Peer-review process The peer-review process is an evidence based quality improvement method

which incorporates elements of clinical audit and feedback that have been shown by a Cochrane review to lead to improvements in practice (Jamtvedt et al 2004).

The peer-review team is a multidisciplinary group of three or four staff and service users of a member service of CofC. The peer-review process aims to

support a host service evaluate their service and to share ideas and insights to improve the quality of their respective services. The team will use the host

community‟s self review workbook to discuss achievements and difficulties in order to validate the scores and comments.

Peer-reviewer’s role

The Peer Reviewer‟s role is to ensure that:

Engage with the host community in reflective discussions about their

practice against the standards in the workbook Highlight areas of achievement and areas for improvement

Enquire and comment on improvements from previous cycles Contribute to the written record of the visit

Review and comment on the accuracy and clarity of the draft local report

Engaging with the host community is your priority on the review

It is important to ensure that discussions in the formal meetings which take place on the review day are focused on the standards in the workbook. Whilst there is a focus on shared learning and discussing best practice, it is important to remember the host community is not being reviewed against the practice of your own community.

How to sign up for reviews A list of peer reviews are sent out to you by the CofC team. You will need to

respond with the reviews you are available to attend.

2

Peer-reviewer Training

Peer-reviewer training is available and all peer-reviewers are encrouaged to attend the training before going on a review. Training dates are located on the Training and Events page of our website. You are able to look up our next

training session and book yourself on to the sessions available. The training will equip you with the skills and knowledge to take part in the peer-review

process. Conflict of interest

You will need to make CofC aware if you believe there is a conflict of interest between yourself and the host community as soon as possible. Peer-reviewers

must inform the lead reviewer if they believe a conflict of interest exists and will impact the review visit. The lead reviewer will then need to find an alternative way forward which doesn‟t involve the conflict of interest or take appropriate

steps to manage the conflict (see Troubleshooting for more).

Troubleshooting Most peer-reviews run smoothly and are an enjoyable and stimulating experience, but if any problems arise on the peer-review day it is the lead

reviewer‟s responsibility to try and resolve them. If you have any concerns about anything you see or are told on the review, please highlight these to the lead

reviewer

3

Order of events

What When Who

You select the reviews you are able to

attend May Peer-reviewer

Confirmation of reviews you have agreed to attend

June CofC

Attend peer-reviewer training session June or Oct Peer-reviewer

The workbook and information about the review is sent out to the lead reviewer and peer review team

Two weeks prior to

review CofC

Make CofC aware of any issues you or are experiencing

As soon as possible Peer-reviewer

Attend the peer-review day Between Aug - Feb Peer-reviewer

Make CofC aware of any issues you

experienced whilst on review As soon as possible Peer-reviewer

Review the draft report following the visit

About a week after the review day

CofC

4

Code of Conduct

It is expected that a lead- and peer- reviewer will:

Represent the Royal College of Psychiatrists in a professional and appropriate

manner at peer review visits

Conduct themselves at peer review visits in accordance with guidance given

through peer reviewer training and documentation, if relevant

Avoid cancelling their attendance at a peer review visit wherever possible,

especially at short notice

Notify CofC project staff at the earliest possible time if they are no longer unable

to attend a peer review visit they have committed to

Be responsible for booking their travel and accommodation to attend peer review

visits, or responding to requests from CofC project staff to book travel on their

behalf, in a timely fashion

Notify CofC project staff of any conflicts of interest they may have, including

previous roles

Be aware of guidance relating to claiming expenses and claim expenses

accordingly

Lead reviewers should return paperwork in full, promptly, after a peer review visit

A lead- and peer- reviewer will not be invited to take part in the role if:

Another reviewer, a member of the host team or CofC project staff make a

complaint or raise a concern about their conduct at a peer review visit:

o Relating to following the training they have received

o Relating to the professional and appropriate nature of their behaviour

The reviewer fails to attend a peer review visit and does not notify CofC project

staff beforehand

The reviewer cancels their attendance at a peer review visit less than 2 weeks

before a peer review, on more than one occasion

The reviewer fails to notify CofC staff of a conflict of interest with a site they

intend to visit/have visited

The lead reviewer does not return the booklets/reports within 14 days of the

review, on more than one occasion

The lead reviewer returns incomplete booklets/reports, on more than one

occasion

If one of the above issues is identified, CofC staff will consider each case individually and

consider a plan of action, including an attempt to rectify the problem.

5

Service Standards and Peer-Review The Service Standards for Therapeutic Communities (9th edition) contain a total of 127

Elements, broken down into 30 Standards and 97 supporting Criteria. Each standard has

typically three or four criterion statements. Criteria are not comprehensive, but are

generally given as examples of good practice to demonstrate meeting the standard.

During the self-review, communities are asked to review against criteria, commenting on

how they meet them and give them a score.

During the peer-review, communities will review the standards, using the self-review

comments to facilitate discussions.

For accreditation, each criterion is given a typing level. This can be used as a guide for

all members when reviewing against the criteria. The different „types‟ are:

Type 1: Essential criteria which are critical to community members‟ safety and rights

and to the service being considered a TC

Type 2: Expected criteria which an accredited TC would be expected to meet

Type 3: Desirable criteria which would indicate best practice

Example Timetable

Below is an example of a typical timetable for a peer-review. The Host TC is asked to

pick the standards they wish to cover during the review and can make amendments to

the timetable to suit them. Alternatively, the Host TC is also able to create a custom

timetable.

Example Timetable

Start

Time

End

Time Aspect Who

Standards to

cover

10:00 10:20 Review team brief Review team only

10:20 10:45 Introductions and Update Review team and whole

community

10:45 11:05 Tour of the community Review team and service

users

11:10 12:00 Meeting Review team and whole

community

Example: Core

Standards

12:00 12:10 Break Review team only

12:10 13:00 Meeting Review team and whole

community

Example:

Joining and

Leaving

13:00 13:45 Lunch Review team and whole

community

13:45 14:45 Report writing session Review team only

14:45 15:15 Evidence portfolio review

and discussion

Review team and a

selection of community

members

Evidence

Standards

15:20 16:00 Report writing session Review team only

16:00 16:20 Feedback Review team and whole

community

6

Types of review Peer-review

During the peer-review the peer-review team will review the criteria with the host community, using the self-review comments to facilitate discussions.

Peer-reviews incorporate elements of clinical audit and feedback that have been

shown by a Cochrane review to lead to improvements in practice (Jamtvedt et al 2007). This is a critical part of the cycle, where valuable lessons are learned from sharing best practice and from frank discussion about problems and

exploring potential solutions. This process brings further attention to the areas requiring development, and provides a space for communities to start to think

about what specific actions they would like to take, supported by the ideas and experiences of the review team.

A peer-review team usually consists of a lead reviewer and 3-4 members from other communities. The review team are required to take a lead in engaging the

host community in the discussions on the review day. They will be expected to share knowledge and learning and help support the community to think about action planning. All members of the review team are required to support the

community to identify areas of achievement and areas for development. All members of the review team are involved in compiling the report, using the

information and evidence gathered throughout the review day and self-review submission.

Accreditation Visit

The Community of Communities has developed an accreditation process within the quality improvement framework to recognise member organisations as Therapeutic Communities. This process identifies and demonstrates good TC

practice using the Service Standards in an environment which engages in service evaluation and quality improvement. Accreditation demonstrates that a

community is fully meeting the essential standards which underpin a Therapeutic Community.

Gaining recognition through an accreditation process provides:

Assurance to clients, commissioners, government departments, regulators and the public that accredited TCs are of an acceptable quality and adhere to a clearly defined TC model

Recognition for local achievements measured against rigorous national standards

A standardised base to support a continuous focus and development on improving the quality of care they provide

Funders confidence to invest in accredited TCs

A professional identity for accredited TCs

7

Accreditation Standards

The accreditation process measures the community against criteria in the Therapeutic

Community Service Standards, 9th Edition. The criteria are categorised into three types:

Type 1 criteria are essential, Type 2 criteria are expected, and Type 3 criteria are

desirable. The host community will be evaluated against all Service Standards for

Therapeutic Communities (9th Ed.), demonstrating how they are meeting the standards

by providing evidence to support and verify their self review scores.

To achieve accreditation communities must meet all the Type 1 criteria, 80% of

Type 2 criteria and 30% Type 3 criteria.

The review team do not make the accreditation decision, the report compiled from the

review will be sent to the Therapeutic Community Accreditation Panel, to decide the

outcome of the visit.

The review team Peer-reviewers: 3 or 4 members from another TC. The peer-review team will review

the community against Service Standards for Therapeutic Communities (9th Ed.), the

workbook is organised into the meetings which take place on the review. At least two

members of the team must come from an accredited service and have 3 years of

experience in the community.

TC specialist: a peer-expert from a TC who has over 5 years TC management

experience. Their role is to provide a more detailed view of the structures and processes

that contribute to the TC. The specialist will review documentary evidence and will take

part in some meetings on the review day, focusing on the standards under the TC

specialist heading in the workbook.

Lead reviewer: trained by the CCQI, the lead reviewer facilitates the review process

and to provides guidance for the host TC and peer-review team.

In Summary

DO’s

Prepare for the visit, read all the information in advance Get involved, ask questions and be inquisitive

Write down important comments you want to discuss at the report

writing sessions

DON’Ts

Divert from the standards Minute the meetings

Compare the host TC directly with your TC

8

Preparation checklist

Documents Received

Contact details for the community and lead reviewer

Peer-review workbook including timetable for the day

Host community‟s previous report (if applicable)

Peer-reviewer handbook

Preparation

Read the peer-review workbook thoroughly:

- Note any areas of interest

- Look for standards where the comment does not justify the score

given

- Highlight any areas of concern

- Compare with the action points from the previous year

Read the previous year‟s report

Familiarise yourself with the timetable – noting start and end times

Organisation

Print out a copy of the peer-review workbook

Organise your own travel requirements

The peer-review workbook and previous report are confidential and

should not be circulated.

9

Workbook Guide

There are four sections within the peer-review workbook:

Community Information

Action Plan from 2014-2015

Workbook

Timetable

Community Information

This contains important information about the community you are visiting, the service

user population and staffing figures for the past 12 months.

There is a space in the peer-review workbook entitled “Our Story‟ which provides a

description and contextual information about the community. This introduces the

community and can provide a helpful starting place when asking the community to

introduce themselves.

Timetable

The community has selected the timetable they would like to use on their review day.

Remember to check the start and end times for the review day, it is important to arrive

at the review 10 – 15 minutes before the start to ensure you are ready for the first

meeting to begin on time.

The timetable should also indicate which sections of the standards will be reviewed on

the day, use this information to help focus your preparation.

Look at the different meetings and sessions scheduled into the timetable and think about

which meeting you would be interested in chairing.

10

Action Plan from 2014-2015

Action planning is a critical aspect of quality improvement. Members are expected to

prepare an action plan to develop and progress for standards which have been scored as

partly met or not met in the self-review and peer-review during the previous review cycle.

When preparing for the review day, read through this and make notes, linking actions and

outcomes to comments in the comments in their self-review for this year.

Example 1:

Workbook

The workbook contains five sections of standards and criteria:

Core Standards

Joining and Leaving

Staff

Therapeutic Framework

External Relations and Performance

Action Planning from 2014-2015

This is the

Standard – you

will be basing

your discussions

around this.

These are the criterion.

You should bring the

self-review comments

related to these criteria

into your discussions

around the overarching standard.

11

Role of the peer reviewer

The Review Day:

Briefing session

The lead reviewer will outline the process and what to expect for the day. You should ,

introduce yourself to the rest of the team

Introduction to the day

Give an overview of your own service and explain your role, share „where your

community is at‟ and acknowledge any issues that you are working with at the

moment to help them relax

Support host TC members to share information about their TC by asking questions

Explore progress the community has made since the last cycle

Standards based meetings

Facilitate and guide discussion through exploration and reflection on self-review

comments

Pay special attention to criteria that are not fully met and support the

community to think about how these could be met and identify action points

Explore progress the community has made since the last cycle

Take notes of conversations and action points to discuss later

Evidence review

Look at the evidence provided and identify how it helps to meet the

standards

Observation

Communities are able to include observation in their timetable to demonstrate how

they are meeting the standards

Be aware of the standards throughout, comments from the observation should be

included against the standards and criteria

You should not become involved (unless appropriate) or take notes during

observation sessions

Report writing sessions

Discuss observations and points to be raised in the feedback session

Assist the lead reviewer to complete the workbook, scoring the standards and

ensuring that there are relevant comments to justify the scores

Identify areas of achievement and areas for improvement using SMART action

points

Contribute to the overall peer-review team comments collected by the lead

reviewer

Feedback session

Thank the host team for their hospitality

Feedback areas of achievement and offer suggestions for improvements

Reflect on the experience of the day with the host community

You will also need to complete the team feedback during the report writing session

to provide feedback on the review process.

12

After the review

CofC will draft the report based on the comments and scores from the day. The report will

be emailed to you for consultation. You should check its accuracy and clarify any

ambiguous or inaccurate comments and add anything you feel has been missed. You

will also be sent an online feedback form to complete about the lead reviewer.

13

Troubleshooting Most peer-reviews run smoothly and are an enjoyable and stimulating experience, but if any problems arise on the peer-review day it is the Lead Reviewer‟s

responsibility to try and resolve them. If you have any concerns about anything

you see or are told on the review, please highlight these to the Lead Reviewer.

Situation Suggestions to deal with the situation

The host community seem nervous and

defensive.

Remind the host community that this visit

is not an inspection. It is a supportive

learning process. Be friendly, calm and

understanding.

The host community do not seem to be

engaging with the day.

Remind the host community that this is a

supportive visit and encourage them to

discuss what they have written in their

self-review comments. Asking for examples

and asking open questions is often a useful

way to open up the discussions.

A complaint or concern is raised about

conduct, relating to unprofessional or

inappropriate behaviour

Notify the lead reviewer, who will need to

make a decision to resolve the issue at

hand if this is possible and continue with

the review or to terminate the review.

You believe there may be a conflict of

interest from the peer review team which

may impact the report

You must inform the lead reviewer of this

as soon as possible. The lead reviewer will

need to make the final decision as to how

to proceed.

You believe the safety of yourself or

member/members of the peer review team

is at risk...

Notify the lead reviewer who will need to

make a decision to resolve the issue at

hand if this is possible and continue with

the review or to terminate the review.

They will make a member of CofC staff

aware of this as soon as possible after the

review no matter what the outcome was.

14

HMP Visits: Frequently asked questions How many residents are there?

All the prison TCs take up to 40 men, except the assessment units and HMP Gartree

which takes up to 25 men, and HMP Send which is a TC for up to 25 women.

Will I know what crimes people have committed?

In some TCs, specifically HMP Grendon, there is a culture of community members

introducing themselves and including details of their offence and tariff i.e. length of their

prison sentence. Fewer TCs do this with visitors now, not least because it is a time

consuming process. If you have any concerns please speak to a member of C of C.

What can I expect when I arrive?

When you arrive at the prison, you will be asked to show a valid photo ID. You will then

be given a visitor‟s pass. The security staff may ask to take a photograph of you to put

on your pass.

The following items are not permitted to be taken into the establishment: Mobile

phones, laptops, iPods, iPads, USB sticks, walkmans, CDs, MP3 players, tablets, music

CDs, cameras, floppy disks, memory cards, umbrellas, tools, scissors, chewing gum,

aerosols, spray perfumes, metal cutlery, tweezers, nail files, pocket or craft knives,

knitting needles, tape measure, DVDs or videos.

Visitors are advised that if they require medication, they may only bring sufficient

quantity that is required for the duration of the visit.

If you have any of these items, you must give them to security, who will keep them at

the gate. Depending on the prison, you may then pass through a metal detector and be

required to put your bag through a conveyor belt (like at an airport). All visitors and

their property are subject to search. This is likely to include a “pat down” to check you

are not carrying an illegal item on or about your person. A staff member from the TC will

then come and take you to the TC.

If you find that you are carrying something that you should not have once inside the

prison, inform the lead reviewer immediately.

Can service users attend HMP reviews?

The contribution of service users is vital and residents at prison TCs often state that the

most valuable part of the day was meeting a service user and hearing about life in a TC

outside of prison. It is therefore crucial that the service users on the peer-review team

feel confident and able to contribute to the discussions.

Visiting HMP TCs can be a very rewarding and valuable experience. Most peer-review

teams report that they thoroughly enjoyed the experience. However, the experience of

being in a secure environment may, for some, feel claustrophobic at times. It can also

be rather daunting to be in such a large community of residents in a unique setting. This

feeling usually passes as you settle into the day. Peer-review teams are usually surprised

at how similar the community is to their own and how comfortable they feel.

Nevertheless, anyone who is anxious or feeling particularly vulnerable may feel more

susceptible to the confines of the environment and it is important to consider this when

constructing the team.

15

Can I visit a prison TC if I have a criminal conviction?

This will depend on the conviction. However, the earlier you supply your security details

to C of C (at least 6 weeks before the visit), the more likely you will be able to visit the

TC.

Can I take my mobile phone into the prison?

No. If you have a mobile phone, you must leave this in your car or at the gate and

collect it when you leave. If you need to make a call, you may ask the TC staff if you can

use their office telephone. C of C will give you a list of items you are not able to take into

the prison, please read this carefully.

What if a resident offers me something?

You should not accept any items that a resident offers you to take out of the prison e.g.

photos, pictures, letters etc. If a resident offers you something to take outside of the

prison, you should inform the lead reviewer, who will inform the TC Therapy Manager.

Can I give residents anything?

Similarly, you must not give a resident anything, however insignificant you think this is.

All residents are very aware of these rules.

Will I be on my own at any point in the day?

You must never be left alone with residents. If you find you are by yourself with

residents, you should locate the nearest member of staff.

What should I wear? (From HMP website)

“Visitors must wear appropriate clothing that is not disruptive, offensive, and does not

pose a security risk. Clothing should not be tight, revealing, or see-through. Clothing

items that display gang, racial or profane language or symbols will not be allowed.

Inappropriately dressed visitors may be denied entry to the prison”.

What do I do if a member of the host TC makes a complaint?

It is not your role to take forward the complaints of residents or staff. If a member of the

community wishes to make a complaint, you should either encourage the member to find

out the prison‟s proper channels for making a complaint, explaining that you are unable

to take it forward and/or tell the lead reviewer immediately.

How can I prepare for the visit?

Arrive at the prison at least half an hour before the first meeting. It can take some

time to pass through security. Furthermore, due to the nature of the structured

programme, and security issues, it is very difficult to reschedule meetings. Plan your

route carefully and allow enough time for traffic, delays etc. If you live far away, you

may wish to consider staying in a nearby hotel the night before.

Bring all appropriate medication and inform Community of Communities before the

visit if you are going to be taking medication into the prison.

Remember that everything takes longer in a prison because of security even going to

the loo!

Remember not to be on your own with residents during the visit. Make sure a

member of prison staff are within sight at all times. This is for the safety of

community members as well as yourself.

Try to anticipate any difficulties you may have with the visit and try to talk these

through with staff from your service or the Community of Communities team.

For guidance relating to the peer-review please see Peer-review Guidance Notes.

16

Community of Communities Contact List

Sarah Paget Programme Manager

spaget@rcpsych.ac.uk 0203 701 2678

Josie Thorne Deputy Programme Manager

jthorne@rcpsych.ac.uk 0203 701 2679

Arun Das Project Worker

adas@rcpsych.ac.uk 0203 701 2676

Laura Simmons Project Worker

lsimmons@rcpsych.ac.uk

0203 701 2675

Community of Communities Royal College of Psychiatrists'

Centre for Quality Improvement 21 Prescot Street

London E1 8BB

www.communityofcommunities.org.uk