Prison Democratic Therapeutic Communities – Integrated Quality Audit Processes

Democratic Therapeutic Communities (DTCs) in His Majesty’s Prison and Probation Service (HMPPS) including Therapeutic Communities Plus (TC+) for offenders with Learning Disabilities (LD) are a recognised offending behaviour programme designed with the aim of reducing reoffending, some having been in existence within the prison system for more than 50 years. They form part of the National Offender Personality Disorder (OPD) Pathway, jointly commissioned between HMPPS and NHS England, offering a pathway of interventions for male and female offenders with complex needs.

There are currently 14 DTCs operating in the Prison Service; 11 of these delivering the DTC core model within five establishments; and three delivering the TC+ model.

DTCs in prisons aim to reduce re-offending through challenging offence-related risk factors. They address the interpersonal problems, attitudes, thinking and emotions of offenders and aim to engage in treatment those who also have additional emotional and psychological needs.

DTCs can provide intervention for offenders with impaired psychological functioning and seek to engage offenders who may not be suitable to undertake other accredited Offending Behaviour Programmes. They are an intensive intervention - prisoners will be expected to remain in therapy for at least 18 months and more likely for two years. Therefore, places in DTCs are normally reserved for offenders serving longer sentences, who have a higher likelihood of re-offending, or who are judged to present a high risk of harm to others.

DTCs have a strong evidence base underpinning their theoretical model of change that should be delivered in accordance with a set of manuals which have been accredited by the Correctional Services Accreditation Panel (CSAAP).

The prison DTCs participate in a mandatory integrated standards-based process of quality assurance processes. These processes require continued development to ensure an effective and appropriate means of measuring the therapeutic environment and the quality of the therapy delivered.

The MoJ requires a Supplier to design, develop, deliver and review an integrated standards-based audit and quality improvement process for all DTCs in HMPPS including TC+.

The service is to be delivered incorporating a full clinical audit, using specialist auditors, within each cycle that measures each DTC’s compliance with the detailed and accredited operating models for reducing reoffending. This review process will provide a measure of the quality of the intervention as a DTC and its clinical integrity; additionally, it will provide an assessment of clinical performance and report to the Correctional Services Accreditation and Advice Panel (CSAAP) in line with accreditation requirements.

The Supplier must also be able to provide avenues for shared learning for all HMPPS DTCs, support their overall development, provide workforce development opportunities for training and improvements in the clinical skills and knowledge of DTC staff and facilitate access to relevant knowledge and learning opportunities.

Critically, the clinical evaluation and quality improvement processes will need to be delivered through a methodology that is in keeping with the philosophy and values of the DTC model and will support the specific therapeutic and clinical requirements of its operation.