REACH model of working |
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People can feel trapped in a cycle of wanting help , not asking for help or asking in ways that communicate their distress through behaviours which are harder for some to understand .
disconnection , abandonment , and perceived failure .
2 . RELATIONAL CONNECTION AT EVERY OPPORTUNITY As past trauma is a significant contributor to substance misuse and mental health issues , it ’ s essential that every contact takes a relational-trauma informed stance . Each contact has the potential to harm or heal , and therefore the primary focus is on building a psychologically safe frame within which therapeutic attachment and intervention can take place . This ensures that the people we work with can feel emotionally and psychologically safe .
3 . FORMULATE THE PERSON AND THEIR RESOURCES Often people are referred to our service with a collection of labels ,
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diagnoses and narratives , and what can get lost is the person ’ s story and experiences . Within our model , hearing the person ’ s narrative of their experiences and resourcefulness , alongside their challenges , is significant . Having a co-created , shared narrative helps the person feel heard , while also ensuring that an understanding of what has happened to them – and how we may be able to help – is realistic and transparent .
4 . BE CREATIVE , FLEXIBLE , AND CONSISTENT To work with people who have experienced substance misuse , mental health , loss and trauma requires a great deal of creativity and flexibility . This can mean a significant adaptation of how we ’ ve traditionally gone about engaging with people . However , it ’ s equally important that there is consistency , boundaries and clarity in the approach . Often people have felt let down and abandoned , so consistency in engagement is paramount to rebuilding a sense of trust , while boundaries offer a sense of physical and psychological safety . This process is not without its challenges , with ruptures and repairs within the therapeutic relationship being a common and often necessary part of the trust building process . For clinicians , openness , curiosity and not enacting rejecting or rescuing behaviour is key .
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5 . ADVOCATE FOR THE PERSON IN THE SYSTEM Organisational systems and processes are complex and can , for many service users , feel difficult to negotiate . It ’ s therefore key that we advocate alongside the person to help them access what they need . However , it ’ s very common for people to be seen as hard to help as a result of stigma and harmful narratives . These narratives and experiences of rejection have often exacerbated a sense of disconnection from society and loss of hope for many of those we work with . Advocating for the person is important in supporting change , but there ’ s also a significant role in supporting the wider system to challenge its own views , narratives , and ideas about people and the ways they present .
6 . MAINTAIN OPTIMISM AND HOPE – DON ’ T GIVE UP Given the multifaceted nature of the difficulties and challenges the people we work with face and present with , it can feel clinically overwhelming at times . A cyclical process of changestability-lapse-relapse-change is the norm . For many professionals this process can challenge the fundamental values of why we work in this field , our own sense of clinical competence and at times lead to a perception of not being good enough at our jobs . For this client group this can be
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experienced as rejection – where they ’ re seen as too complex and passed to someone else or told they need something else , further exacerbating a sense of hopelessness . Having access to regular , consistent and skilled psychological supervision is therefore a must-have .
This approach of a psychologically informed frame is not easy , and can face constant challenges . However , it ’ s ultimately the only way to consistently support stability and recovery for those with complex homelessness , substance misuse and mental health needs . By ensuring this frame and its principles are in place and constantly reflected on maintains clinical optimism , shared understanding , and collaborative partnership working . Overall , this approach ensures that the care provided is stabilising rather than inadvertently damaging , thus working to reduce further trauma and enhance the quality of life of those in need .
Dr Stephen Donaldson is consultant clinical psychologist , Ben Sweeting is advance nurse practitioner , mental health , and Richard Croall is advance nurse practitioner , dual diagnosis – all at the REACH team . Edward Loveless is assistant psychologist , Tees , Esk and Wear Valley ’ s NHS Foundation Trust .
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