Ward climate and (long term) forensic care

(How and why) should ward climate differ between forensic facilities?

Written by Meike de Vries, Researcher: Pompestichting, The Netherlands

Ward climate is an important factor within the treatment of inpatients in secure settings. Ward climate can be seen as a multifactorial construct including the material, social, and emotional conditions of a given ward and the interaction between these factors (Moos, 1989). In several studies, climate is found to play a role in therapeutic outcomes and regarded as an aspect of program responsivity that enhances treatment effects. Within high secure forensic hospitals establishing and maintaining an optimal climate is an important, but also a very challenging task due to the complex patient population and setting which incorporates both therapeutic- and security goals.

Although different facilities can have different (treatment) objectives, they strive to keep patients in a responsive therapeutic environment which is designed to address patients’ needs. For instance, the Pompestichting in the Netherlands has a high secure treatment clinic aimed at rehabilitation and reduction of the risk of recidivism, and a facility for long term forensic care (LFPC), that focusses on stabilization of psychiatric problems and enhancement of quality of life. The divergent objectives of these two facilities result in different orientations of care. For instance, in the treatment clinic the focus lies on therapy and behavioral change, while pressure for treatment is (almost) absent within the LFPC. Furthermore, factors found to play a role in ward climate like the physical environment, competencies of staff members and patient characteristics, differ between these two facilities.

Subsequently the question rises whether differences in physical environment, patient population, and orientations of care are represented in different perceptions of ward climate. Within the Pompestichting ward climate is being monitored using the Dutch version (Bulten & Fluttert, 2007) of the Essen Climate Evaluation Schema (EssenCES; Schalast et al., 2008). The EssenCES is a short questionnaire measuring three factors of climate in forensic services (therapeutic hold, experienced safety, and patient cohesion/mutual support).When comparing the perception of ward climate between patients from the two facilities differences are found with regard to patient cohesion and therapeutic hold. While patient cohesion is rated more favorably among patients residing within the treatment clinic, patients residing within the LFPC rated therapeutic hold more favorably. Feelings of safety did not seem to differ between these groups. The relationships between the three climate factors also differed between the two groups (see figure 1 for a visual representation and table 1 for descriptive statistics).

Figure 1. Differences between two facilities on three factors of ward climate (EssenCES)[1] – patient perceptions.

Meike

The results of this comparison should be interpreted with caution due to for instance the relative small (unequal) samples. Nevertheless, it provides an interesting starting point for further research into this theme. What are important determinants of these differences? How does climate contribute to the achievement of the (treatment) objectives of these specific facilities? As knowledge on ward climate increases, so do the chances of effectively using climate as a tool in fulfilling facilities’ objectives, whether that is treatment, rehabilitation, stabilization or quality of life. So please feel invited to contribute to this interesting field of research!

Table 1. EssenCES, descriptive statistics, patient samples from two facilities (M, SD).

Treatment clinic (n=154) LFPC (n=46)
M SD M SD
EssenCES Patient cohesion 258.79 110.20 220.70 110.47
EssenCES Experienced safety 266.10 113.79 277.93 204.97
EssenCES Therapeutic hold 230.16 124.49 282.76 121.57

* Significant differences (MANOVA, Pillais’ Trace = .07, F(3, 196) = 4.82, p = .003; univariate F tests patient cohesion: F = 4.23, df = (1,198), p = .04; and therapeutic hold: F = 6.39, df = (1,198), p < .01.).

References

Bulten, B.H., & Fluttert, F.A.J. (2007) Essen Climate Evaluation Schema (EssenCES-NL). Germany: Institute of Forensic Psychiatry.

Moos, R. H. (1989). Ward Atmosphere Scale manual (2nd ed.). Palo Alto, CA: Consulting Psychologists Press.

Schalast, N., Redies, M., Collins, M., Stacey, J., & Howells, K. (2008). EssenCES, a short questionnaire for assessing the social climate of forensic psychiatric wards. Criminal Behaviour and Mental Health, 18, 49–58.