Qualitative study of welcome houses: a recent initiative designed to improve retention in therapeutic communities

Abstract

Background: Welcome houses (WHs) have been introduced as a stage at the start of some European therapeutic communities (TCs) to improve treatment retention. In contrast to the structured, rule-bound approach of many residential therapeutic facilities (often described as ‘total institutions’ (TIs)), WHs provide a relatively ‘gentle’ introduction to residential life. This article explores the influence of WHs on treatment retention from the perspective of TC staff and residents.

Methods: Thirty-five qualitative interviews were conducted in two TCs with WHs in the United Kingdom. Participants included staff (n = 13), current residents (n = 13) and former residents (n = 9). Interviews were transcribed, coded and analyzed using framework.

Results: Participants reported that retention was affected by three core factors: ‘intensive care and support’, ‘rules and order’ and ‘time and space’. Each factor was described as influencing retention both positively and negatively, but via different mechanisms. WHs seemed to increase retention amongst people who had never been in residential treatment previously or who had complex needs, but decrease retention amongst those who were more stable at treatment entry.

Conclusion: WHs retain many of the core characteristics of TIs, but in an adapted ‘softer’ form. As such, WHs might be better described as ‘reinventive institutions’. WHs should not be a mandatory stage within TCs. Rather TC providers should consider each new resident’s need for WH as part of their assessment. Further research is needed to quantify the impact of WHs on retention and to test apparent associations between retention outcomes and resident characteristics.

Keywords:

• Substance misuse
• therapeutic communities
• retention
• welcome house
• total institution
• qualitative

Acknowledgments

We would like to thank Phoenix Futures for supporting this research. In particular, we would like to thank the staff and clients who were interviewed for the study.

Disclosure statement

Joanne Neale is part-funded by, and John Strang is supported by, the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. JN receives honoraria and some expenses from Addiction journal in her role as Commissioning Editor and Senior Qualitative Editor. JS is a researcher and clinician who has worked with a range of types of treatment and rehabilitation service-providers. JS, through his employer, previously worked with Phoenix (joint service development and provision during the early 1990s) and he also served on their Board of Directors through the early and mid-1990s. He has also worked with a range of governmental and non-governmental organisations, and with pharmaceutical companies to seek to identify new or improved treatments from whom he and his employer (King?s College London) have received honoraria, travel costs and/or consultancy payments. This includes work with, during past 3 years, Martindale, Reckitt-Benckiser/Indivior, MundiPharma, Braeburn/MedPace and trial medication supply from iGen. His employer (King?s College London) has registered intellectual property on a novel buccal naloxone formulation and he has also been named in a patent registration by a Pharma company as inventor of a concentrated nasal naloxone spray. For a fuller account, see JS?s web-page at http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx.

Funding

We would like to acknowledge the Pilgrim Trust for funding the study.