ARE YOU HOMELESS, SOFA SURFING OR AT RISK?

A homeless young person being supported by a Centrepoint keyworker.

PIE: An Introduction To 'Psychologically Informed Environments'

Over the past few months, Centrepoint has started an important journey to implement a ‘Psychologically Informed Environment’ (PIE) across the organisation. Here, Consultant Clinical and Forensic Psychologist Dr Helen Miles, explains what this will mean for the charity and our homeless young people. 

What is a ‘Psychologically Informed Environment’?

At first glance PIE might sound complicated, but the principle of it is actually relatively simple: at its most basic, PIE is a particular approach to the development, delivery and evaluation of our services.

Evidence collated in Helen Keats’s research paper ‘Psychologically informed services for homeless people: Good Practice Guide’ suggests that staff trained within this psychological framework work more efficiently with clients experiencing complex trauma, helping them to better understand their behaviour, take responsibility for themselves and develop positive relationships. This in turn helps our clients move away from rough sleeping.

Essentially, PIE provides psychological safety and security for our clients. One of the prominent reasons young people end up homeless is because of the breakdown of family relationships – this particular approach aims to help them rebuild those damaged connections. Because of this, it’s a strategy that’s being adopted more and more across the whole homelessness sector.

Why is it important?

Relationships are at the heart of how Centrepoint operates. The relationship between our key workers and the young people that access our services is particularly important, so therefore our framework for PIE will focus on this aspect of the business in particular.

While it’s vital for our vulnerable young people to understand why they feel certain ways and have the tools to be able to process and control those feelings, it’s also essential that Centrepoint staff are be able to recognise and describe their needs in psychological terms – to understand the connection between thoughts, feelings and behaviours, for example, or the impact of the client’s early experiences on later life. PIE doesn’t necessarily create a new way of working, but instead builds on the knowledge our staff already hold, encourages a more reflective way of working. Therefore, our PIE will be more of an evolution than a revolution, simply enhancing that good practice that already exists within our services.

What is ‘attachment theory’?

Here’s where things get specific: because Centrepoint’s framework is based around relationships, we’ll be adopting the ‘attachment theory’ approach, outlined by psychologist John Bowlby. In a nutshell, attachment theory was developed through research in child development and clinical psychology, and describes the innate biological need inside all humans to drive connections towards others. It’s a system that has evolved because of the necessity for an infant to develop a ‘safe’ attachment to a primary caregiver that ensures they are able to get their physical needs met (food, shelter and protection), as well as their emotional needs (warmth, love, regulation of stress).

This attachment then becomes what is known as a ‘secure base’ for further exploration of the world as we get older. As a consequence, our early childhood caregiving experiences, or ‘attachments’, also help to establish the mental representations we have about ourselves in relation to others. This in turn creates expectations about future relationships and the wider world.

How does this relate to Centrepoint?

Research has shown that a significant number of people who have experienced or become homeless experienced complex trauma in their earlier lives – this suggests that they have ‘disrupted’ attachments, and have thus suffered the consequences associated with this kind of early upbringing.

As well as highlighting the impact of disrupted attachments on one’s later development and behaviours, attachment theory also highlights the critical role of the keyworker and young person’s therapeutic relationship in bringing about positive change. It shows just how important it is for Centrepoint to provide a home, rather than just a place to stay – a ‘secure base’ for those in their care. Luckily, because our attachment system is present throughout our lives, there are opportunities to reverse previous damaging attachment experiences when a young person enters a Centrepoint service and creates positive relationships with staff.

As such, Centrepoint will be offering all staff PIE training, ensuring that they have an understanding of the importance of a ‘secure base’. It’ll also ensure they have a positive grasp on the ways these disrupted attachments disadvantage young people and shape their current or future behaviours. Beyond this, staff will also have training on the psychological tools they can use to develop motivation, positive self-esteem and emotional control in the young people they work with (although we will continue to refer to mental health specialists where appropriate for more complex issues).

But PIE expands beyond the emotional; the physical environment is also crucial to ensuring our clients’ wellbeing. The space around them should have the ability to make young people feel safe and encourage positive relationships, so needs to be maintained to good physical condition. The design of the space, which will depend on the needs of those that use the services, will send a positive message about valuing those living or working within it.

Because of this, Centrepoint plan to ensure that, moving forward, all building or maintenance projects are PIE-informed, working with our partner landlords to create harmonious spaces. In addition to this, suggestions from staff and young people on changes to the physical environment of their services are welcomed – there will be an ‘ideas application process’ launching in the near future that’ll allow us to fully involve, or ‘coproduce’ PIE with those that use our services going forward.

‘Reflective Practice’ is also a mandatory part of PIE, as it provides staff with a space to process and discuss actions, reflect on what has and hasn’t worked well, explore current issues, learn from incidents and develop actions moving forward, which improves the responsiveness of our services. It also provides staff with a structured space to explore different ways of thinking about how a young person is presenting challenging behaviours, and try to come up new solutions to address these, taking into consideration certain factors that are unique to the individual. These sessions will be offered monthly to Centrepoint staff by a clinical psychologist.

How will we know if it’s working?

Westminster Council’s ‘PIE Implementation and Assessment Guide’ states that evaluation is a critical part of PIE – being able to evaluate the progress of this approach not only helps us to continually develop evidence for increasing the use of PIE in the charity sector, but also contributes to national policies around youth homelessness.

This isn’t the last you’ll hear about Centrepoint’s Psychologically Informed Environment – we’ll be evaluating this proposed PIE in conjunction with our national academic partners. If you’d like more information about PIE in Centrepoint, contact our PIE lead, Dr Helen Miles. You can also check out Dr Miles’s weekly ‘PIE blog’ at Medium.com/@DrHelenMiles.

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