User:Robin gh johnson/sandbox

With this page, I am creating a dummy run or test page for what will later become a page on 'psychologically informed environments,. The final version should at least mention the roots in TCs andcEEs, and the psychodynamics of organisations, as well as the social inclusion programme and then the PSA 16 work and finally the guidance. Some mention of a social model of disability too. Linked to Reaching Out. Lankelly Chase and Fulfilling Lives.

The phrase 'a psychologically informed environment', commonly shortened to "PIE", is a term which was first used in 2010 in guidance for homelessness services issued by the UK Dept of Communities and Local Government, jointly with the National Mental Health Development Unit, to describe homelessness services that took into account the psychological and emotional needs of people who are homelessness, as evidenced in the way these services worked (DCLG/NMHDU, 2010). Its potential use, however, is not solely restricted to that sector, but can be used to illuminate or guide service development in a wider range of fields (SITRA, 2016).

Key features

In 'operational guidance', published two years after the first DCLG/NMHDU guidance paper (Keats et al, 2012), an attempt was made to specify in more detail some of the key or characteristic features of a PIE. These are usually described in terms of five, or sometimes six, main issues. In addition to these five, a sixth feature, reflective practice, is sometimes identified as a distinctive issue in its own right; and sometimes as an aspect of staff training and the action learning culture.
 * Having or developing a 'psychological model'
 * Taking care over the design and use of the built environment and its 'social spaces'
 * Giving some priority to staff training and support, in the light of the needs of the client group
 * A focus on creating and managing relationships as central to the work
 * An organisational culture of learning from experience, ('action learning' or 'evidence generating practice')

These five or six features are now generally seen and treated as a unified framework or approach, forming a whole; but there is still some debate over how useful it is to treat this framework as prescriptive - ie: as indicating what services should do, if they wish to develop as a PIE - or simply as descriptive, describing 'what works".

Similarly it is not clear whether a project or service needs to show tangible progress, or progressive thinking, in all these areas, in order to be considered a PIE. There is however a growing consensus that there is no particular threshold that must be achieved - no tick box of prescribed activities, but instead being a PIE should be seen as a continuous process of development. A PIE is therefore "more a journey than a destination" (Middleton, 2015); and everybody is somewhere on this path, even if some are further advanced than others. But these at least were the key themes and common elements that the authors felt they could identify clearly enough to recommend as constructive practice.

It is sometimes asserted that a PIE will reduce evictions, and challenging or aggressive conduct, or increase positive behaviour by increasing self-worth, esteem, belief and hope (HomelessLink, 2016; Riverside, nd). But these are perhaps more properly seen as the expected or desirable consequences of working with a PIE framework; and further evaluative studies would be needed, to confirm whether it is in fact the case that a PIE approach necessarily lead to these results, or merely motivates the adoption of a PIE (Mental Health Foundation, 2016). In any case, in other sectors, other measures of success would be needed

It has been argued that the concept of a PIE is very close in spirit, and perhaps in practice, to 'Trauma Informed Care', and the two are perhaps complementary (HomelsssLink, 2016). The relationship between them both and other psychologically minded frameworks in homelessness, such as Housing First, pretreatment, and system change brokerage, is less well articulated (Johnson, 2016).

Origins of the term

The term PIE itself, though first used in print in the DCLG/NMDU guidance, had been coined originally by Robin Johnson and Rex Haigh, for a full length article on the concept later published in the Journal of Mental Health and Social Inclusion (2010). In that paper, they suggested ‘But for the moment, at least, the definitive marker of a PIE is simply that, if asked why the unit is run in such and such a way, the staff would give an answer couched in terms of the emotional and psychological needs of the service users, rather than giving some more logistical or practical rationale, such as convenience, costs, or Health And Safety regulations.’

Rex Haigh had at the time been the clinical adviser to the UK Dept of Health on personality disorder in the community; and had helped steer the NINHE pilot projects on novel approaches to working with such complex needs. Robin Johnson had been the mental health and housing lead for the National Social Inclusion Programme, and while there liaising with DCLG over housing and homelessness, had met Helen Keats, civil servant, and Nick Maguire, clinical psychologist and researcher at Southampton University. These three formed the core team for the first guidance paper; and were joined by Peter Cockersell to co-author the operational guidance. Johnson was tasked with finding a useful term, to describe the creativity in homelessness services, which the first guidance document - and later the second - wanted to identify and promote.

Johnson and Haigh both had extensive backgrounds in the UK-style ('democratic') therapeutic community as a treatment modality; and both were then members of a working party co-ordinated by the UK Royal College of Psychiatrists, which was developing the 'Enabling Environments' programme, as a standards-based assessment tool for constructive or healing, place-based social practice (Haigh et al, 2013). It was suggested, however, that the term therapeutic community was too 'psychiatric', and also too assocIated with a particular form of community structure, to be useful to describe what was happening in homelessness services; and the enabling environments language was too abstract, and the standards-based approach too prescriptive, to be suitable in this field.

A 'psychological model'

In any mental health or learning difficulties unit, for example, such as a care home or supported accommodation, we might surely expect a psychological model to inform the overall plan and the day-to-day workings of the unit. In a drug or alcohol support services, we would expect an understanding of the psychology of addiction. In homelessness, it is the recognition of the high prevalence of poor mental health and traumatised lives that informs the service, in a PIE. In any of these fields, extra understanding derived from formal psychology - or any other areas of social science - is likely to be valuable.

But equally valuable - and underlying all this 'clinical intelligence' - is a more informal psychology of 'emotional intelligence' or 'active empathy'. Concerned to keep the PIE concept, and the actual development of services, rooted in ordinary, non-technical language to reflect and appreciate ordinary workers’ experience, Johnson and Haigh have suggested that the key question was: ' granted their background and past life experience, what is the person in front of me likely to be making of what I am saying?'  It’s not having the right answer that makes for a ‘psychological model’; it’s the fact that the question is asked (Johnson, 2013; also Haigh, 2012).

The built environment and its 'social spaces'

Many services have given careful thought to the use of any buildings, not just their condition but Anywhere that has a building may give thought to the use of ‘the built environment’ - typically cited as the second key issue in a PIE - meaning here not just the physical condition of the building, and the 'messages' that conveys, but also the subtler ‘messages’ they convey, in posters, lighting and furnishings,; and also in their layout of spaces, the opportunities and barriers – the ‘social spaces’ they create, that is to say, the opportunities or impediments to interpersonal encounters (Boex & Boex, 2012).. The built environment itself may support or hinder constructive interactions between staff and users, and also between users as peers, forming some kind of community, which can be therapeutic in itself.

It has also been argued that thoughtful use of any environment, including one not owned or managed by the project, is a PIE. Thus a walk in the park, or a keyworker session in a cafe, or a car, may be a deliberate use of the environment to change the power relations in a worker-client interaction (Corcoran, 2015; Francziska, 2015; Ypeople, 2016). This suggest that there is no clear boundary between an environment, meaning what happens within a building or nrtwork, and an environment, maening the world around it.

Staff training and support, in the light of the needs of the client group

With better recognition of the nature of their work, in serving some of the most vulnerable and chronically excluded, comes more attention to the training and other support needs of staff and volunteers. ‘Staff training and support’ is presumably a recognised need in any form of supported housing; it was included as a key theme in a PIE, as a way of stressing recognition of the real nature of the work homelessness services were doing, in working with some of the most complex needs, some of the most chronically and multiply excluded. (We will return later to one of the key issues here, the value of reflective practice,)

Relationships as central

A focus on creating and managing relationships as central to the work is central to the way that a service then operates. In a PIE there would be some emotional intelligence evident in the design of day to day routines, the management of infractions, the opportunities to make reparations or otherwise participate. Creating and managing  supportive relationships and aspirations is seen as actually the central task. But in attempted descriptions of a PIE, this multi-faceted and pervasive element was always the hardest to find the right words for. It is often described as 'managing relationships' - the almost philosophical point, that relationships are the heart of the service. But talk of ‘managing’ does not really do justice to the lengths some services have gone to, to create new kinds of roles, relationships, and structures.

Another attempt to pin this core point down has been to talk of the 'rules of engagement', a somewhat tongue in cheek use of a military term, that stresses that it is the practical ways that emotional intelligence and understanding is expressed in the day-to-day running of the service, that counts. The modus operandi, the terms of the contract - these create the 'environment', just as much as the building does, or the attitude and skills of staff. Some have talked of the need for the service as a whole to be a 'learning organisation'; and again, this takes us to the issue of ‘reflective practice’.

An organisational culture of learning from experience, ('action learning' or 'evidence generating practice')

Finally, there was a commitment to learning from experience, and even of adding, in some way, to the growing body of evidence of ‘what works’, or what is called, in healthcare, 'evidence-generating practice'. In therapeutic community, this was called a 'culture of enquiry'; in management theory, creating 'a learning organisation' (Jones, 1968; Main, 1983; Woodcack & Gill, 2013).

The fifth in the 'standard pack' of PIE themes is called 'evidence generating practice'. This can be read in at least two ways. On the one hand, it is an attempt to get services to treat outcomes, data and other measures as signs of the effectiveness of what they are doing, and to learn from that, in self-evaluation and development (paper on utcomes measures).

It is a prompt for an action learning approach, just as much as for data, which will tend to be dominated by contract compliance concerns. And so, once again, reflective practice provides the framework for service development,

Secondly, talk of evidence was an encouragement to services to see what they are  doing as valuable, as contributing to the sum of human knowledge', as potentially participating in research, and just as deserving of proper study as any other area of welfare practice.

Links with other progressive thinking

Further reading

Aseervatham V (2015) “Five top tips for commissioning PIEs” (video)

DCLG/NMHDU (2010) Non statutory guidance on meeting the psychological and emotional needs of people who are homeless. (aka ‘the complex trauma’ guide)

DCLG et al (2012) “Psychologically informed services; operational guidance for homelessness services”

Haigh R, Harrison T, Johnson R, Paget S, Williams S (2012) “Psychologically Informed Environments and the “Enabling Environments” initiative” in J. Housing Care and Support, 15 [4]

Johnson R & Haigh R (2010) “Social Psychiatry and Social Policy for the 21 st Century (Part One); The psychologically Informed Environment” in J. Mental Health and Social Inclusion.

Ritchie C (2015) “Creating a Psychologically Informed Environment: assessment and implementation”

All texts available via the PIElink’s community of practice online library, at www.pielink.net

https://www.riverside.org.uk/care-and-support/supported-living/   last accessed 22/3/2016

The article will mention the pie link as vehicle. And also references may have several links. Video. (Esp the Handy Guide. )