‘A return to the real world? — Reflections on recommencing some face-to-face delivery of our Psychologically Informed Environment (PIE).
11.09.2020: As I reflect on the past week as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity; Centrepoint, the highlight has definitely been a partial return to some face-to-face, albeit COVID-19 compliant, reflective practice in some of our London supported accommodation services. Although wider national travel is not yet possible, and indeed some of our Centrepoint services in the North are still operating within local COVID-19 lockdowns, being able to visit in person some services local to me in London has been a very positive reminder of why I love being a Psychologist and how much I am honoured to do this job. Whilst, life is not yet fully back to normal, as I continue to wash my hands a lot, wear a mask and observe social distancing, this week has felt like a small step back in that direction, at least professionally! Moreover, although face-to-face work and travel outside the home is not without risks, I am aware that many of our amazing Support and Housing staff have been doing this throughout the pandemic. Therefore, where possible, I believe that it is now right and appropriate that the PIE Team manage the ongoing risk and offer this where we can to improve our reflective practice offer to our ‘frontline’ staff in the organisation.
As I have reflected in previous blogs (c.f. https://medium.com/@DrHelenMiles/remotely-connected-54030233603f), remote working is not without its challenges as a Psychologist, most significantly in building relationships and connections with others over the barrier of a screen. Whilst some research shows that online therapy or support is ‘better than nothing’ (increasing flexibility, availability and access) and can even be effective in terms of outcomes (e.g. see reviews by Simpson, 2008; Andersson, 2014), arguably remote sessions can miss what is important in terms of the process of being ‘in a room’ with others. Moreover, whilst video technology has improved significantly in recent years, it can still be unreliable, and technology issues can take up valuable time and create a barrier to engaging in what can sometimes be difficult or emotional conversations. It has certainly been interesting to note that some teams wherein I was offering face-to-face sessions prior to the COVID-19 lock-down have struggled the most with the remote format, perhaps more than other teams for whom sessions have only ever been in a remote format.
Having worked ‘frontline’ myself for decades has meant that as well as giving me a deep admiration and respect for staff in these roles, recent months spent sitting at a desk have been quite disconcerting, unusual and challenging at times. Hence this week, being able to sit ‘in person’ with our staff who have over recent months, been just a face on a screen or a voice (if connection is poor), has allowed me to really engage in their space, listen more intently and actually ‘feel’ their concerns, issues and anxieties. It is not that this is not possible remotely, as recent necessary changes to my working practice has demonstrated, but I personally find it easier when I am physically present, and it means there is less chance of misunderstandings, missing key comments or non-verbal cues, and confidentiality issues over insecure connections is less of an issue. Feedback from staff this week has also highlighted that they find face-to-face easier, as I am no longer ‘just a head’ on an often small smart phone or tablet screen!
On reflection this week, visiting the services has also enabled me to have those informal conversations about other aspects of PIE (e.g. our plans for the physical environment or staff training in the future), and offer brief case advice or speak with staff 1:1 about any issues or concerns they have outside of the confines of the formal reflective space. These spontaneous conversations are harder or not even possible in a time-defined remote reflective practice space wherein the whole team is present. This has reminded me of the importance of our PIE Team goal to have a psychologist in every service at least one day a month in the future, as what we can offer is more than just a monthly reflective practice session. Rather we can offer a psychological perspective on many different areas, as well as to be ‘available to listen’ to staff and homeless young people, deepen our understanding of the unique local challenges that each service faces, and also have an opportunity to further promote and embed PIE approaches whenever the opportunity arises. Starting to work again face-to-face this week, has also enabled me to reconnect with the day-to-day realities of life in our supported accommodation services, especially with the post COVID-19 changes, and allowed some limited contact with our homeless young people. Of course, it is often one thing to ‘hear’ about the challenges that many of our staff and homeless young people face on a daily basis, but quite another to ‘see’ it.
Of course, any return to face-to-face work in this new post COVID-19 world, has increased risks. Consequently, it has been key to follow all our own organisational risk management policies, as well as guidance from my own professional body; The British Psychological Society (c.f. https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20-%20Files/Returning%20to%20the%20workplace%20-%20safety%20considerations%20for%20practising%20psychologists.pdf). This includes using appropriate PPE (e.g. masks) and considering any associated barriers to communication, adding in additional commuting time (something I haven’t missed!) to services and minimising use of public transport (e.g. driving where possible, or using my scooter to travel from a mainline station to avoid buses and tubes in London). This helpful guidance also suggests not sharing resources with staff teams (e.g. taking my own laptop), using outside space where possible or opening windows for ventilation, infection control (e.g. washing and sanitising hands), maintaining social distance, and changing clothes on return from work to minimise risks of transmission of COVID-19. Further useful advice from the British Association for Counselling and Psychotherapy on face-to-face working for psychotherapists, counsellors or psychologists can be found here: https://www.bacp.co.uk/news/news-from-bacp/coronavirus/faqs-about-coronavirus/
Of course, it is still not possible to switch back to full face-to-face work at the current time. Infection rates of COVID-19, particularly in some regions of the UK, are increasing as lockdown restrictions have been eased to some degree and children have returned to school. Therefore, it is incumbent on me to not be complacent and to ensure that I do as much as possible to minimize the risks of exposure to COVID-19 and to ensure that our ‘frontline’ staff and homeless young people remain as safe as possible. Moreover, it is not possible to travel to all our services across the UK yet, nor even some of our services in London where a lack of space prevents safe social distancing if the whole team comes together for a reflective practice session. In addition, due to some of our services being smaller and therefore having lone working staff, it is not possible or practical for the whole team to come together in one physical location.
Consequently, we have decided as a PIE Team to offer a hybrid remote/face-to-face model for the foreseeable future for our reflective practice sessions. It is important to me that our PIE meets the needs of the staff (and the homeless young people we support), and consequently, we are now offering an individualised rather than ‘one size fits all’ approach moving forward, guided by the teams themselves. This means in practice that some teams will opt for face-to-face sessions as this is possible and preferred. However, other teams may opt for remote sessions because these allow all members of the team to connect wherever they are working and/or because of challenges with offering face-to-face reflective practice sessions within in the physical space they are operating from. In addition, our ad hoc sessions for our ‘support’ teams, who are primarily continuing to work remotely, will also reflect their current working conditions and be offered via video technology. We will also be considering a combined approach in some teams, where although we may be facilitating a session face-to-face in a service, having a remote offer on a laptop alongside can also allow staff to connect who may wish to but may not be on shift at the allocated time (e.g. night shift staff) or are still working at home for medical reasons.
Throughout this whole period of COVID-19, I have realised that key has been to be flexible and to accept that our plans can and will change. However, as long as we are continuing to respond to the needs of our staff and homeless young people in a psychologically informed manner, I am confident that we are still on the right path to the wider implementation of a PIE across the organisation. This week again highlighted to me, albeit in person, the positive value of creating some space for staff to take a break and pause from the daily routine of their role, to reflect and consider their actions, thoughts and feelings, and strengthen their team relationships. As I noted at the beginning of this blog, I am honoured to be a psychologist and to be invited into others’ spaces to hear them, and hopefully help them. This is a privilege that I do not take lightly, and I hope I have and will continue to do justice to my professional title.
Of course, I don’t have all the answers as a Psychologist(!), even with all the evidence based understandings of the human mind and behaviour, as well as the associated interventions our profession has developed over the years. However, something else I have again been reminded of this week, is that key to our professional role is the importance of creating and facilitating a space for others to share their challenges, listen to others and jointly develop psychologically informed solutions. There is so much skill and knowledge already within some of our staff teams, that what is most important or needed sometimes is just a little space to allow this to be developed and utilised most effectively for the positive benefit of the homeless young people we support. Finally, I would like to sincerely thank all of the staff this week I have seen face-to-face for welcoming me back into their services with such open arms, warmth and interest in PIE, and I look forward to continuing to offer an ‘in person’ PIE whenever and wherever this is possible…
