“Enabling and empowering homeless young people with disabilities — A Psychologically Informed Environment (PIE) approach…’

24.03.2022: As I write this week’s PIE blog in conjunction with Dr Marc Pescod (PIE Educational Psychologist), as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, we are aware that this March is Disability Awareness Month in the UK. Disabilities can present in many forms; physical or mental / learning, some are more obvious and some are less so, but all can affect functioning, access to opportunities and quality of life. Moreover, we know that disabilities are often over represented in homeless populations, because they may affect an individual’s ability to live independently or access the resources that provide the financial security required to maintain a ‘home’. Therefore, we wanted to discuss in this week’s PIE blog, the specific issues related to disability and youth homelessness, and in particular how a psychologically informed or PIE approach can be helpful in understanding, mitigating and supporting homeless young people with disabilities.

With regard to the prevalence of disabilities amongst homeless young people, we know from our data that around 9% of Centrepoint (2019) young people have a diagnosed ‘disability’. Although this figure is similar to the national rate of disability in children (c.f. https://commonslibrary.parliament.uk/research-briefings/cbp-9602/), we also know that it is likely our data is an underestimation due to issues within this population obtaining a diagnosis (Collins & Schormans, 2021). Disabilities that are less physically obvious and/or are related to learning needs might easily have been missed if the homeless young person is in multiple social care placements or has been absent from / repeatedly moved around education providers. Their behaviour may be viewed as problematic, rather than as a result of specific communication or learning needs, and the young person excluded or moved rather than an explanation explored or obtained. It is not uncommon to hear stories in the media about parents fighting for diagnosis / support for their disabled children. Even our previous UK Prime Minister; David Cameron has highlighted this issue (c.f. https://www.theguardian.com/politics/2009/jul/16/cameron-ivan-disability-conservatives), which begs the question, what happens to those young people without such family support or advocacy?

There are of course many different types of disability. Moreover, many individuals who consider themselves to have a disability are able to function in their everyday life with the right support or interventions. As PIE lead, I live with a chronic pain disability (Trigeminal Neuralgia: TN), which thankfully is manageable with the medication I take each day and some minor modifications to my lifestyle. Although this can present challenges at times, I am grateful that so far my disability is something that does not significantly impact upon my day to day life, although the pain of a ‘flare’ or the impact on my sleep can be sudden and exhausting respectively. If I am honest, the hardest thing about TN is that it is a ‘hidden disability’, and so I can look distant or like I am not smiling, but really it is just about me trying not to move my face to avoid further pain!

However, other disabilities can have more a significant impact, effecting an individual’s ability to live independently or access opportunities such as education or employment. There is in fact a vast range of disabilities, all of which are considered protected characteristics under the UK Equality Act (2010), which states that someone is considered disabled if they live with a physical or mental impairment that impacts on their normal daily activities. The focus is thus on the effect rather than the diagnosis per se. The UK Equality Act (2010) also highlights the importance of ‘reasonable adjustments’ being put into place for that individual whether at work or within society more widely. Nevertheless, we can all recognise that we live in a world designed for ‘able’ individuals, and that those that do not fit this narrow definition face significant challenges in society across their lifespan.

With regard to homelessness and physical disabilities, research highlights that individuals living with such a disability are more likely to experience poverty. This is perhaps because of having to rely upon welfare benefits or not having access to the same range of employment options than their peers, making them more vulnerable to homelessness or having to live in less than adequate accommodation (Dennis et al, 2010; UN Feantsa Report, 2017). Moreover, once homeless or in temporary accommodation, that environment can further exacerbate their disability and the consequences. Consequently, many homeless individuals have severe or chronic problems, including poor general health and physical disabilities (Shlay & Rossi, 1992), which they may struggle to access appropriate health support to manage due to their lack of a fixed address or registration with a GP. Other research studies have highlighted that amongst homeless populations, those with a disability have often been homeless for longer and have worse mental health and quality of life than those without a disability (e.g. Guillen et al, 2021).

Specifically considering learning disabilities, we know that young people who are struggling with homelessness are more often at risk of difficulties relating to their learning than those of their housed peers. For example, national data from the United States showed that the rates of learning disabilities is double in individuals experiencing homelessness than the general population (Sullivan-Walker et al, 2017). Similarly in the UK, research highlights that 11% of school aged young people experiencing homelessness had ‘Statements’, as opposed to 3% of the national average (Mitchell, 2004). ‘Statements’ (now called ‘Educational, Health and Care Plans’ or EHCP’s) are the legal document for an individual with significant learning needs that outlines what support they require to access the curriculum beyond what is usually available in mainstream schools.

Consequently, when working in the homeless sector we need to be mindful of the possibly that the young people we are supporting may have some additional needs. Whilst if these are physical they may be more obvious (although not always), they are far more likely to be ‘hidden’ if they are related to learning needs and/or a disability. Furthermore, the chance of these individuals having experienced difficulties in their previous experiences of education (and possibly employment) is very high. We know that a lot of homeless young people with such needs drop out of school because of challenges with learning, which may be seen on the surface as mental or behavioural issues resulting from these underlying needs. Recent Centrepoint research (Pescod, 2022) explored the experiences of young homeless people in the education system and their own perceived lack of ability to engage in education and progress academically was a significant reason for their eventual withdrawal from schooling.

However, having a learning disability or difficulty does not mean that a young person cannot ‘learn’. In the same way that having a physical disability does not mean that a young person cannot physically engage in the wider world. It just means that learning or moving around a physical space might be harder for them than their ‘able’ peers. As a society, we would challenge us all to stop looking at an individual young person and asking the question of ‘What can they do?’, and think instead about ‘What could they do?’ given the right support, opportunity and ‘reasonable adjustments’. The young person’s potential is far more important than their current ability in the current context and circumstances. As a result, in psychologically informed support work, we need to consider what we need to put in place to enable them to meet their potential.

In a psychologically informed environment or PIE approach, this might mean that we consider the physical environment of a space. Can an individual with limited mobility move around their home successfully, and if not, what do we need to do? Are we ensuring that their physical environment is appropriate for them, such as ensuring that they can access bathroom and kitchen facilities (e.g. at the right height or with suitable aids)? If an individual has specific learning needs, how are we presenting information to them (e.g. visual cues, simplified and clear instructions, checking understanding)? Moreover, as part of any psychologically informed approach, are we making them more dependent or are we empowering them as much as possible? For example, when helping a young person to complete a benefit form, we might assume that their learning disabilities means that they would be unable to complete the form independently. Whilst the first time that might be true, can we do ‘with’ rather than ‘to’ so that in the future they may be able to do it independently?

Consequently, when supporting homeless young people with disabilities, taking a psychologically informed approach focusing on empowering them and giving them as much personal control as possible, means we need to reflect on our approach. Whilst, it might be easier for us in our time pressured jobs to ‘just do it for them’, actually this can have unintended consequences on their self-esteem and self-confidence in the future. Perhaps instead we can take a more PIE approach to our support by considering ‘How much can they do by themselves right now?’, and then ‘How much could they do with the right support / help / time’?, thereby indicating to us ‘What is the support that they need from me to achieve this’? This change in perspective in terms of our support offer could be the difference between a completely dependent or reliant young person who will struggle to move on versus an empowered young person who may be able to achieve their version of independent living in the future.

Of course, the difficulties that some of our homeless young people can face often are more than just their specific disabilities. Their actual challenges can sometimes be compounded and/or cemented in place by a ‘solid block’ of a ‘lack of confidence’. Experiencing failure after failure, and being reminded of just your weaknesses rather than your strengths (e.g. by medical or educational professionals) is naturally going to deter anyone from wanting to continue to try. If we do not feel we can be successful at something, because perhaps the goal we previously failed to achieve was too far or too fast, why would be believe that the future would be any different and engage in it further? It is therefore important that we work at the young person’s pace, focus on building upon their current strengths, and set goals that are realistic and achievable in the first instance. These goals are like ‘stepping stones’ to bigger goals, which allow them to experience a ‘taste’ of success that motivates them to continue.

“I don’t think I can sing and therefore I will not jump into a karaoke booth anytime soon” is a stance we can both complete relate too! We do not just lack an X Factor vocal ability (!) but we both also lack any confidence that we will ever be good enough to sing in public. Similarly, if a young person with learning disabilities believes that they “cannot learn”, why would they want to look at a college prospectus with us? However, learning can take many forms (e.g. academic or vocational etc.), and perhaps it is about finding the most appropriate form of learning for that young person, that enables them to gain confidence to encourage other types of learning.

We recently heard of the story of a young person who felt unable to learn, thereby refusing any support in accessing education. However, from spending time with their key-worker, they developed a common interest in music, specifically the Ukulele. The key-worker started teaching the young person ukulele and before long, they had grown in his ability to play the musical instrument. More importantly, they grew in confidence that it was possible that they could ‘learn’ something new, which eventually led to them having enough confidence to engage in more formal education. Whilst not every young person we support will want to learn a small Portuguese guitar (and nor should they!), this example highlights that there might be something a young person wants to try out (e.g. a sport) or something new they might be willing to learn. This might provide them with much needed confidence to change their relationship with learning or activities. Then, with this newfound focus on the young person’s potential rather than just their limitations, we can support them to manage their disabilities differently and become the most empowered version of themselves.

In summary therefore, taking a psychologically informed approach to thinking about ‘disabilities’ is being able to both recognise but also see beyond the disability that that homeless young person may present with. It is being mindful that not all disabilities are visible and not all disabilities (even the same diagnosis) impact upon that individual in the same way. Both physical and mental disabilities can affect their psychological well-being, including their self-esteem and self-confidence. They can also increase the risk of homelessness because of the impact on their ability to access opportunities in and/or navigate the wider environment. Taking a PIE approach to considering disabilities also means taking an individual person centred approach. We need to consider what adaptations are required for any given young person in order that they can reach their potential and have access to the opportunities that their peers have. Finally, it is important that we ensure that individuals with a disability are empowered to be part of our wider community, which is central to a life of dignity, autonomy, inclusion and equality…