‘”It’s not just for the money”; Why do you work in the homeless sector and what impact does a Psychologically Informed Environment (PIE) have on this?’

05.08.2022: As I write this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, I am sitting on a very early train to Manchester, on route to deliver reflective practice sessions to our amazing frontline teams in that region. Probably like most of us at this time of the year, I am counting down the days to our family holiday next week and a break to rest, refresh, recharge and make childcare in the school holidays a little bit easier! I have also been reflecting this week about why I joined Centrepoint to lead the development of their psychologically informed environment or PIE as well as plan the 3-year evaluation of this work that will commence on my return. Whilst we have been evaluating some aspects of PIE as we have gone along (e.g. staff training / reflective practice), this formal evaluation will fill in some of the gaps in terms of wider organisational metrics (e.g. staff burnout and attrition). I have also received some independent positive feedback on PIE from staff within the organisation this week about the value of PIE that I am hoping will allow the investment of further resources in our small team so that our PIE journey will continue to develop. However, the highlight of my week is still the time I spend in our supported accommodation services helping staff to apply psychological tools and understanding to the homeless young people that they work with within their team reflective practice sessions.

Sometimes if we are honest, working in the homeless sector is difficult and challenging. As discussed staff reflective practice sessions this week, homeless young people or even young people generally are not necessarily easy to engage with, or willing (and able) to address the many challenges that that face and/or the factors that might have lead them to become homeless. For example, disrupted family relationships or attachments, experience of the social care system, mental health issues, substance use, and disengagement from education, training or employment to name just a few issues. Many discussions within RP about the challenges that our staff face on the frontline often (jokingly) note, “it is a good job we aren’t here just for the money!” It is because we are passionate about helping some of the most vulnerable young people in the UK to #changethestory and have ‘a home and a job’ that brings many of us to work each day. We know that rewards or reinforcement in our roles can be intermittent, but when success comes, it can be so powerful, so positive and so impactful that it can sustain us through the more challenging periods. However, there are periods when we can question why we are doing this work, when perhaps it can sometimes feel too overwhelming because of the level of complexity, or system / organisational challenges we are facing. I think it is therefore helpful to pause on occasion to remind ourselves — why are we all here in the homeless sector? What are our motivations, values and reasons for being in our role?

Personally, the reasons that I do this work are complex and varied and if I am honest, sometimes when it is difficult I can doubt this decision. Occasionally I can think to myself that it is not too late to change my mind and revert to that alternative career that I have always dreamed about — being a florist! (I am a big fan of flowers and nature, which make me very happy!) For the record, I am not planning to stop being a psychologist any time soon, but I think all psychologists, because of the length of training, often joke about having a Plan B career! However, the reason I have ended up a psychologist and one working within the youth homeless sector is a combination of many factors. This starts with some lived experience of being a young person seeking housing due to family breakdown, through a fascination with ‘people’ whilst studying at University via a set of values that led to a two-decade plus career in the UK National Health Service. It is this employment experience, wherein I worked with many ‘complex’ cases many of whom were homeless, which resulted in a desire and understanding of the importance of effecting change early (i.e. early intervention with young people). However, I would argue that it is not just about what thinking about what has lead us to our current position but also what keeps us here when it is challenging. For me, the answer to that has always been the people I work with, whether that be the direct service users or now the staff within the organisation; after all that is why I became a psychologist in the first place.

Anecdotal conversations with many frontline staff in reflective practice sessions as well as a brief review of the psychology research literature (e.g. Olivert et al, 2010; Peters et al, 2022) both highlight that the homeless sector (along with other Health and Social Care sectors) does suffer from high staff burnout and attrition. Many people start in this line of work, and realise that it is perhaps not for them after all. Those that leave are often not supported sufficiently by the organisation that they work for, or may struggle to develop long term self-care strategies and work-life boundaries that help us cope with the ongoing challenges and potential for vicarious trauma in this work. For example, in their recent annual report Homeless Link (2022) have highlighted that staff burnout is a concern for more than three in four homeless services (c.f. https://www.insidehousing.co.uk/comment/comment/burned-out-homelessness-service-staff-are-leaving-to-take-up-better-salaries-in-retail-and-haulage-75935). Specifically, 78% of the 327 organisations surveyed by Homeless Link (2021–2022) agreed that staff burnout is an issue with 72% agreeing that this is affecting their ability to recruit and retain staff. They also note that this work is challenging, arguing that “from their patience in developing trusting relationships with people who have often experienced significant trauma, to their resolve and tenacity in negotiating a stretched system with long waiting lists and minimal affordable housing, homelessness workers dedicate their working lives to improving the lot of some of society’s most vulnerable people”.

So why is staff leaving an issue? Because in a PIE ‘relationships are key (Keats et al, 2012). High staff turnover and burnout is not good for homeless young people, because just as they form a therapeutic working relationship with a staff member, if that staff member leaves then this is another broken attachment for that young person. This may trigger feelings of abandonment in that young person which can naturally make them less willing to engage with the next worker whom they may feel will just leave them too. Consequently, it is highlighted by Homeless Link (2022) that in order to get the best outcomes for homeless young people it is important that we recognise the mechanism of change — ‘relationships’ and understand that it is no longer enough to rely on “homelessness workers’ sense of vocation in retaining and recruiting staff”. We need to support staff to remain enthusiastic, motivated and engaged in their role, so that whilst some staff turnover would be expected as in any job as a result of life circumstances or career opportunities, it is not seen as the ‘norm’ in the sector.

As a result, Centrepoint is looking through our PIE informed People Strategy and our ongoing HR Pay and Reward Review, at what else needs to be done to attract and retain staff across the organisation. However, whilst pay levels and career progression in the sector are arguably an important issue (as across all Health and Social Care frontline roles), staff tell me that it is more than just any financial remuneration that either keeps them in their jobs or pushes them to leave. There is something more here; they often tell our team that it is about proper ‘recognition’ for the complexity of the work they undertake to directly or indirectly support homeless young people. For example, our team see and hear from the frontline about the level of risk, challenge and complexity that our staff are managing day to day within our supported accommodation services and the impact that this can have on their psychological well-being. Moreover, our support teams are also under significant pressure within their roles, knowing that their work directly influences this frontline (e.g. available resources, funds, systems and processes).

Therefore, how can a PIE approach be key in supporting our staff, which of course then indirectly benefits the homeless young people we work with in Centrepoint? As noted above, PIE is all about relationships (Keats et al, 2012); building, maintaining and harnessing their power to create positive change (see recent blog here for further discussion of the power of relationships — https://drhelenmiles.medium.com/healing-or-harming-harnessing-the-positive-power-of-relationships-in-a-psychologically-8cbd32d0424c). However, the different elements of a PIE can also be helpful in this regard. Firstly, the importance of staff training and support. Training staff is a signal that they are valued and worth investment. It is a recognition of the importance of their role. In addition, it is also an opportunity to provide them with additional skills and knowledge in order to undertake this job, building on their existing strengths further to improve outcomes (e.g. for homeless young people).

This is one reason that at Centrepoint, in addition to having a PIE introduction day, we now have 16 different PIE ‘Modules’ available for staff to access in both face to face and online sessions other a range of topics. These include generic courses such ‘Risk Assessment & Management’, ‘Basic Counselling Skills’, ‘Managing Challenging Behaviour and De-escalation Skills’, ‘Professional Boundaries’, ‘Engagement and Endings’, ‘Motivational Interviewing Skills’, ‘Drug & Alcohol Awareness’ and ‘Mental Health Awareness’. However, more specialist courses are also now available covering topics such as ‘Suicide & Self-harm’, ‘Neurodiversity Awareness’, and skills in working with specific groups such as unaccompanied minors / refugees and young people at risk of serious violence and criminal exploitation. Further PIE informed training (e.g. Keyworkers Skills, Manager Development Programme) is due to start shortly. This expanded training package ensures that our staff know that continuing professional development (CPD) is available within the organisation as a benefit to them (as well as of course improving outcomes for those we work with).

Moreover, as per a PIE, having regular team reflective practice is key to reducing staff burnout. For example, research across homelessness services in eight European countries (e.g. Lenzi et al, 2020) found that the availability of training as well as reflective supervision opportunities were positively associated with work engagement and negatively associated with staff burnout. Similarly, studies by Maguire et al (2017), Homeless Link (2019), and Reeves et al (2021) showed that reflective practice had a positive impact on staff burnout and attrition. Our own recent reflective practice audit (Tussis & Miles, in peer review) and an independent organisation recently speaking to our staff teams highlighted that positive impact of reflective practice sessions on Centrepoint staff. For example, as one staff member noted

“Reflective practice is good for the morale of the staff team. We share knowledge gets lots of advice from [the facilitator], we discuss concerns we are going through in the service, we can reflect on how we dealt with serious incidents and how we can support each other”.

Reflective practice is therefore another important investment in staff, giving them the space to ‘think’ rather than just ‘do’, creating an opportunity to consider or formulate the complexity of the work they undertake, process any associated feelings, learn from previous incidents, and thereby manage future challenges more effectively (c.f. see recent PIE Blog here: https://drhelenmiles.medium.com/reflecting-on-reflective-practice-in-a-psychologically-informed-environment-9d3d3c4ed160).

In a PIE, consideration of the physical environment is also important (Keats et al, 2012). Therefore, investing in the places that our homeless young people live in and our staff work in, can also have a positive impact on psychological well-being and increase staff retention and well-being. As this previous blog highlights (c.f. see PIE blog here: https://drhelenmiles.medium.com/the-impact-of-our-physical-environment-on-our-psychological-well-being-a-psychologically-3ae63b740dd2), there is a relationship between our internal world and our external environment. Coming to work in a run-down building that is not fit for purpose does not make us want to come to work after all. Investing in our buildings is also an indirect investment in our people and ensure that staff want to work for an organisation that considers their working environment. For many years, I worked in the NHS / prison service the physical environment was, frankly, depressing. Often too hot in the summer and too cold in the winter, with therapeutic areas that did not inspire any sense of recovery or progress could be very challenging, even without the actual daily difficulties of the role itself. Hence, the physical environment has to be part of any solution to supporting our people at Centrepoint whether the homeless young people, the frontline teams or the support teams.

Finally, PIE would also propose the important of research, evaluation and evidence based practice (c.f. see PIE blog here: https://drhelenmiles.medium.com/not-just-numbers-why-data-and-research-matters-in-a-psychologically-informed-environment-db7da280ecd2). Having an understanding of why we are doing X and not Y, that is informed by data driven decision-making is critical. In other words, knowing that what we are doing is based on sound evidence and consideration and not just because that is what we have always done. Moreover, knowing as a staff member that the data we are collecting is being positively utilised is also motivating and is more likely to drive up data quality and collection rates. This aspect of a PIE is also important to our policy and lobbying work to #EndYouthHomelessness in the future, as it ensure that we are arguing for change from a position of evidence as well as experience, thus increasing the power of any arguments. Staff tell me that being part of a positive change for homeless young people in the UK is also important to them, not just on a micro level (i.e. in their work with an individual homeless young person) but also on a macro level (i.e. being part of the wider movement for change). Being able to zoom out and be part of a ‘bigger picture’ can be motivational when sometimes the daily grind can feel hopeless.

In conclusion, my reflections this week as to why I work in the homeless sector keep bringing me back to the importance of PIE, and what psychologists can offer to organisations like Centrepoint. Our team is of course only one part of the myriad of roles within the charity, all of which are important parts of the bigger picture. However, I believe what we offer spans the whole organisation and is useful to address some of the identified challenges in the sector (e.g. staff burnout and attrition, improving trauma informed practice and outcomes for homeless young people). Sometimes it can be hard for me to articulate the value of a PIE, I am after all a psychologist and not a sales person(!), but hopefully just considering each aspect of a PIE approach in turn in this blog can highlight the value of a PIE. Psychologists are not a ‘nice to have’; there are an essential part of multidisciplinary working. This is the main reason that the homeless sector has significantly invested in PIE approaches, and psychologists, over the past decade both in terms of commissioning and delivery. Moreover, I am in this job because I care passionately about the lives of homeless young people in the UK, and the staff that support them, and I believe that a PIE approach can be a positive benefit to both. As I head off on my annual leave shortly, I think this is as good a time as any to stop and reflect why we are here, after all for many of us it really is ‘not just for the money’…