‘Not just numbers? — Why data and research matters in a psychologically informed environment …’

28.01.2022: For this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, I have been reflecting again on the value of data and research in a PIE. I have touched on this topic in previous blogs (c.f. https://drhelenmiles.medium.com/q-whats-the-evidence-the-role-of-research-in-the-homeless-sector-b10f6fac0125) but I thought it was important to return to this theme as research and evaluation is a key, but sometimes neglected, ‘ingredient’ in a PIE. Psychologists are ‘evidence based practitioners’; in other words the interventions we offer must be solidly grounded in the evidence base of ‘what works’ in the homelessness sector. Although research on PIE is still in its infancy, initial studies suggest that psychological or PIE based approaches to working with a homeless population do ‘work’, specifically in increasing positive outcomes (as measured by the Outcome Star) and decreasing negative outcomes such as challenging behaviours and evictions (e.g. Cockersell, 2011; Stronge & Williamson, 2014; Phipps et al, 2017). I also wanted to return to this topic this week to highlight some of the research that the PIE team has been involved in over the past year, and how this is contributing to both the research literature in this area, as well as being utilised for policy recommendations and fundraising campaigns in order to #endyouthhomelessness.

This is a particularly relevant point this week, because of the launch of Centrepoint’s ‘Data-Bank’ Report (c.f. https://centrepoint.org.uk/media/5154/databank-report-2020-21.pdf) on Tuesday 26th January (c.f. https://twitter.com/centrepointuk/status/1486267923941449730). This research report entitled ‘Beyond a number: The scale of youth homelessness in the UK’ (2022) is an analysis of the Youth Homelessness Databank, which tracks the number of young people approaching local authority homelessness teams across the UK. Of most significant concern it that ‘for the fifth year in a row, the number of young people who asked for help from their local council because they were homeless or at immediate risk of homelessness has increased’ (Centrepoint, 2022; p.4). Specifically, it is estimated by Centrepoint that in the year 2020/21, almost 122,000 young people approached their local council for housing support. As the report highlights, this is data collected during the first year of the COVID-19 pandemic, so this increase is worrying because many measures were supposed to have been put in place during lockdown to limit the number of people experiencing homelessness (e.g. the eviction ban, the temporary uplift in Universal Credit, the ‘Everyone In’ Scheme).

The data from across local authorities in the UK indicates that these rises in youth homelessness were widespread, and as perhaps expected from a PIE perspective, were often related to breakdowns in relationships (that were arguably under more strain than usual during the COVID-19 lockdowns when we were all advised to #stayathome). For example, this Centrepoint research indicates that ‘the percentage of young people who were homeless or at risk of homelessness because their family were no longer willing or able to accommodate them increased from 45% in 2019/20 to 49% in 2020/21’ (Centrepoint, 2022; p.4). Moreover, rates of domestic violence were also noted to have increased from 7.9% in 2019/20 to 9.3% in 2020/21. This Centrepoint data is also supported by other research from the Ministry of Housing, Communities and Local Government (2021), which noted that the main three reasons underlying youth homelessness were (1) family no longer willing or able to accommodate (49%), (2) domestic abuse (9%) and (3) friends no longer willing or able to accommodate (6%). The breakdown in relationships that commonly underpins youth homelessness is why within a PIE approach in homeless services, ‘relationship’ (re)building is often both so challenging but so important for positive outcomes.

This year’s Centrepoint report also highlights a specific project that I have been directly involved with. Amy Brennand, a student from the Institute of Psychiatry, Psychology & Neurosciences; Kings College London (IOPPN; KCL), examined the specific impact of COVID-19 on youth homelessness via calls to the Centrepoint National Youth Homelessness Helpline (c.f. https://centrepoint.org.uk/youth-homelessness/get-help-now/). This vital service, delivered by an amazing team of staff and volunteers, can be considered a ‘frontline’ of youth homelessness in the UK as it receives calls from young people across the UK who are homeless or at immediate risk of homelessness. Advice about how to access relevant services as well as their rights under the Homeless Reduction Act (HRA; 2017) are provided as well as empathic and compassionate support. I have the pleasure of offering this team reflective practice and staff support, and have therefore heard directly about the particular challenges that are being faced at the moment by young people in the UK. It was in this context that the joint project with IOPPN; KCL was undertaken, in order to understand better both the scale of youth homelessness during the pandemic, as well as the impact on helpline staff.

The results of this research indicated that there was, unsurprisingly, an increased demand for the Helpline throughout COVID-19. Specifically, there was an increase in calls from ‘8,937 between April 2019 and February 2020 to 12,742 between March 2020 and February 2021’ (Centrepoint, 2022; p.24). This research also utilised a ‘Thematic Analysis’ approach (Braun & Clarke, 2006) to look at the main themes being discussed during calls. This highlighted three main themes or issues when a young person called the Helpline; (1) Need for Safety, (2) Need for Support, and (3) Suitability of Living Conditions. Young people calling the Helpline highlighted that they often felt ‘unsafe’ in their current housing, with many reporting that they were fleeing physical abuse and violence, or emotional / mental abuse and controlling behaviours from others, exacerbated by the conditions created by COVID-19 (i.e. lockdowns). Other young people also highlighted the need for support, particularly around their mental health, housing needs or financial support. Many reported being unable to access this support during the pandemic as services ‘closed their doors’ or only had a remote offer that was difficult to engage in. Finally, unsuitable current living conditions were also noted by callers, perhaps because housing was unsuitable, or because the environment they were living in was characterised by significant arguments or conflict.

Consequently, undertaking this research over this period has enabled Centrepoint to gain a greater understanding of the current state of youth homelessness in the UK, including the prevalence (i.e. how many young people are effected) and the drivers (i.e. the causes) of homelessness amongst this population. As per a PIE, the Youth Homelessness Databank is a good example of the need to have this robust data and evidence to drive decision making in the homeless sector. This can be decisions on operational matters (i.e. the need to have more staff on the Helpline to manage the increase in calls or where an intervention is needed to reduce the risk of homelessness such as family mediation), strategic (i.e. where the focus of intervention should be to #endyouthhomelessness by 2037) or even policy recommendations (e.g. see page 6–7 of the Centrepoint report).

I would also like to take this opportunity to highlight in the PIE blog, other research that has been conducted over the past year in conjunction with the PIE team and how this has been utilised in wider Centrepoint work and decision making. For example, one early research project that our team was involved with was an examination of the prevalence of Mental Health Needs amongst Homeless Young People (Krist et al, 2021), which fed into a Centrepoint (2021) report on this issue (c.f. https://centrepoint.org.uk/media/4650/prevalence-of-mental-health-need-report.pdf) and a subsequent fundraising campaign. Shelby Krist (another IOPPN:KCL student) looked at the records of 3,452 young people that accessed Centrepoint’s housing and support services in 2019, from multiple regions including London, Manchester, Sunderland, Bradford and Barnsley. It was found that mental health issues were reported in over half (54.1%) of homeless young people, most frequently anxiety (34.3%), depression (33.1%) or stress (26.4%), and a third of homeless young people (32.3%) had a formal mental health diagnosis, much higher than that generally reported in a comparative non-homeless population of 16–25 year olds. This research therefore highlights the need to recognise and address mental health issues in this population, as per a PIE.

Other research that has been conducted that has important in influencing decision making, and tendering processes has also included work last year looking at the factors that underpin youth offending and homelessness (c.f. Self et al, 2021; https://centrepoint.org.uk/about-us/blog/is-there-a-link-between-youth-homelessness-and-youth-offending/). Tara Self (another IOPPN; KCL student) conducted a systematic review, which found again the powerful negative impact of disrupted family relationships and early trauma on the risk of offending behaviours in homeless young people. The influence of substance abuse, mental illness, gang involvement and involvement in the care system was also noted to increase the risk of later criminal activity in this population. Again, this highlights the key importance of addressing these issues within supported accommodation services through evidence based psychologically informed interventions in order to reduce the risk of subsequent offending behaviours. This review also highlighted the issue that many homeless young people may engage in minor offences such as theft in order to survive or acquire money or shelter (even if that is within a custodial setting). Breaking this cycle through the provision of both a ‘home and a job’ is therefore critical, although this research also indicated that there was a lack of suitable accommodation placements for homeless young people who also have an offending history, particularly when leaving custody. This research therefore made specific recommendations (e.g. types of housing placements, and the need to invest in family mediation /relational support) as to what can be effective interventions with this population in order to prevent further reoffending and/or homelessness.

Lastly, as per a PIE, our team are also constantly reviewing and evidencing our PIE delivery and practice. As well as an ongoing evaluation of our PIE training offer, we have recently completed a review of the PIE reflective practice offer within the organisation, which has now been submitted for publication in a peer reviewed academic journal (Tussis & Miles, 2022). This research, carried out by Lorena Tussis (Clinical Psychologist in Training on placement last year with the PIE Team), has enabled our team to understand how our reflective practice offer has landed with staff, what is helpful and what is less so, and importantly where we can improve this offer (i.e. though provision of managers only groups, looking at how we can offer sessions to staff not able to engage in the current reflective practice such as night workers). We are hoping with a planned expansion of our team over the next year, we can therefore offer a greater number of sessions as well as ensure that sessions are delivered in a format that is most beneficial to staff. Without undertaking this research, we would not be able to ensure that our reflective practice offer ‘works’ and make evidence based decisions about the nature of this offer moving forward.

These are just a selection of research projects that the PIE team has been involved in recently, but of course, there are other research projects that our brilliant Research and Policy Team in Centrepoint are currently progressing separate from our PIE team, but underpinned by the PIE principles of evidence based practice and co-production (c.f. https://centrepoint.org.uk/what-we-do/policy-and-research/). For example, this has included work evaluating our innovative services such as ‘Housing First’ (c.f. https://centrepoint.org.uk/media/5040/evaluation-of-haringey-housing-first-for-care-leavers-final-report-nov-2021.pdf) as well as research co-produced with and directly involving some of our young people on the current welfare benefits system (c.f. https://centrepoint.org.uk/media/5009/d235-uc-peer-research-report-a4-v5-screen-singles.pdf). Of course, all of this research would not be possible without the support of our Data Insight and Analysis team, who have been extremely helpful in helping us to obtain and understand Centrepoint’s data relevant to a particular hypothesis or research question. This ‘behind the scenes’ support team, is therefore a vital part of supporting Centrepoint’s PIE journey and our team is extremely grateful for their patience and support over the past year.

In summary, being a PIE organisation is more than just being psychologically informed in our supportive relationships and interventions with homeless young people, ensuring that we offer staff training and reflective practice, and having a physical environment that is mindful of the psychological well-being of those that live and work there. PIE is also about utilising evidence and data to inform our internal decision-making across the whole of the organisation as well as our external campaigning and policy work. Research enables us to understand exactly what the issue may be as well as ensuring that what we are doing is ‘working’ (and if not, why not?) I am therefore a big fan of data (and even the odd spreadsheet!), and utilising this wisely in our day-to-day roles. Having a PIE ‘mind-set’ is therefore about all of us seeing data as not something that is perhaps annoying or laborious to collect, but is actually a key tool in all our roles in order to optimise our outcomes and amplify ‘what is working’.

Therefore, something we could maybe reflect upon this week is about the how we can develop this ‘research’ or ‘evidence based’ principle of PIE further in the organisation in the future. Perhaps we have ideas for research within our own areas that we can discuss with others and take forward? Are there any questions we need answers to that research or data could assist us with? Perhaps we already have data available that we can reflect upon or review to ensure our decision-making is evidence based? Perhaps it is just about ensuring that we commit to recording data within our roles to the highest possible quality in order that it can be used effectively by others? Arguably, if we just have the same old thinking and practice, we will just have the same old results and we can risk failing to innovate, develop and ultimately not ensure we are creating the best possible outcomes for homeless young people…