‘Reflections on the National Youth Homelessness Conference PIE Workshop: Our PIE journey so far’

16.10.2020: The highlight of this week as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity; Centrepoint, has been our PIE Team / PIEineers co-produced presentation / workshop on our PIE journey so far at the Centrepoint National Youth Homelessness Conference (c.f. #YouthHomelessConf to see the other highlights and join the conversation). In the post COVID-19 world, this conference and our PIE workshop occurred virtually rather than face-to-face, which was a challenge as a presenter but hopefully improved accessibility for those working across the homeless sector, allowing more organisations to join. Over the three days, the conference has been interesting and inspiring, and the themes included ‘Prevention of youth homelessness’, ‘Putting young people at the heart of what we do’, and ‘What next for youth homelessness post COVID-19?’

Our specific workshop outlined the background for our Centrepoint PIE, and the progress made so far, as well as creating an opportunity for attendees to share their PIE experiences / journey in their organisations. It was a particular pleasure to co-present with one of the PIEineers; Catherine (an ex-Centrepoint resident), who once again represented herself and other young people brilliantly. Alongside the other PIEineers (and Centrepoint staff), she has been critical in keeping me focused on the issues of homeless young people and ensuring that they remain at the heart of what we want our PIE to be, as well as advising on various aspects of PIE to ensure that it is relevant and meets the needs of those homeless young people that access our services as well as the staff that work within them.

For example, so far, the PIEineers have developed and fed back on the Centrepoint PIE strategy and framework, influenced the PIE Training content (including developing case studies), devised a PIEineer interview question for our Clinical Psychology posts and offered informal feedback on candidates. They have also provided feedback on our proposals to improve the physical environment including what homeless young people want and need within supported accommodation as well as how to develop an appropriate applications process, and have informed our PIE evaluation. Finally, they have also made key contributions to our PIE communications; including devising (and starring in!) a PIE launch video, a poster about PIE for young people, contributing to the PIE blog and co-presenting at national events such as the conference this week and the British Psychological Society Clinical Psychology Conference earlier in the year.

As a reminder, our Centrepoint PIE journey began with research on what PIE involves in the homeless sector (e.g. Keats et al, 2012: https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf) and also a significant period of reflection on how this would specifically apply to our organisation. Although there are perhaps ‘key ingredients’ to a PIE (rather like an actual pie!), there are also variations in the ‘ingredients’ which create what an organisation requires in order to be appropriately ‘psychologically informed’ and meet the unique needs of those that use or work within a particular service. Consequently, I spent some time ‘scoping’ and understanding our organisation better when I first joined Centrepoint last year, wherein I visited all the services that we offer across the UK. I think I am still the only current member of staff in the organisation to have had the pleasure to visit EVERY service! Luckily, this was pre-COVID so I was able to travel easily to all our London services, as well as visit our services in Manchester, Bradford, Barnsley and Sunderland. This was an extremely useful process, as it reminded me not only of the breath and local variation of our services, but also their commonalities, most specifically about the need to develop ‘key relationships’ with our homeless young people in order that these can be the catalyst for positive change.

Specifically, as Seager (2015) notes non-PIE homeless work has ‘automatically prioritised physical shelter, provided by a roof, over the psychological shelter and security that can only be formed over time, in the mind, through relationships. Without the right psychological conditions, the offer of a roof alone can never be enough and may even be damaging because it signals a failure to understand and honour the depth of emotional damage behind the homelessness’. Consequently, a PIE is an attempt to meet the fundamental needs of homeless individuals by providing psychological safety and security, AND rebuilding damaged attachment relationships through the provision of a ‘professional home and family’ (Johnson & Haigh, 2010; 2012).

This importance on ‘relationships’ has led Centrepoint to utilise ‘Attachment Theory’ (Bowlby, 1969; 1977) as the theoretical underpinning to what we do. This universal theory of human development does not ‘pathologise’ our homeless young people (a key request of the PIEineers), but recognises the role of ‘Adverse Childhood Experiences’ (known as ACEs) in impacting our future sense of self, our thoughts about ourselves, others and the wider world, and consequently our emotional responses and behaviours. Being aware of an individuals’ past experiences, can often ‘shed light’ on or ‘explain’ their current presentation, and therefore why they may be reacting in a particular way to us. Importantly, as highlighted by some of the other Centrepoint young people that contributed to the conference this week by speaking about their experiences, it was this formation of a positive key relationship in their life that was often the ‘magic ingredient’ that transformed it. They noted that having someone unconditionally believe in them, show them empathy and be willing to take time to build trust with them (c.f. Rogers, 1959), was key to help them identify and achieve their goals. As Seyi Obakin (CEO, Centrepoint) noted in his closing speech, sometimes it can only take ‘one trusted adult’ that can help a young person turn their life around and help them fulfil their potential. And that’s why, within Centrepoint and many of our partner organisations attending the conference this week, our ‘keyworkers’ are truly ‘key’ to all we do.

We also discussed in the workshop, both within the presentation and in the subsequent breakout discussion groups, the other ingredients of a PIE. Firstly, we highlighted our Centrepoint PIE Training for staff. As the Westminster Council (2015) PIE Guide notes (c.f. https://www.homeless.org.uk/sites/default/files/site-attachments/Creating%20a%20Psychologically%20Informed%20Environment%20-%202015.pdf), training staff to deal with the complex needs of the homeless young people that they work with is critical. Consequently, pre COVID-19 lockdown, we introduced face-to-face PIE training, consisting of a two day package. Day 1, for all staff in the organisation, consisted of an introduction to PIE and relationship building / basic counselling skills, reflective practice, the basics of formulation, attachment theory and trauma informed care, and space for staff self-care. Day 2, for all ‘frontline’ staff working directly with homeless young people, was developed to help staff develop skills and confidence in specific evidence based psychological ‘tools’ or ‘techniques’ that would assist them in their sessions (e.g. problem solving, emotional regulation, positive behaviour management, dealing with negative thoughts and building self-esteem).

In the first 6 weeks of PIE training before its suspension due to COVID-19 restrictions, the PIE Team trained 109 staff over eight PIE Day 1 training sessions in London, Bradford and Barnsley. The majority of those trained (n=93, 85%) were frontline staff, and overall attitudes, knowledge and skills showed significant (p<0.001) positive improvement post training. One of the challenges moving forward now, especially as there is no likely return to face-to-face training any time soon, is to consider how to move a highly ‘interactive’ training session to a remote or online format, but that is one that we are currently exploring in the PIE Team and was reflected in discussions with other organisations. We hope to have a new PIE training ‘offer’ to Centrepoint staff by the new year, which will consist of breaking Day 1 training into two shorter online sessions, and the provision of ‘PIE tools’ training videos that staff can view at times convenient to them, and discuss within their reflective practice sessions.

As noted in the workshop, because of COVID-19 our PIE delivery in Centrepoint has focused since lock-down on the provision of Reflective Practice, as this is an aspect of PIE that has been noted to be important in developing ‘psychological mindedness’ (e.g. Westminster Council, 2015). Reflective practice enables staff to reflect on their working practices and support continuous improvement. It also provides a space to process and discuss complex issues, utilising models such as Gibbs (1988) ‘Reflective Cycle’, in order to support them to consider why a homeless young person may be presenting in a particular manner (e.g. with challenging behaviours). This can also create the opportunity for them to formulate new solutions to address issues, which consider the predisposing, precipitating, perpetuating and protective factors unique to that individual.

Moreover, reflective practice can provide a space for staff to manage and reflect on their own thoughts, emotions and behaviours, and can build team working and collaboration, increasing resilience and decreasing burnout / staff attrition. This latter value of reflective practice has perhaps been the most important since COVID-19 when many frontline staff in our organisation, and in others who attended the conference, have continued to provide essential services to homeless young people in increasingly challenging and risky situations. For example, our PIE Team in Centrepoint, since March 2020, we have facilitated over 120 reflective spaces in a mix of remote via zoom, face-to-face with social distancing and PPE, or a hybrid of both, monthly for our ’Frontline’ teams as well as on an ad hoc basis for our ‘Support’ teams. Interestingly, in the breakout discussions at the conference reflective practice was agreed as being an important part of a PIE within the homeless sector due to the often-challenging nature of the work, although it was noted that some organisations have been more able to deliver this than others due to resources or access to appropriate facilitators.

In a PIE, the physical environment is also critical; where we live clearly effects how we feel, a fact that highlighted to all of us during the recent COVID-19 lockdown when we have been spending significantly more time at home than usual. Our physical spaces should be co-produced with those who live and work in them based on their needs, maintained to a good condition, and promote psychological and physical safety. As Keats et al (2012) summarises; the physical environment should communicate the message that those who live or work in it are valued and provide an affirmative response to the question; ‘would I want myself or my family to live there?’ Areas that might need therefore to be considered include noise and acoustics, light, open spaces, art or decoration, colours and materials, ventilation, furniture, safety and confidentiality, and I am delighted that our organisation is seriously investing in this aspect of PIE moving forward. We have started off small with a local applications process (releasing over £25,000 of funds so far), but we have now developed PIE informed property maintenance standards, as well as beginning to utilise other funds to uplift our services and make them a ‘home’.

During the breakout discussions at the conference, it was interesting to discuss the physical environment with other charities, who even whilst they may not have vast funds, understand the value of this ‘ingredient’ of a PIE, and have made small but significant changes to the physical environments that they operate in. This highlighted to me that whilst the ‘big changes’ are important, small changes can also be very powerful especially when they are co-produced with the homeless young people living there. For example, one charity spoke about their young people simply having a choice of colour for their new bedding on arrival to the service, whilst another noted the importance of minimising notice boards and creating welcoming communal spaces that feel less ‘clinical’ or ‘hostel’ like and more like our own ‘homes’.

Finally, we also noted in our workshop the importance of using data and evidence to evaluate any PIE initiatives but also to inform our future practice and inform future social policy around youth homelessness with the aim to #endyouthhomelessness. Reflecting on this area in the workshop breakout spaces, it was noted that there was often insufficient research on the subject of youth homelessness. Therefore, our recent student projects to review the evidence on youth offending and homelessness, as well as a review of our 2019 data to understand the specific and current needs of homeless young people are particularly helpful. Moreover, working in conjunction with smaller organisations, can build up the evidence base of ‘what works’, vital to ensure that we all have the best outcomes for homeless young people wherever we are operating in the UK.

When reflecting more generally on PIE within the breakout sessions of the workshop, many attendees as well as ourselves highlighted repeatedly the challenges and changes to our plans to deliver PIE’s in this post COVID-19 world. However, being ‘psychologically informed’ is arguably even more critical than ever, as we see how the pandemic is having longer-term consequences. For example, how it is particularly impacting young people in terms of education and employment, housing and opportunities, as well as how the recent lockdown(s) and uncertainty about the future is significantly effecting our mental (as well as physical) health. Sadly, this is likely to be ‘the new normal’ for the foreseeable future, and therefore we need our PIE’s, however they are ‘made’ in Centrepoint or in other organisations, to remain adaptable to the ongoing challenges in this uncertain future. We need to have a willingness to keep going when change can sometimes feel difficult or insurmountable, and keep continuing to focus on what remains most psychologically important; our relationships. With our homeless young people, with our colleagues in Centrepoint, and with our wider charity and statutory partners, we will be stronger together when we build these relationships. I therefore hope our PIE workshop at the conference can be a starting point in an ongoing conversation about the role and value of PIE in youth homelessness to #changethestory and ensure that every young person in our society has a safe place to call ‘home’…