‘What is the role of research and evaluation in a Psychologically Informed Environment (PIE)?’
24.07.2020: As I reflect on this past week one of the highlights has been catching up with some students, who I have been co-supervising their Master’s Degree research projects within Centrepoint, the UK national youth homeless charity, and whose work is almost complete despite the challenges of undertaking it during the COVID-19 lockdown! Research and Evaluation, particularly that which can identify good practice or highlight ideas for future positive changes to practice and influence social policy direction around homelessness services, is a key part of any Psychologically Informed Environment (PIE). However, it can sometimes get less focus than other PIE ‘activities’ such as staff training, reflective practice and the psychologically informed changes to the physical environment, hence I have decided to focus this week’s PIE blog on this topic.
The importance of undertaking research or evaluation within an PIE is outlined by Keats et al (2012), who note in their PIE Good Practice Guide (c.f. https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf, p.26) that; ‘evaluation of outcomes is crucial in the development of psychologically informed services … because they are a cornerstone of reflective practice, which in turn is a cornerstone of psychologically informed environments’. Specifically, ‘if you do not know what impact what you say or do is having, how can you know whether it is positive and how can you improve it? … It is an opportunity for staff and clients to learn”. Consequently, we have embedded research and evaluation as part of our PIE ‘vision’ for Centrepoint, outlining that we want our PIE to ‘contribute to the research base of what works’ and to ‘use this evidence to improve the quality of our service delivery as well as influencing national policy in addressing youth homelessness’. In the words of our PIEineers (i.e. the homeless young people co-producing our PIE), we want to ‘use facts and data to make positive changes for young people to reduce youth homelessness’.
Therefore, the Centrepoint PIE has been being evaluated since its launch within the organisation last year. This has involved some staff and homeless young people completing some measures pre-PIE, which will be repeated in the future (i.e. post-PIE) to see whether there has been any improvement in a variety of staff and young people outcomes (e.g. relationships, burnout, anti-social behaviour, risk incidents, satisfaction with services, etc.). We have also assessed staff attitudes and knowledge about PIE, and their satisfaction with the PIE training that we were able to provide before the COVID-19 lock-down. The initial analysis of this preliminary data has demonstrated significant improvements (p<0.001, n= 109) in staff understanding and interest in PIE following just one day of PIE training as well as high levels of satisfaction with the training session(s). Our reflective practice sessions will also be evaluated in due course, as will the tangible changes to the physical environment.
Why is research or evaluation so key in a PIE? Psychologists often describe themselves as reflective evidence based practitioners; in other words, we consider and think about the relevant psychological research evidence and attempt to apply it to the current situation. Consequently, throughout our psychological training, we are taught to critically evaluate and use the evidence to guide and apply our thinking in any given context. For example, I used to often tell my therapy clients that I was like a ‘bridge’ between the all the research on mental illness and their personal experiences. My role was to apply, in conjunction with them, what we knew works to their situation, adapting it to their context or circumstances through the creation of their individual formulation or ‘story’ about their experience. In current reflective practice sessions with staff teams, we use this idea of a ‘formulation’ in case discussions, considering the key factors for an individual young person, and devising action plans based on what might be helpful for them because of what we have tried or learnt before. Psychologists are therefore scientists, perhaps with a touch of ‘relational’ artistry (!), and we use data and evidence (perhaps far too much statistics for most of us sometimes!) to guide our decision-making. Consequently, if an organisation is to become ‘psychologically informed’ or a ‘PIE’ then it too needs to consider it’s data or evidence in its future decision making, strategic planning and delivery.
Of course, given the complexity and uniqueness of humans, we cannot just apply research findings from one situation or context to another; we have to consider ‘how’ they might apply, if in fact they do? For example, does research on homelessness in one country, with different societal attitudes, systems and structures, services or resources apply to another? This is therefore one project I have been co-supervising with the Policy, Research & Communications Team over the past few months, looking at the evidence around youth homelessness and youth offending. Specifically, the MSc student has been conducting an international systemic review of the academic peer reviewed as well as the ‘grey’ policy papers or publications in this area. This is no small task, as the student has identified and read hundreds of papers, reports and policy documents from around the world during this process, as they follow a process to draw out the key conclusions. This then enables them to make some recommendations on what are the issues for this population, what interventions may have been shown to be effective and efficient, and therefore what we could or should be utilising (if we aren’t already), as well as advising on future service provision design and making wider social policy recommendations. Of course, the specific challenge of this process is to apply international research to the UK context, and to consider what might work within our systems and processes (e.g. homeless legislation and resources, Criminal Justice System) or even using this research to identify where changes to these current systems may be needed and then using our organisational influence as the leading UK youth homelessness charity (with our partners) to lobby for these.
The second MSc student that I have been co-supervising is looking more directly at our Centrepoint data; reviewing, organising and processing thousands of (anonymised) case data sets of homeless young people that have been referred to or supported by Centrepoint in 2019. This data is being analysed by different domains (e.g. physical health needs, mental health needs, housing needs, other risks issues, educational or employment issues etc.). This will enable the organisation to understand the characteristics of a homeless young person in the UK accessing our services, 50 years on from the formation of the charity, and of course, whether there are any regional variations. As a result, using this information, we can ensure that we are offering the ‘right service at the right time and in the right place’ to address the varied needs of this very vulnerable and diverse population. Importantly, this allows our future service planning to be evidence based and pro-active rather than ad hoc or reactive.
Since coming to Centrepoint just over a year ago now as a psychologist, it has been very interesting and rewarding to work for an organisation that is using research and evidence to influence policy work, as well using data to try and improve standards within services. Both are part of a PIE approach, although often when working in statutory services you are limited to just the latter. I have come to realise that Centrepoint is not just about delivering supported accommodation services, or education and training opportunities to homeless young people in the UK, but is actively trying to do away with the need for its self as a charity by engaging in activities to #endyouthhomelessness! This is particularly evident in our Policy, Research and Communications Team, who have been working throughout the recent global pandemic to continue to highlight issues, advocate for homeless young people and to lobby for changes in wider society. This week, another highlight was co-facilitating their team away day, including holding a remote reflective space for them to explore their experiences of the lock-down period before starting to think about ‘what next in this new normal?’ What was interesting in this space was that despite the diversity of experiences of staff, some furloughed and some working remotely throughout this period, there were many shared experiences, emotions and thoughts, which hopefully allowed the team to come together and continue their valuable evidence based work to #changethestory for homeless young people in the UK.
One example of this valuable work is the report released last week about the particular challenges that young people in the UK who are at risk of homelessness or are homeless have experienced during the recent COVID-19 lockdown (c.f. https://centrepoint.org.uk/media/4293/locked-out-report.pdf). As Billy Harding (Centrepoint Policy & Research Officer) reports in his blog here: https://centrepoint.org.uk/about-us/blog/locked-out-youth-homelessness-during-and-beyond-the-covid-19-pandemic/ there have been significant increases in youth homelessness during the lock-down with councils reporting higher numbers of young people seeking help and calls to our own Centrepoint Helpline (0808 800 0661) increasing by 50% (c.f. https://www.yorkshirepost.co.uk/health/coronavirus/number-homeless-people-who-have-died-coronavirus-reaches-16-councils-tell-young-people-sleep-rough-2910671. This is not really surprising given the increased pressure on family relationships, increases in unemployment, reduction in services and resources available, and the consequences to mental health that have been associated with the COVID-19 lock-down. However, whilst the evidence is indisputable, the report notes; ‘without addressing the structural problems which led to thousands of people needing to be accommodated as a public health emergency — such as a severe lack of affordable accommodation, insecure and low paid work, difficulties accessing services and a social security system which has become uncoupled from the real costs of living — there is a real risk that for too many, a return to normal will mean a return to the streets’.
Therefore Centrepoint’s evidence based recommendations (e.g. https://twitter.com/centrepointuk/status/1283715048683249664) and campaigns to respond to the issues of youth homelessness (e.g. #chancetomoveon; https://centrepoint.org.uk/chance-to-move-on) are vital, and because they are underpinned by facts, evidence or data they have arguably more power to drive system change as they are more difficult to ignore or dismiss. Research and evaluation in a PIE consequently has a critical role to play, to help us to learn, develop and move forward to be more effective, efficient and strategic. As noted in a previous blog (c.f. https://medium.com/@DrHelenMiles/listening-to-the-data-making-psychologically-informed-decisions-in-policy-and-practice-60268a0b4600) we live in a ‘data-driven society’. As a result, psychologists would argue that we need to reflect on and use this research evidence to make positive changes to our ‘new normal’ world …
