Psychologically Informed Environments

A Psychologically Informed Environment (PIE) “... is one that takes into account the psychological makeup – the thinking, emotions, personalities and past experience - of its participants in the way that it operates.” [1] It’s an approach to supporting people who have experienced complex trauma and adverse childhood experiences (ACEs)[2] It also considers the psychological needs of staff working with challenging behaviours: developing trauma related skills and knowledge thereby increasing motivation, job satisfaction and resilience. Originally developed for the homeless sector its principles are transferable and beneficial to a variety of other fields. The PIE framework is not prescriptive, each element can be achieved in a variety of ways, tailored to the specific service.

The Key Elements

A PIE has 5 elements:

1. A psychological framework: using psychological approaches, tools and models to support and inform our interventions e.g. Trauma Informed Care, a strengths-based approach, cognitive behavioural coaching.

2. Relationships: staff use therapeutic style relationships to build trust and provide consistency to ensure people feel psychologically safe, a prerequisite to change. This can be supported by adaptations, to policies and procedures such as referral, assessment, and support planning.

3. Staff support and training: working with people who exhibit challenging behaviour or are reluctant to engage, can be emotionally draining and frustrating. Becoming a PIE encourages this behaviour to be viewed from a different perspective, one of trauma. PIE services intentionally support staff to build emotional resilience in working with such behaviours and embed reflective practice. This leads to greater staff competence, confidence, and commitment, reducing burn-out, increasing motivation.

4. The environment: there’s a wealth of evidence showing that people’s behaviour is influenced by the physical environment. How lighting, colours, temperature, and design, for example, can impact on actions and mood, whether an individual feels psychologically safe or threatened. PIE applies this understanding to shaping the design and delivery of services working with vulnerable people.

5. Evidence generating practice: measuring and evaluating the impact of changes implemented. Have they had the intended impact? Do they need to be modified? What have we achieved? What have we learned?

Trauma Informed Care

Trauma informed care (TIC) can be used as a psychological framework for PIE. It helps us to understand the impact of trauma and adverse childhood experiences over a person’s lifetime. It asks organisations and individuals to consider how their actions may re-traumatise people and re-evaluate each element of their service design and delivery through the lens of trauma.

TIC has 4 elements:

1.       Realising the prevalence of trauma

2.       Recognising its impact

3.       Responding by putting this knowledge into practice and therefore

4.       Avoiding Re-traumatisation

Research[3] in 2015 found 85% of men known to criminal justice, substance misuse and homelessness services had experienced traumatic events in childhood.  Being homeless, having a chronic long-term health issue or disability can be traumatic in itself. Coupled with other adverse experiences such as bullying, racism or abuse the issues are compounded and can result in coping or survival strategies which appear unhelpful, anti-social or self-sabotaging.

TIC considers not “what is wrong with you?” but instead “what happened to you?” It views negative behaviour as a trauma related coping mechanism, a survival strategy. TIC teaches us that we can avoid re-traumatisation by developing trauma informed policies and practices. To support this, skills and knowledge should be developed around attachment theory, adverse childhood events (neglect, physical abuse, witnessing domestic violence etc…) developmental trauma and how the brain is impacted by “toxic stress” in childhood.

Strengths based practice

We operate in a deficit-based system, attempting to “fix” people by focussing on need and risk. Strength-based practice considers the abilities people have, their passions, strengths and potential.  It requires us to have different conversations, to ascertain and appreciate what insight, expertise and knowledge individuals and communities have, on themselves and their situation. How they can resolve the difficulties they are facing. It is a collaborative, enabling, socially just and respectful way of working with people. Look for what’s strong, with people and communities, not what’s wrong. 

 Homeless Link have recently published a toolkit which defines the approach as 

“... way of working that focuses on peoples’ strengths, skills and goals. It shapes ever thing we do; from how we interact with people to the types of support and services that are offered. It is grounded in building relationships and working alongside people so that they can identify and develop their assets and reach the goals they want to achieve. It involves a deep level of listening and a different way of working in order to activate the strengths of individuals, networks and communities. It goes beyond one-to-one interactions, redefining the focus of services and changing organisations from the inside out.”

https://www.homeless.org.uk/sites/default/files/site-attachments/Becoming%20Strengths-based.pdf  

The core principles

 Taken from a range of models include:

1. Addressing the power in-balance by power sharing e.g., through co-production and collaboration 

2. Enabling conversations which ask questions identifying what’s important to the individual, helping them to come up with solutions, building a sense of safety, trust, and motivation

3. People can and do learn, grow and change 

4. Start with what people can do, not what they can’t 

5. The problem is the problem, not the individual 

6. The community is viewed as an oasis of resources and should be the setting for our work 

7. It’s socially just practice, challenging the status quo of a deficit-based approach 

[1] Robin Johnson, co-author of “Psychologically Informed Services for Homeless People – Good practice guide” 2012 Dept of Communities and Local Gov and developer of http://pielink.net/

[2] Complex trauma refers to the psychological problems and linked patterns of thoughts, feelings and behaviours which tend to result from prolonged exposure to traumatic experience. (Good practice guide 2012)

[3] Hard Edges report Lankelly Chase 2015