CPD module: psychologically informed environments – what they are and how they can make a difference

Jason Smith is assistant director of support at Pobl Group, joining the housing association in 2022 from Caredig housing association. He is also a non-executive board member at Llais Cymru, a board member at Taff Housing Association and a board trustee at Cymorth Cymru.

Gareth Williams, senior quality and performance manager at Pobl, has worked for the housing association for 20 years, starting as a scheme support officer within a young people’s accommodation service. He leads and manages key operational performance items and quality standards. Part of his role includes implementing and embedding PIE and trauma-informed care within its support services.

After reading this article, learners will be able to:

• Describe the concept of psychologically informed environments (PIEs)
• Detail why PIEs can be useful in supporting those who have experienced, or who are at risk of experiencing, homelessness
• Tie understanding of PIEs’ specific relevance in homelessness services to an understanding of adverse childhood experiences (ACEs)
• Understand some practical ways of implementing the PIE approach
• Understand the broader applications and potential benefits of PIE within housing organisations
• Detail the experiences of one organisation which has implemented the PIE approach
• Have a sense of which further learning would be helpful, and ideas for additional reading and reflection

Research has shown that there is a strong link between those who experience homelessness as adults and those who have experienced traumatic events, including during childhood. Such events can affect someone’s physical and mental well-being in the long term. They can also affect how successfully someone is able to interact with support services.

The idea of psychologically informed environments (PIEs) originated in homelessness services. Such environments take into account the potentially complex emotional and psychological needs of those within them. They are built around an understanding of how traumatic events in someone’s life might have affected them.

The PIE concept posits that by understanding such experiences and such needs, services can more effectively support individuals – while also creating better working environments for staff.

At Pobl Group – Wales’ largest provider of support services for people experiencing or at risk of homelessness – the PIE approach has been widely implemented. It has been credited with reducing adverse incidents in services and with helping to reduce staff turnover.

This article explores the concept of psychologically informed environments. It draws on experiences at Pobl Group to consider how the approach can be valuable to providers of housing services.

What is the concept of PIE? When did it emerge?

A psychologically informed environment (PIE) is one which takes into account the potentially complex emotional and psychological needs of those within them, building services around this understanding.

The concept was first formally described in a 2010 journal article by Robin Johnson and Rex Haigh. The paper, published in Mental Health and Social Inclusion, built on guidance issued that year by the UK government. Mr Johnson, a social worker turned researcher, and Mr Haigh, a consultant psychiatrist, coined the term PIEs to describe services “that recognise that many of their clientele will have suffered some degree of emotional trauma” and that are “attentive to… needs” resulting from that.

Their initial 2010 paper suggested that the definitive marker of a PIE was simply that “if asked why the unit is run in such-and-such a way, the staff would give an answer couched in terms of the emotional and psychological needs of the service users, rather than giving some more logistical or practical rationale, such as convenience, costs, or health and safety regulations”.

What types of emotional trauma might those using homelessness services have experienced? How common are such experiences in this group?

Evidence suggests that having lived through traumatic events is extremely common in those with experience of homelessness. Sometimes such events will have occurred during someone’s adult life, but often they date back to childhood. In these instances, such occurrences are called adverse childhood experiences (ACEs).

At Pobl Group, a review of three schemes for those with experience of homelessness found 100% of residents had four or more adverse childhood experiences.

Examples of such experiences include:

• Physical, sexual or emotional abuse
• Neglect
• Parental substance misuse
• Parental incarceration
• Exposure to violence
• Losing a parent, whether through divorce, death or abandonment

How might childhood trauma affect the way in which someone interacts with services?

Childhood trauma can affect the way in which the brain develops. Someone who has experienced trauma in early life may find it harder to regulate and/or communicate their emotions. They may become angry at things which seem inconsequential to someone who hasn’t experienced trauma. Sometimes they may shut themselves off, refusing to discuss their concerns.

Those working in support services might sometimes interpret such behaviour unfavourably. They may see someone who seems unnecessarily aggressive; who is responding in an illogical way; or who is unwilling to help themselves. This interpretation, which is based on a misunderstanding of someone’s motivations, can serve to worsen the behaviour being regarded as ‘poor’. The ultimate result might be the likes of violence, police call-outs, eviction of service users, and staff sickness and high turnover.

Pobl Group is Wales’ largest provider of support services for people experiencing or at risk of homelessness. Around seven years ago, two of the high-support schemes now run by the organisation were experiencing poor outcomes. There were high rates of anti-social behaviour, evictions and staff turnover.

Leaders implemented a psychologically informed environment (PIE) approach to improve outcomes. The approach was piloted in some of the services that had experienced particular challenges. In one, serious incidents fell from 86 in one year to around five the next year. Evictions dropped from close to 50% each year to none. Staff turnover and sickness levels also fell notably.

How can a PIE improve the quality of support for people with experience of homelessness?

In a psychologically informed environment, staff understand that:

• Living through traumatic events can seriously affect the way in which someone thinks and behaves
• It is important to take time to learn about the individual experiences and needs of service users
• Providing the best possible support involves taking someone’s experiences and psychological needs into account

At many housing organisations, staff already have some level of understanding of this. But PIE can provide a more formal framework and a common language in which to describe this aspect of an organisation’s work.

What are the key elements of a PIE approach?

In 2012, the then-Department for Communities and Local Government published guidance on how to implement the PIE approach in homelessness services.

It detailed a framework which can be used to redesign a service such that it becomes a PIE. The charity Homeless Link has summarised these as:

1. Developing a psychological framework – allowing services to have a shared understanding of, and response to, the people they support

2. The physical environment and social spaces – improving the space available to engage with and support people in the service

3. Staff training and support – enabling workers to move away from crisis management and work in a more therapeutic and planned way

4. Managing relationships – helping staff and clients self-manage their emotional and behavioural responses to triggering events

5. Evaluation of outcomes – enabling staff and clients to evaluate the effectiveness of the PIE approach and to continually reflect on what works and what doesn’t

This framework has come to be known as PIEs 1. More recently, the creators of the model have refined it further, to create what they call PIEs 2.0.

This centres on a modified version of the five core elements:

Developing more ‘psychological awareness’ of the needs of service users

• Valuing training and support for staff, volunteers and service users
• Creating a service culture of constant learning and enquiry
• Creating and/or working with ‘spaces of opportunity’
• Fine-tuning the three Rs – the rules, roles and responsiveness of the service

For organisations new to PIE, however, they argue that it is perfectly logical and reasonable to start with the five initially described ‘headlines’.

In a practical sense, how can a PIE approach be implemented? And how can its success be evaluated?

An article by Robin Johnson on his website PIELink.net makes clear that “there is no one right way to ‘be’ a PIE; and likewise, there is no right way to develop as one or to introduce the PIE approach in existing services”. He adds: “There is no check list of things to do to be a PIE. No boxes to simply tick. That way you miss the discussion – which is the best bit.”

He therefore recommends a self-assessment approach to both implementation and evaluation. It covers the following steps:

• Your views on where you are at as a service (initial assessment)
• Explaining your views (evidence)
• Assessing what helps and hinders (diagnosis)
• Making a plan for the future
• Talking it over with someone else (peer review)

PIELink contains forms which help teams work through this process. They can all be downloaded for free.

47%
English adults who have experienced at least one ACE, with 9% experiencing four or more

45%
Pobl employees with lived experience of trauma

Can the PIE approach be applied beyond homelessness services?

Across every single part of society there are people living with the continued impact of traumatic events, and/or with other psychological needs. Indeed, the UK Trauma Council has reported that more than one in three people in the UK are exposed to at least one potentially traumatic event by the age of 18. In 2018, the work of a House of Commons Select Committee highlighted that:

• 47% of English adults had experienced at least one ACE and 9% had experienced four or more
• Half of Welsh adults had experienced at least one ACE and 14% had experienced four or more
• Public Health Scotland had estimated that prevalence in Scotland would be at least as high

This means that the PIE approach has wide applicability. It is not only relevant in homelessness services.

At Pobl, the approach has now been introduced across the group. This includes within internal departments. Senior executives have been trained in the approach, as have the likes of finance and IT teams.

Members of the human resources team completed a day-long workshop on the PIE model. This involved talking through scenarios in which staff might need support, and considering how a PIE approach should inform the way in which that support is given.

It is important to remember that some of those who work in housing associations may well have chosen their career based on their own personal experiences. A survey of the workforce at Pobl discovered that 45% of employees had lived experience of trauma generally, or homelessness specifically. This reinforces the idea that PIE is an approach with value for employees as well as service users.

How can staff be trained in a PIE approach?

At Pobl Group, members of the support team offer regular PIE-related learning activities:

• The concept is covered in an induction session.
• There is a monthly ‘introduction to PIE’ training session – all new employees take this within a few months of starting, and it is also open to existing employees who would like refresher training. This three-hour session covers research on ACEs, the impact of trauma on brain development and the way in which Pobl Group uses the PIE approach to support people.
• There is also bespoke training available – this involves supporting individual teams or services to identify the very specific needs of service users.

At Pobl Group, the approach was initially piloted in a small number of services. Workshops were held with the staff teams in these schemes, and a framework developed which was specifically appropriate to these services.

Key changes covered by this framework included:

• Asking individual service users what support they would find most helpful in a crisis, then providing that support
• Redesigning spaces to give more communal areas, allowing better interaction between staff and service users
• Providing more activities for service users

Each team at Pobl has a PIE self-evaluation and action plan, using the templates on PIELink. The organisation uses a software solution (PIE Abacus) to complete, organise and analyse these plans.

How does a PIE evolve over time?

By definition, a psychologically informed environment is one which takes into account the psychological needs of the people within it. When those people change, the environment may need to change as well.

Flexibility is needed – there is no real finish point to implementing PIE. It is a journey rather than a destination.

• How psychologically informed is the service or organisation in which you work? Is consideration of psychological needs only in the context of ‘customers’ of the service, or is it also applied to staff?
• Does your service or organisation currently use the PIE framework? If not, could it be useful? If already used, are there aspects detailed in the framework which are not currently being covered, or could be improved?
• What one thing could you do to take a more psychologically informed approach to your own work?
• What one point in this piece do you want to share with colleagues who may not have read it? And how will you share it?

Summary

PIEs take into account the potentially complex emotional and psychological needs of those within them. They are built on an understanding that traumatic events in someone’s life might impact on their thinking and behaving.

Given so many of those who experience homelessness will have been through traumatic events in their lives, PIE is a particularly valuable approach to supporting this group. But it can be applied far more broadly within housing organisations, both to external-facing services and to internal settings.

At Pobl Group, Wales’ largest provider of support services for people experiencing or at risk of homelessness, the approach has been widely implemented. There have been associated reductions in anti-social behaviour and evictions, and in staff turnover.

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• Johnson, R. Introducing the PIE approach, PIELink
• PIELink (founded and originally edited by Robin Johnson, one of the originators of the PIE approach) – online community of practice for those interested in developing PIEs
• Adverse Childhood Experiences (ACE) Hub Wales
• Koh, K. and Montgomery, A. E. (2021) Adverse childhood experiences and homelessness: advances and aspirations, The Lancet
• UK government (2012) Psychologically informed services for homeless people: Good Practice Guide
• UK government (2010) Mental health good practice guide: Meeting the psychological and emotional needs of homeless people
• Johnson, R. and Haigh, R. (2010) Social psychiatry and social policy for the 21st century – New concepts for new needs: The psychologically-informed environment, Mental Health and Social Inclusion