PSYCHOLOGICALLY INFORMED ENVIRONMENTSJean TempletonSt Basils

THE VISION…• To see adequate provision made in

homelessness services facilitating effective treatment for psychological issues within homelessness

• To ensure that staff are adequately equipped to effectively deal with complex problems

• 2008 Rough Sleepers Strategy

WHAT IS COMPLEX TRAUMA? A number of terms used interchangeably

Complex Trauma Complex PTSD Type II Trauma Disorders of Extreme Stress Not Otherwise Specified

(DESNOS; DSM-IV (APA, 1999)) Describes observations of:

Alterations in emotion and impulse regulation Dissociation Changes in self-perception Difficulties relating to others Somatisation Alterations in belief systems held by the individual

ISSUES Interpersonal issues

Attachment Emotion regulation Negative beliefs about self and others Impulsivity Other trauma experiences

Flashbacks, rumination Complicated by natural processes in adolescence

Identity formation (beliefs, belonging) Emotion regulation ‘Separation’

PSYCHOLOGICAL, EMOTIONAL AND BEHAVIOURAL PATHWAY TO REPEAT HOMELESSNESS

Childhood abuse / neglect

Emotion dysregulation

Experiential avoidance

Maladaptivecoping style(externalising)

Rumination

Shame, guilt

Drug and alcohol use

Asocial and antisocial behaviour

Lack of social and practical functioning skills

Repeat tenancybreakdown

Triggers:

•Release from prison•Relationship breakdown•Discharge from armed services•Loss of tenancy

Modelling

Attachment problems

PSYCHOLOGICALLY INFORMED ENVIRONMENTS (PIES) Whole environment operates according to an

agreed psychological framework Keywork sessions Use of reflective practice Residents’ meetings Peer mentors

Environment may also reflect psychological thinking Residents’ input into surroundings Residents’ use of facilities

Effects are monitored (measured) Meaningful

CHANGE Need to be clear about what it is we expect to

change For clients For staff For service

Clarity about how we expect to facilitate change Emotional change Behavioural change Cognitive change Change in attachment experience

PIPIE AIMS AT ST BASILSE AIMS AT ST BASILS

• Improve positive outcomes for young people, build resilience and capability and enable them to move on and sustain their independence in an increasingly challenging environment

•Ensure staff have skills, attitudes, behaviours and resilience to cope and support positive outcomes for young people

ELEMENTS OF THE PROGRAMME1. Core training in psychological skills for all staff2. Specialist training for some3. Development of evaluation framework and

infrastructure and review and analyse data over 3 year period

4. Reflective Practice groups in collaboration with NHS partners

5. Review tools and working methods to ensure they support an approach consistent with Psychologically informed environment

Professional Standards Personal

Effectiveness Organisational Effectiveness

- Reflective

Practice

Outcome-Led Approaches

-Payment by Results

Young People’s Voice

Co-Production-

Personalisation

OUR PARTNERSDr Nick Maguire, Senior Clinical Psychologist, Southampton University

Birmingham and Solihull Mental Health Foundation Trust

Department of Communities and Local GovernmentPro Bono EconomicsLondon Housing Foundation University of Birmingham – Mental Health Study positive outcomes for young people

LEARNING AND IMPACTS Reflective practice in consistent groups is absolutely critical Embed techniques and approach in all your work Part of induction and regular refresh

Year 1 KPIs: 13% reduction in serious incidents 50% reduction in NTQs for behavioural issues 19% reduction in unplanned departures 26% reduction in sickness absence 7% reduction in grievance and disciplinary actions

PIE at St Basils

Youth Involvement

ReviewEquality and

DiversityAction Plan

Training and L& D

Programme

ReflectivePractice

Mental Health First

AidProgramme3 year

monitoring and review

Lifeskills programme

Asset Management

Strategy

Outcomes Star

IntegratedApproach to

LSW

REFERENCESDCLG – Psychologically Informed Services for Homeless People- Good Practice Guide February 2012 www.stbasils.org.uk/publications#external

jean.templeton@stbasils.org.uk