Psychologically Informed Environments

1. Psychologically Informed Environments Jean Templeton St Basils

2. 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

3. 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

4. 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’

5. Psychological, emotional and behavioural pathway to repeat homelessness • Triggers: • Release • from prison • Relationship • breakdown • Discharge from • armed services • Loss of • tenancy Shame, guilt Emotion dysregulation Drug and alcohol use Experiential avoidance Rumination Asocial and antisocial behaviour Maladaptive coping style (externalising) Modelling Childhood abuse / neglect Repeat tenancy breakdown Lack of social and practical functioning skills Attachment problems

6. 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

7. 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

8. 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

9. Elements of the Programme • Core training in psychological skills for all staff • Specialist training for some • Development of evaluation framework and infrastructure and review and analyse data over 3 year period • Reflective Practice groups in collaboration with NHS partners • Review tools and working methods to ensure they support an approach consistent with Psychologically informed environment

11. Our Partners • Dr Nick Maguire, Senior Clinical Psychologist, Southampton University • Birmingham and Solihull Mental Health Foundation Trust • Department of Communities and Local Government • Pro Bono Economics • London Housing Foundation • University of Birmingham – Mental Health Study positive outcomes for young people

12. 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

14. references DCLG – Psychologically Informed Services for Homeless People- Good Practice Guide February 2012 www.stbasils.org.uk/publications#external jean.templeton@stbasils.org.uk