Beginnings: Setting Up A Service Which Considers Psycholigcal Needs

In our previous blogs we have spoken about why it is important to consider trauma and psychological needs, and we have thought about trauma informed principles and how these could be applied to your workplace. In this blog we are going to bring these two ideas together and talk about how to design services which hold in mind the psychological needs of their staff teams and service users. 

A model for services: Psychologically Informed Environments

A Psychologically Informed Environment, or PIE, is conceptualised as a service which has been designed with psychological needs as their primary concern. It takes into account the principles of trauma-informed care but differs slightly in that it advocates for an underpinning psychological model which best fits the service. PIEs have been implemented and researched across the housing and homelessness sector, from hostels to day centres and community support services. 

The PIE framework has five key principles for consideration:

• Psychological awareness – developing an understanding of the psychological reasons why a person might be responding or acting in certain ways, and what they might need, underpinned by a chosen psychological model.

• Staff training and support – recognising that staff need support and guidance to work in this way and to embed a culture of caring for ourselves as well as others. 

• Learning and enquiry – a state of curiosity, being open to learning and reviewing our service. This might be through formal evaluation, or feedback from staff and service users. 

• Spaces of opportunity – thinking about the physical and social spaces we provide and ensuring that these are spaces which open up possibilities and new ways of thinking. 

• The three Rs, rules, roles and responsiveness – ensuring that the rules or boundaries we hold are explicit, and that we are able to respond to the needs of our service users. This includes clearly defining the roles and expectations of everyone within our service. 

These five principles are underpinned by a focus on relationships and reflective practice. We will talk more about what a good professional relationship looks like and the role of reflective practice in later blogs. 

But what does this mean in practice?

As with the trauma informed principles, sometimes it can be difficult to think about how this might work in your service. We’ve outlined some ways in which you can start to bring these ideas into your work here, but please feel free to get in touch if you think your team would benefit from some more support to implement this.

A good place to start might be to look at all the formal and unspoken rules that exist in your service. For example, if you have a “did not attend” policy, or if there are rules about when people can and can’t access your building. Firstly, you need to ask yourself why this rule was put in place. If we take the example of the “did not attend” policy, it might be because there were several missed appointments which caused a waiting list for your service. Although this takes into account the business needs, and the needs of  those on the waiting list, it’s important to look at how the policy is implemented. Are the rules clearly communicated throughout someone’s support? Have efforts been made to understand why they might be missing appointments and to provide appointments which suit them better? This might mean community appointments, or appointments later in the day. For example, a person who struggles with traumatic flashbacks and nightmares might struggle to attend appointments early in the morning, they might oversleep or find it difficult to get going after hardly sleeping at all. 

If we are scheduling appointments based on service needs, rather than on an understanding of the needs of the service user, we might expect to see more missed appointments. If we can understand why, we can be more responsive to their needs. It’s important that your policies allow for this responsiveness, to avoid re-enacting previous rejecting or dismissive patterns from a person’s life. 

Another good place to start might be to explore how open your service is to feedback from the staff team and service users. Are there clear pathways for people to provide feedback? If we are aiming for an environment which fosters learning and enquiry, a formal complaints policy probably isn’t going to be enough to generate genuine and thoughtful feedback. Are there spaces where you could try to get more feedback?
Once we’ve gathered this feedback it’s important to respond clearly and openly to it. This doesn’t mean we have to take every suggestion on board, but it does mean that we have to outline the reasons why certain ideas can’t be taken forward at this time, and consideration of how this might be possible in a different way or in the future. This might also support the staff team to raise training needs, or areas where they feel they need more support to develop and grow. 

Does it work?

The research evidence behind the PIE framework is growing all the time, with more services adopting and evaluating their implementation. 

Existing research suggests that staff feel they have more skills to help to motivate clients and support them to reach their own conclusions, whilst also improving engagement (Benson & Brennan, 2018). Staff also reported feeling more empowered in their interactions with clients, and that they felt that they were able to go beyond simply “managing” behaviour to build meaningful relationships with their clients (Benson & Brennan, 2018). Phipps et al. (2017) found that staff appreciated reflective practice spaces to pause and think about the various challenges of the work, and that both staff and residents said that the relational approach improved the care provided. 

If this is something you’re thinking about implementing in your workplace, and you feel you could benefit from some support, please contact us to talk through some options.