Dr Ray Middleton is the Workforce Development Lead for the National Lottery Community Fund’s Fulfilling Lives programme in Newcastle and Gateshead (FLNG). With a special interest in trauma-informed care, Ray is piloting a programme to develop Psychologically Informed Environments (PIE) in frontline services combining an innovative ‘Open Dialogue’ approach to mental health with PIE using the ‘Ladder4Life’ framework he developed.
A Psychologically Informed Environment (PIE) is a space which considers ‘the psychological make up – the thinking, emotions, personalities and past experience – of its participants in the way that it operates’ (Johnson et al., 2012).
As described in my last blog at FLNG we have long been enthusiastic promoters of PIE and have used our experience to develop and deliver a PIE training programme that supports other local services to use the PIE self-assessment framework to inform how they deliver their services. The PIE framework guides services to measure progress through self-assessment and by training and supporting local services to use PIE we have been able to draw out some early learning points around the common themes that help and hinder self-assessment in the key PIE areas:
- A common hindrance cited around Psychological awareness was a lack of understanding among staff of the effects of trauma (and secondary trauma on staff). This tended to be linked with increases in staff over-busyness and burnout. Training around trauma-informed approaches and reflective practice spaces with peers to process the emotional ‘wear and tear’ of the work were seen to help in this area.
- Training and support: Formal support structures were reported as helpful (such as 1-2-1 supervision, incident debriefs, team meetings and handovers) if they happen as planned. A hindrance was the difficulty of finding good quality relevant training tailored to the job people actually did (such as trauma-informed, motivation building, collaborative working) tailored to specific roles (such as housing support worker or employment coach). There was also a difficulty in practicing new skills learnt and embedding them in the day to day work, instead of just forgetting skills learnt on a training day in the busyness of the work.
- Learning and enquiry: A help identified was the ability to measure progress and then learn from this, such as reflecting on ‘good news stories’ of progression. However, time and workload pressures were a common hindrance that made it hard to protect space to reflect, develop skills and learn on the job.
- A good induction which is clear about staff Roles, rules and responsiveness of the service was seen to help, with ongoing peer support to stay in a consistent role helping in the ‘3 Rs’ However, a common hindrance theme emerged when different personalities interpret staff roles differently and rules are often inconsistently applied by staff. Also, some people took up staff time disproportionately, meaning quieter people did not benefit fully from the service offer which was seen as unfair.
- Spaces of opportunity: In this area staff were sometimes able to think more systemically about the wider local offer of services available and spot gaps or spaces of opportunity that did not accept the people they support. However, a significant theme identified was people lacking the motivation to access what was on offer which could help them develop. This raised the question of whether motivation building skills tailored to people’s job roles would be good to focus on in future training.
- Reflective practice: We chose to include ‘Reflective practice’ as a sub-topic under the standard PIE area of ‘Learning and enquiry’ and have found that running regular reflective practice groups in staff teams was seen to be beneficial when it happened. However, services often said they were hindered by lack of in-house skills to run reflective practice sessions and lacked finances to pay for an external facilitator. This raises the question of whether training around facilitating reflective practice groups might build capacity within the sector for this to happen. There appears to be some reluctance amongst some staff to prioritise and protect reflective practice time, which may be linked to their overall levels of busyness. However, our thinking is that regular reflective practice sessions would reduce stress levels and lead to better decision making and consequently reduce busyness levels but this is of course reliant on buy-in of PIE at a strategic level. More can be read about the role of reflective practice within PIE here.
Psychological Framework demonstrated visually in the Ladder4Life by Ray Middleton
Pizazz is the PIE self-assessment framework designed by Robin Johnson (www.pielink.net) that we use to guide us through the PIE self-assessment areas outlined above. We’ve found this to be a useful, user-friendly tool to help any service get started on their PIE journey. More information of Pizazz can be found here.
We have also taken part in the first wave of an iAbacus PIE pilot. This is software that allows a service’s PIE data to be inputted into a website and database. Detailed reports can then be run to compare and enhance learning and development, which could be particularly useful for larger organisations wanting to coordinate their approach to PIE. Having tried it, our experience has been that the iAbacus works, is user-friendly and useful. It has allowed us to produce individual service specific PIE reports in a visually appealing format and we can envision how these reports could be used for internal/external reflective dialogues as they present the data clearly. However, as with all pilots it is important to hold in mind that at this stage this is an experimental exploration of new technology which may help. More information about the PIE iAbacus can be found at www.iabacus.co.uk/pie.
Other learning points
People trained to be PIE Leads were in general able to understand the PIE categories, to successfully facilitate reflective discussions with their staff teams and to generate a baseline PIE self-assessment for their service. However, the quality of the data gathered did vary. Some services generated comprehensive data which included over 15 helping and hindering factors in each area whilst other services gave less depth to their answers by identifying only one or two factors that helped and hindered.
In our own service we implemented a monthly reflective practice session for frontline staff after reflecting on the initial baseline PIE self-assessment. We also delivered training on trauma informed care (TIC) in our induction and a number of other psycho-social techniques to improve our ‘psychological awareness’ and ‘training’ areas, such as validation skills, motivational interviewing, solution-focussed practice and collaborative problem solving skills.
In general, services needed a month to be able to get the team together to discuss and reflect on the PIE areas to create self-assessment. In reality most services managed to complete this in six weeks with some prompting and encouragement from me! The general atmosphere in most services was over-busyness and so for innovation and learning to happen there needed to be a named person to take responsibility for PIE within a service (the PIE Lead) and within the organisation (potentially a ‘PIE Co-ordinator’ role).
We found services in organisations where there was buy in and understanding about PIE from senior staff did better at gathering the data on the ground. The extent to which commissioners understand and value PIE also appears to motivate staff to gather good PIE data.
Finally, the challenge and tension with generating PIE self-assessment data is that, whilst it enables learning and development, organisations tend to be anxious about exposing themselves to the judgements of others by showing their internal service self-assessments. However, it is only by being honest about where we are currently at that we can take the next realistic steps to get better.
So that is a brief update for now about what we have learnt on our PIE journey up to this point. If you would like to know more about the PIE training Fulfilling Lives Newcastle Gateshead offers or have any questions about our approach please drop me an email at Ray.Middleton@fulfillinglives-ng.org.uk or visit the Workforce Development area of our website. You can also read my previous blog about PIE here.