The PIE Approach
Psychological and mental health problems affect most people with multiple and complex needs, and often these are linked to traumatic experiences in their past. There is growing evidence that for agencies supporting people with multiple needs, working in a 'psychologically informed' way will achieve better outcomes.
A psychologically informed approach is referred to as PIE (Psychologically Informed Environments). This approach takes account of the psychological make-up; the thinking, personalities and past experience of participants in the way it operates. It obtains better outcomes for residents, patients and service-users, by considering not only their psychological needs, but also those of the people who work with them. This helps to develop skills and knowledge; and increase motivation, job satisfaction and resilience.
PIE was initially developed for homeless hostels, where focus on the physical environment – and de-institutionalising it – was clearly shown to be able to make a positive difference. But alongside this, at the core of the PIE approach is a focus on the people within the environment and the relationships they develop. In this respect PIE can be used by outreach and day centre staff as well as accommodation services. In fact PIE can apply to all agencies, both statutory and voluntary – who seek to support people with multiple needs. With this broadening out of the PIE approach in mind, the Opportunity Nottingham Board authorised funding for a PIE Action Learning Set (ALS) in 2016. The ALS brought together staff from seven very different agencies across Nottingham City, and was also considered a useful pilot activity for the Opportunity Nottingham Practice Development Unit (PDU).
Although the participating agencies were quite different, they all had two things in common; firstly at least some of their work was with people facing multiple needs, and secondly they had a commitment to operating in a more psychologically informed way by the end of the ALS. Other than that, there were no preconditions to attending the ALS. Becoming a psychologically informed service is seen as continuous journey, not a series of boxes to be ticked. So, whilst participants agreed 'to do something' to operate in a more psychologically informed way, precisely what their action would be was an individual decision.
The ALS was delivered across five workshops over a five month timeframe. Participant actions were agreed at the initial workshop, and at subsequent workshops participants provided updates on how they were getting on with implementing these. Sometimes progress was good, other times barriers were encountered. Where this happened the workshops were used to reflect on how to overcome these barriers. As well as providing a focus for actions, the workshops provided an opportunity to consider how to apply the main elements of PIE at each participating agency. These elements form the acronym PETER*:
P – Psychological Frameworks
E - Environment
T - Training and support – which includes reflective practice
E - Evaluation
R – Relationships
During the ALS, participants developed a real rapport, and although each participant set themselves very different actions, everyone encouraged each other and provided support to overcome individual difficulties. Participant feedback included the following;
"The small group format helped me to understand what can be done to have a real impact for service-users."
"Very informative and insightful – it gave me space to think."
"Hearing from other agencies helped clarify my own ideas."
Implementation ideas varied between participants. Some involved whole services – for instance implementing elements of PIE through a team development strategy. For other agencies changes were quite specific, with one participant focusing on their service having a conversation with service-users on initial engagement, rather than emphasising the need to complete paperwork.
*Psychologically Informed Environments, Claire Ritchie, No One Left Out: Solutions Ltd for Westminster City Council 2015.