Achieving change with a reflective culture – Psychologically Informed Environments (PIE)

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Change happens
It is natural from time-to-time that support workers feel frustrated in response to the actions of service users. These actions can sometimes ‘appear’ irrational at first glance. Why would you not turn up for an important court hearing, the result of which will affect your future? Why would you shout at a receptionist who cannot give you an appointment there and then?
Change happens through effective engagement, but fostering engagement is difficult when frustration gets in the way. Not understanding why a service user behaves in a certain way, or feeling the hard work put in on the service users’ behalf is unappreciated, support workers, who are only human, can get irritated. Service users sense it and withdraw.

Psychologically Informed Environment (PIE) Training breaks these barriers down.
Originally devised by St Basils in 2011, a bespoke version of PIE Training is being delivered to all organisations in Birmingham Changing Futures Together’s No Wrong Door Network. The roll out of the training began in September 2016.  It’s making a significant impact. “Some teams have completed their PIE Training,” explained Deborah Pearsall of Birmingham Mind, a partner in the No
Wrong Door Network, “and some have not. There is a clear difference in the outcomes between the two groups; the PIE Training is radically improving our results.”

Each PIE Training course involves three intensive days followed by monthly reflective practice sessions, facilitated by a psychologist. During the three days, attendees learn about the link between present behaviour and past experience. They gain an insight into why someone with a complex and difficult history may make a decision that will, for example, put them at risk or increase the likelihood of a negative outcome, into why they find it difficult to engage with support.  Attendees also gain a valuable insight into their own behaviour and learn to reflect on the way in which
they interact with their service users. When Emma Brown took up the role of Operations Manager at WAITS (Women Acting in Today’s Society), another partner in the No Wrong Door Network, she realised she was sometimes talking a different language to her team. “As a psychologist I have been trained to see past the surface and understand why a service user may
behave in ways that appear irrational. “But without this insight, support workers can sometimes feel personally responsible for the actions of their clients; ‘if I was better at my job, she would have turned up to the appointment’. This, naturally, can lead to feeling frustrated or let down by a service user.

The PIE Training gave us a shared language and helped the team focus on the link between an individual’s past experiences and present behaviour. They could see how her history shaped her relationship with them and the organisation.

“The monthly reflective practice sessions are a crucial element. They have habituated the new approach. We always worked in a person-centered way, looking at the whole person instead of a set of issues. With the PIE training and reflective practice, we are better able to understand the psychological context within which service users operate, and work with them to reduce any barriers
they may face with regards to our support. The team is happier too, no longer carrying the full weight of responsibility and all that goes with it.”

Julie Carnell, who leads the North Locality Support Services team at Birmingham Mind, explained the difference the PIE Training has made to her team. “We already worked with a person-centred approach so for us the training built on a pre-existing base of understanding. “We’re now much more self aware and there is a consensus ‘less is more’. Team members don’t rush to ‘rescue’ clients anymore. Instead of trying to fix their problems the focus is on building their capacity and autonomy. This means treating the service user as an adult, working at their pace, allowing them to make mistakes and supporting them when they do. It can be difficult for the team member, especially if they can see the ‘bump in the road’ coming, but the change in the service user is far more sustainable.  “Always non-judgemental, but now equipped with new tools and more confident in themselves, team members are having honest conversations with service users and, understanding the power of silence, giving them the space to reflect on what’s been said. Every team member said that while using their PIE tools they had witnessed a service user have a
‘light bulb’ moment. This change is difficult to quantify in the moment but it’s significant and lasting.

“The resilience of the team has grown too. Understanding more of their own behaviour patterns has helped them recognise and evolve their coping mechanisms. This has the added benefit of service users being given the space to develop their own, authentic coping mechanisms rather than having those of someone else foisted on them. The team also values supervision more and feels a deeper, more stable connection with each other.

The PIE Training has strengthened the team, improved the way we work with service users and is leading towards more significant and sustainable outcomes.

One Team
Natalie Allen, Programme Director for Birmingham Changing Futures Together, which leads the No Wrong Door Network (the Network), recognises the value of all in the Network being trained. “With No Wrong Door a service user can seamlessly access a whole system of support from one point. To deliver this properly we need to be consistent; it’s not helpful if service users pick on differences and perceive one agency as ‘good’ and another as ‘bad’. The PIE Training is spreading a consistent approach. Service users know what to expect and are being supported to develop their own autonomy and everyone in the network increasingly feels part of strong, united, wider team.”

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