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Challenges to implementing PIE: Commissioning

1. Commissioning
2. Managing change
3. Competing demands on time
4. Impact of Austerity
5. Evidencing Impact
6. Choosing your psychological approach

Six of the key challenges to becoming a psychologically or trauma informed environment.[1]  In this series of blogs, I’ll be considering these potential barriers by sharing lessons learned from a variety of sources. My aim is to continue the conversation, reflect on what’s worked, and consider potential ways of moving forward.

Let’s start with commissioning.

Increasingly commissioners seem to be including PIE in their service specifications.  Indeed, Bristol are working to become a psychologically informed city.[2]  What doesn’t appear to be happening is the required, parallel reduction in commissioners’ expectations, a change in impact measurement or evidencing success. If we believe that relationships hold the primary key to sustainable change these too, need to change.

Victoria Aseervatham, City of Westminster rough sleeping commissioner and early-adopter of PIE, now includes the approach in all service specifications. “Commissioners need to be patient and bold” she advises, “to free themselves from the shackles of Supporting People.”

A key advocate, Victoria took an active approach in promoting and demystifying PIE, developing the market and educating herself on what it actually means for a service to become psychologically informed. Victoria recognises that to authentically implement PIE you have to understand it, “not just tick box it,” and be flexible in you approach to data collection and output measurements.

The Supporting People programme made significant positive change in the sector. But. There remains a cohort of people living and dying on our streets. A group of multiply excluded individuals whom services are unable to engage; not because they’re “hard to reach” but because we are not offering a service they want to engage with. So, what should we do?

Rather than “oversimplifying problems to make management of social interventions easier”[3] we need to embrace complexity and build on a complexity-friendly commissioning model which asks “…. funders and commissioners to tolerate new risks, manage their fear of the unknown, and to help build people’s capacity to make effective decisions in situations of uncertainty.”[4]

This is challenging, this is systems change. How about taking a few small steps instead?

1. Add up the cost of not providing effective interventions to the cohort of entrenched rough sleepers in your borough. Use that money differently; training in psychological approaches to facilitate behaviour change. Providing a psychologist to support staff and keep them emotionally resilient. Consider it social return on investment.

2. Stop implementing a deficit approach to support (now there’s a paradox!) Commission strengths-based services.

3. Re-evaluate what success looks like. If Peter has managed to avoid abandoning or being evicted for 4 months rather than 4 weeks, as has been the case for the last 2 years, acknowledge that, celebrate it.

4. Allow staff the time to reflect on why Peter managed to tolerate being in accommodation longer this time. What worked? What could be done differently next time you implement elastic tolerance and avoid having to ask him to leave?

5. Be flexible with your move on target and length of stay. 

6. To achieve the latter 5 points, commissioners, need to let go. Let go of the need for “hard” outcomes and re-evaluate the “soft” ones. You know, the ones like having self-esteem, valuing yourself, a feeling of psychological safety and self-respect. Let go of the belief that paperwork and recording is more important than building relationships.

Let go of the way we do things and try something different.

And if that doesn’t float your boat ask yourself one simple question. How many times do we need to fail someone to realise that what we’re offering just isn’t working?

Watch Victoria’s top tips for becoming psychologically informed here.[5] Watch out for the forthcoming workshop Overcoming  Challenges to Implementing PIE and training course on Commissioning PIE courtesy of www.nooneleftout.co.uk and www.aneemo.com.

Footnotes

[1] Opportunity Nottingham survey 2018

[2] Golden Key/Second Step event 2017

[3] Boulton, J. Allen P. and Bowman C. (2015) Embracing Complexity: Strategic Perspectives for an age of turbulence. Oxford University Press

[4] “A Whole New World: Funding and Commissioning in Complexity” Collaborate for social change and Newcastle University

[5] You will need to register with PIE Link (free)