A review of the reflective practice (RP) offer in a youth homeless charity in England during COVID-19 as part of a psychologically informed environment(PIE) approach

IntroductionCommunity pharmacies are key in the delivery of care to people who use drugs (PWUD), providing specialist harm reduction, and treatment interventions such as naloxone, Injecting Equipment Provision and opiate replacement treatment. PWUD are disproportionately burdened with mental ill-health and frequently report trauma history which impacts on engagement. A successful approach in the homeless sector, is that of Psychologically Informed Environments (PIE). The core elements of a PIE are: creating a space which engenders a sense of safety and wellbeing; reflective practice so staff can develop a shared model of working; training and support for staff; and considering the therapeutic aspects of service provision to vulnerable people (1).AimThis pilot study tested training pharmacy staff in applying a psychologically informed environments approach to improve the delivery of care to PWUD.MethodsThree pharmacies were recruited from those with high involvement with PWUD. A range of location and type of pharmacy were included. Whole pharmacy teams were invited to an evening training session. Bespoke training was provided by clinical psychologists with PIE expertise.Training was assessed by anonymous quantitative questionnaires using rating scales. Changes in the attitudes of staff were assessed by questionnaire before and 6 months after training. Descriptive statistics were applied. Qualitative interviews with staff at 6 months (planned for 3 months) explored what changes, were made after PIE training to adapt the delivery of care. The study used peer researcher-led telephone interviews for patient/client feedback on observed changes and experiences in participating pharmacies. Recruitment was via the three pharmacy teams due to covid restrictions. Thematic analysis was applied to qualitative data. Normalisation Process Theory provided a framework for assessing change.ResultsThree pharmacies (16 staff) participated. Training evaluation was positive; all participants rating training structure and delivery as very good or excellent. Covid-19 lockdowns restricted follow-up data collection which took place at six months rather than three. Attitude scores were positive (>0) for all participants at baseline (median 15.0) increasing to 20.0 at 6 months. This was not statistically significant (S=4, p=0.549).Staff interviews revealed training had encouraged staff to reflect on communication and considered the impact of current practice which could be discriminatory e.g. their use of first names, use of private areas and level of explanation to people. The increased mental health challenges for patients from Covid-19 restrictions gave an opportunity for staff to apply their new skills to this patient group and others who were struggling with isolation, as staff across pharmacies noted mental health challenges for patients. Five patients from two pharmacies were interviewed but time delays in data collection meant changes in delivery of care were difficult to recall.ConclusionThe study was limited by small sample size and covid-related delays. However, findings indicated that training whole pharmacy teams in PIE was well received and justifies a larger study. The approach allowed staff to reflect on practice and identify previous, potentially discriminatory practice. The importance of clear and compassionate communication was evident.Reference(1) Johnson R, Haigh R. Social psychiatry and social policy for the 21st century ‐ new concepts for new needs: the ‘psychologically‐informed environment.’ Ment Heal Soc Incl. 2010;14(4):30–5.

Despite well-being initially being high on the agenda for UK health organisations, the COVID-19 pandemic has highlighted significant gaps around provision for well-being of pharmacists in the UK. The COVID-19...

While psychologically informed environments (PIEs) are gaining in prominence in efforts to improve well-being and practice in the homeless sector, their empirical foundations remain tenuous. We present a unique scoping needs analysis of staff and client well-being, staff attitudes and the social-therapeutic climate in a UK-based homeless prevention organisation (prior to PIE implementation). Our aims were: (a) to apply a robust framework to pinpoint need and target forthcoming PIE initiatives and (b) to establish a validated needs baseline that informs and measures efficacy of PIE for its future development. Four established personal and practice well-being measures were administered to 134 (predominantly 'frontline') staff and 50 clients. Staff completed the: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), Professional Quality of Life Scale (measuring compassion satisfaction [CS], burnout [BO] and secondary traumatic stress [STS]), Attitudes related to Trauma-informed Care Scale (ARTIC-10; measuring practice attitudes towards trauma-informed values) and the Essen Climate Evaluation Schema (EssenCES; measuring perceptions of client cohesion, safety and practitioner relationships in housing projects). Clients completed the WEMWBS and EssenCES. Vulnerability to STS was evident in nearly two-thirds of frontline staff and it was a statistically significant predictor of BO. It was not, however, associated with lesser levels of CS. We discuss this complex dynamic in relation to highlighted strategic recommendations for the PIE framework, and the identified potential challenges in implementing trauma-informed and reflective practice in the organisation. We conclude with a critique of the value and the lessons learnt from our efforts to integrate stronger empirical substance into the PIE approach.

Purpose The purpose of this paper is to consider evidence for the effectiveness of the psychologically informed environments (PIEs) approach to working with homeless people in the five years since the national guidance was published. Design/methodology/approach The author reviewed the intended outcomes of the original guidance and then looked at a range of data from evaluations of current PIE services in UK and Ireland. Findings The findings were that the PIE approach is effective in meeting the outcomes suggested by the original guidance; in reducing social exclusion and improving the mental health of homeless people; and in improving staff morale and interactions. Research limitations/implications This is a practice-based evidence. There needs to be more practice-based evidence gathered, and it would be useful if there were some standardised measures, as long as these did not limit the richness of the data which suggests that PIEs have a wide, not narrow, impact. Practical implications The implications are that homelessness services should use the PIE approach, and that they should be supported by clinically trained psychotherapists or psychologists; and that wider mental health services should look at the PIE approach in terms of working effectively with socially excluded people with complex needs/mental health problems. Social implications PIEs are an effective way of working with socially excluded people with mental health problems/complex needs, enabling the reduction of social exclusion among this very excluded client group. Originality/value This is the first review of evidence, much of it so far unpublished, for the effectiveness of PIEs, despite the fact that this approach has been increasingly adopted by both providers and commissioners in the homelessness sector.

Inappropriate and costly GP prescribing is a major problem facing Primary Care Trusts. Educational outreach into practices, alongside other measures, such as audit and feedback, have the potential to enable GP prescribing to become more evidence based. High GP prescribing costs are associated with GPs who see drug company representatives; tend to end consultations with prescriptions; and 'try out' new drugs on an 'ad hoc basis' and use this as evidence of the drug's effect. An educational intervention called 'reflective practice' was developed to meet these and other educational needs. The design of the intervention was informed by studies that have identified the pre-requisites of successful behaviour change in general practice. The study investigated the following: (i) Is it feasible for GPs to attend the sessions included in the educational intervention? (ii) Is the intervention acceptable to the participants and the session facilitators? (iii) What are the barriers to the group educational processes, and how can these be overcome? Four practices were recruited in South West England, all of them experiencing problems with prescribing appropriateness and cost. Reflective practice sessions (including a video-taped scenario) were run in each of these practices and qualitative methods were used to explore the complex attitudes and behaviour of the participants. A researcher observed and audio-taped sessions in each practice. At the end of the programme, a sample of doctors and all the facilitators were interviewed about their experiences. The recorded data were transcribed and analysed using standard qualitative methods. The doctors in the largest partnerships were those who had the greatest difficulty in attending the sessions. Elsewhere, doctors were also reluctant to become involved because of previous experience of top-down managerial initiatives about prescribing quality. Facilitators came from a broad range of professional backgrounds. While knowledge of prescribed drug management issues was important, the professional background of the facilitator was less important than group facilitation skills in creating a group process which participating GPs found satisfactory. The video-taped scenario was found to be useful to set the scene for the discussion. Preserving the anonymity of responses of the GPs in the initial stages of the sessions was important in ensuring honesty in the discussion. Reaching a consensus on management of common conditions was sometimes difficult, partly because the use of the term 'best buy' implies economic pressures, rather than benefits to patients, and partly because of the value with which GPs regard the concept of clinical autonomy. 'Reflective Practice' appeared to have the potential to make GPs aware of the link to be made between their clinical management decisions and the evidence provided by the British National Formulary and Clinical Evidence. The study indicates the importance of preparing the practice adequately, including providing protected time for all GPs to attend the educational intervention. Scenarios and the structure of the sessions need to make more explicit the links between everyday practice and published evidence of effectiveness. Emphasis on cost-effectiveness may be counterproductive and wider benefits need to be emphasized. We have also identified the skill profile of the facilitator role. Our study indicates a need for a clearer understanding of GPs' perception of clinical autonomy and how this conflicts with the goal of agreement on practice guidelines for treatment. The intervention is now ripe for further development, perhaps by integrating it with other interventions to change professional behaviour. The improved intervention should then be evaluated in a randomized controlled trial.

This paper sets out how the Psychologically Informed Environments (PIE) model, which originated in the homelessness sector, can be applied to the complex medical environments of Neonatal and Paediatric Intensive Care (P/NICU). Whilst there are key differences between NICUs and PICUs, there exist so many commonalities, most notably the similarity of parent and staff experiences and the coexisting medical, psychological and developmental needs of babies and children. PIE provides a whole systems approach to improving psychological wellbeing in all those in the environment: babies, children, parents, families and staff. The paper explores how PIE methodology could be applied to P/NICUs; offering examples grounded in practice; and describing how PIE can meet the fundamental needs of babies and children, parents and staff and has the potential to prevent the challenging environment having a negative impact on those who are exposed to it.

Aim Reflective practice is essential in the development of autonomous, critical and advanced practitioners, and can positively affect nurses at all levels. This study aimed to evaluate nurses’ experiences of participating in reflective practice sessions in a medium secure mental health service.Method Data were gathered over four months in 2013, through semi-structured interviews with eight nurse participants.Results Analysis revealed four themes – nursing growth, unsafe terrain, unmet needs, and a sense of direction and improved practice, which comprised both positive and negative elements.Conclusion To the best of the authors’ knowledge, this study is the first of its kind and contributes to the evidence base on reflective practice. Reflective sessions, although useful, are not always used effectively because of nurses’ concerns about psychological safety in the group and because of lack of staff. Better education about the aims, objectives and nature of reflective practice might improve nurses’ engagement.

AimsReflective practice is a core component of undergraduate as well as post graduate training. Reflective practice provides an opportunity for individuals to learn through their experience as well as gaining insight into themselves and their practice. If completed effectively, it has been shown to reduce stress and improve mental well-being. Our aim therefore was to provide regular group reflective practice sessions with the aim of supporting junior doctor's mental wellbeing during the second wave of the COVID-19 pandemic.MethodJunior doctors within a critical care setting were offered two-weekly group reflective practice sessions focusing on ‘difficult or challenging cases and encounters.’ The sessions were offered to all junior and middle grade doctors within a critical care department in a small district general hospital. Consultants were also able to attend. The groups were facilitated by a consultant liaison psychiatrist and an accredited balint group leader. Critical care doctors were provided a feedback questionnaire assessing the impact of the sessions and the levels of stress and burnout. The themes emerging from the sessions were also explored.ResultA total of six reflective practice sessions were offered during a three-month period. A total of four reflective practice sessions were completed; two sessions were cancelled due to high workload on the department. Each session lasted approximately 50mins. On average a total of 3-4 junior doctors attended each session. The sessions were conducted face to face in a socially distanced manner and with all participants wearing face masks. The sessions were predominately attended by foundation doctors and SHOs. There was occasional attendance by middle grades and a consultant.The predominant themes that emerged included: guilt, prolonged suffering, desensitisation, support and exhaustion. Despite the challenges associated with the pandemic and lockdown, many of the doctors also acknowledged the benefit of being at work during both waves of the pandemic. There was a sense of collectiveness and group belonging. The group found it beneficial to be able to share their experiences and challenges faced; this was most striking amongst the very junior members of the team.Questionnaires were also provided to gain additional insight into the wellbeing of the critical care doctors. Worryingly the results highlighted a significant proportion of doctors were experiencing signs of burnout including fatigue (77%), lack of energy (54%), cynicism (31%), frustration and irritability (45%) and detachment (38%). Many of the issues highlighted were in response to the demand created by the pandemic and a lack of medical staffing wth 69% of doctors requesting regular feedback on staffing issues.ConclusionBurnout and low morale were already highlighted in a significant number of junior doctors prior to the pandemic. COVID-19 has identified a clear need for NHS employers and medical leaders to provide emotional and psychological support to staff. It is vital that we create an open environment where individuals can express their feelings openly without fear that they will be judged. Group reflective practice provides an avenue to build on collectiveness created during both waves of the COVID-19 pandemic. This pilot has demonstrated that if introduced as part of a wellbeing support package, junior doctors within a critical care setting are able to utilise the sessions in an effective and productive manner.

Homelessness is a growing social issue that is a consequence of structural inequities and contributor to the development of health inequities. Community-based research (CBR) has been proposed as an effective research strategy for addressing health equities and promoting social justice through participatory processes. The purpose of this article is to examine the application of CBR principles and practices in the homeless sector and the implications for the production of knowledge and social change to address homelessness. Drawing on our experiences as researchers and service providers, we reflect on the significant successes and challenges associated with using CBR in the homelessness sector. In our discussion we emphasise insights, challenges and lessons learned from a community-university partnership that focused on an evaluation of a transitional shelter program in a large urban centre where housing is expensive and often unavailable.Keywords: Homelessness, housing, transitional housing, transitional shelter, program evaluation, community-based research

We are currently reviewing the support we have on offer to all staff and volunteers at Ashgate Hospicecare. As a hospice we are acutely aware that the trauma experienced at work can and does impact on individual health and well-being and we want to facilitate an ongoing discussion around experiences at work, for all our staff. A recent staff and volunteer survey highlighted concerns around staff well-being and we want to make sure the support services we have in place are effective and accessible to all, and as a result we are creating a campaign to engage individuals in patient-facing roles in a discussion about clinical support and reflective practice and what it means for them. The campaign will prompt the ‘Ashgate Team’ to explore the importance of supervision, support and reflective practice in relation to the parts of the role they already feel important, for example patient care – it will also give the Team a preview of the different streams of support that will be on offer as we implement a new support package, for example, clinical supervision, reflective practice sessions (both group and individual) and educational session in relation to self-care. (We currently have a successful ‘Schwartz Round’ programme, with sessions well attended each month). The campaign will also reinforce the message that Ashgate Hospicecare values individual well-being and understands that individuals need the time to engage in reflection and supervision, ensuring that staff and volunteers feel able to take time to focus on themselves and each other. When developing our campaign, we have engaged in conversation with both staff and volunteers and other service providers and hospices to ensure that the support services we provide best meet the needs of our staff and volunteers. We plan to have different streams of support, some mandatory (clinical supervision) and others that can be utilised as and when required.

The study aimed to investigate the relationship between teachers' reflective practices in the classroom and students' tolerance. Both qualitative and quantitative data were collected using a mixed-method research approach. Quantitative data was gathered through the use of an interpersonal tolerance scale, while qualitative data was obtained through ten focus group discussions with a total of 71 respondents. The study examined the extent of reflective teaching practices among the teachers and their impact on students' level of tolerance. To analyze the quantitative data, the researchers employed the Pearson Chi-square test. This statistical test is commonly used to determine the association between two categorical variables. The qualitative data analysis involved identifying various themes based on the discussions, such as linking theory with practices, mental preparation/readiness, making dead knowledge alive, discourse analysis, and content analysis. The findings of the study suggest that a significant number of teachers do not effectively link theoretical concepts with practical implications in their teaching practices. Additionally, many teachers are not adequately prepared or ready to handle new situations in the classroom. Furthermore, the study found that some teachers teach using outdated materials, presenting old knowledge with a new presentation style or "rapper”.

The strategy to develop newly joined radiographers in a COVID-19 world: a curated orientation programme

This discussion paper focuses on “reflective practice” as conceptualized by Donald Schön with its particular application in homelessness research and practice. Reflective practices are slowly gaining ground among scholars and practitioners engaged in the homelessness sector since the onset of the pandemic where increasing reliance on tele-mediated communication has transformed the ways in which research and practice take place. This paper starts by revisiting the concept of reflection as propounded by John Dewey and later recalibrated by Donald Schön, followed by a discussion of how two specific reflective practices, namely reflection-in-action and reflection-on-action, can be leveraged in homelessness research and practice. The paper concludes by discussing some implications of such practices for researchers and practitioners involved in the homelessness sector in the pandemic era. These implications focus on issues such as housing affordability and affordable housing, case management and support services, and barriers caused by the pandemic to homelessness research.

PurposeThe purpose of this paper is to present a case for reflective practice with an intersectional focus in supporting practitioners working with gender-based violence (GBV). It is argued that GBV increases women’s experiences of social exclusion requiring support systems that are inclusive and alert to intersecting forms of oppression. Some challenges to inclusive practice are identified and some supportive practices are suggested.Design/methodology/approachReflective practice examples are drawn from UK-based advocacy and therapeutic work involving women experiencing GBV.FindingsThree critical challenges to inclusivity are identified: poor knowledge of intersectionality, misuse of power and over-reliance on the scope of empathy.Research limitations/implicationsThese themes are drawn from case examples gained from work-based practice with services in London and the southeast of England. The findings have limited scope but could be used to stimulate further research.Practical implicationsIf health and social care services are to achieve a more inclusive response to women who experience GBV then reflective practice needs to shift the focus to a broader inquiry into women’s experiences. Whilst reflective practice cannot overturn the power invested in the health and social care sector it can help individual practitioners to respond to the inequalities they observe.Social implicationsIt is argued that providing a regular reflective space is an effective mechanism for fostering inclusive practice responses to women experiencing GBV.Originality/valueIntersectionality, power and empathy are identified as central themes for improving practitioner responses to GBV. How these themes apply to interactions between practitioners and abused women is demonstrated through examples from reflective practice sessions.

The COVID-19 Pandemic and Eating Disorders: A Wake-Up Call for the Future of Eating Disorders Among Adolescents and Young Adults