Psychologically-informed and reflective practice: safeguarding people experiencing homelessness, 18 January 2021

Presentations for this event are available here.


Webinar

Webinar transcription

Adi Cooper: Good afternoon everyone and welcome to this session. I'm Adi Cooper and I work for the Care and Health Improvement Programme as a care and health improvement advisor for London and also lead on safeguarding adults. So, I'll leave Michael to introduce himself in a moment but I just wanted to give a bit of background to this session. This is the third of a series of eight sessions that we're working on which builds on the work that we did last year regarding safeguarding adults and homelessness. So, during 2019/2020, some of you may have attended one of the four national workshops that we organised around this area of work on safeguarding adults and homelessness through the Care and Health Improvement Programme. And those workshops brought together people from around the country and from different organisations and sectors to listen to speakers and to discuss all the issues that arise regarding working with people and safeguarding with people who experience homelessness and particularly those who are at risk of, or experiencing abuse or neglect. And the outcome of those four workshops was published in a briefing that Michael wrote on safeguarding adults and, and homelessness that's on the Local-, Local Government Association website. It was jointly published by the LGA and ADASS, the Association of Directors of Adult Social Services. And Michael's going to mention that when he does his piece shortly. So, originally, before the COVID pandemic, if we can remember back to when that was, we'd planned to disseminate that briefing through a series of regional workshops to support further discussion around these issues and debate at local more regional levels, but, obviously COVID has changed all that.

 

So, in discussion with members of the advisory group who we set up-, there's a group of advisors of experts who we've been working with throughout this whole project and we talked to them about what would be most useful at this time, what would be helpful in terms of taking this work forward, and it's the outcome of that conversation that has led to this series of eight sections which are thematic based. So, they're based on a range of themes. And, so, today's theme is around psychologically informed and reflective practice with people experiencing homelessness. But, all the workshops share the same objectives which I'll just run through. So, the objectives of today, which are similar to the other seminars, the other virtual seminars, are to provide an opportunity to share information particularly regarding positive practice with this area of work, adult safeguarding and homelessness, to also provide an opportunity to understand how safeguarding people who've experienced homelessness might have changed over the last year due to COVID and the responses that have happened, such as Everybody In. And, and Michael's going to talk about this a bit more, to provide input into a further briefing that then updates what we have already been, what we have already been producing. So, I just want to re-iterate, if people could use the Q&A function which is at the bottom of your screens for any questions that you would want to raise, that would be really helpful. Michael and I will bring those together and provide an opportunity for some discussion, albeit quite tricky on, on Zoom, after the presenters have spoken. The slides will be available afterwards on the LGA website and also hopefully the recording of the session.

 

So, if you miss any or if you want to share any of this information with your colleagues, that will be there. And, please use the Q&A function to engage with us. So, today's session, as I said, is on psychologically informed and reflective practice with people experiencing homelessness and the two speakers that we've got today, Katy Shorten and Linda Guthrie, will be joining us at 3.15 pm. So, the first slide that was on whilst people were joining the session showed the agenda for this afternoon. But before we introduce them when they arrive, I'd like, I'd like Michael to provide an update on the briefing that we did and talk a bit about where we are and, and how these sessions are going to progress. So, Michael, I'm going to hand over to you at this point for you to share your slides and talk to them. Thank you.

 

Michael Preston-Shoot: Okay, thank you very much everybody, Adi, and good afternoon everyone. My name's Michael Preston-Shoot and I chair two safeguarding adult boards, one in Lewisham in London and one in Brent in London and I chair the London regional group of SAB Chairs and I also am the author of quite a few safeguarding adult reviews which I will talk about later on in this sequence of webinars. So, that's, that's a,a short bit about me. But, my reason for speaking to you today, and it's absolutely wonderful to see more than 150 people in the virtual room, is to talk about the second briefing on adult safeguarding and homelessness that will follow the conclusion of the eight webinars. So, as Adi flagged up, you can find on the LGA website the first briefing that we produced following four workshops in England on the theme of adult safeguarding and homelessness and that briefing presented the best evidence that we have from research and from safeguarding adult reviews about positive practice with people experiencing homelessness and it presented practice across five domains. The five domains are direct practice with, with individuals. The team around the person. Organisational support for the team around the person. Governance by safeguarding adult boards and other partnership arrangements in, in local authorities. And then lastly, the national, legal policy and financial context within which adult safeguarding and policy relating to people experiencing homelessness are located. If you've looked at the first briefing you will also have found a section on the relevant legal rules and also a section that brought together learning from safeguarding adult reviews that were in the public domain by the time the briefing was published in March 2020.

 

What we really want to do is, in the second briefing, is to update the evidence base and some of that updating will be enabled by the presentations in the eight webinars and those presentations focus on one or more of the five domains that I have flagged up on, on, on this slide. So, for example, later on in the, in the series, there is a session on people with no recourse to public funds which will pick up part of the national, legal and policy context within which adult safeguarding and homelessness is located. Later on in the series there will be a session on safeguarding adult reviews which are a core part of the governance responsibilities of safeguarding adult boards. And I guess the focus of today from Katy and Lydia on psychologically informed and reflective practice will pick up the domain around direct practice with individuals but also the domain of the team around the person and organisational support for the team. So, some of the updating of the briefing will draw on the presentations in the eight webinars, but, I'm also hoping that the second briefing will include examples of good practice that you and your colleagues might wish to put into the public domain that might support the recommendations that Adi and I make for sector led improvement. So, if you have case studies, vignettes of positive practice with individuals and you are prepared to put those case studies or vignettes in the public domain please send them to me and I'll put my email address up very shortly. If, picking up the theme that was in the second of the eight webinars last week on commissioning, if you have examples of positive practice in relation to commissioning and the provision of services for people experiencing homelessness, then also please let me have them.

 

The webinar next week will be on what we have learned through the pandemic about positive practice with people experiencing homelessness and I do know from my work as a SAB Chair, that quite a number of local authorities continued their efforts to find accommodation and wraparound support for people experiencing homelessness when the Everybody In initiative ended at the conclusion of the first lockdown. So, again, if you have examples of positive practice as a result of learning from the pandemic, would you please let me have those too. By all means put some initial information in the Q&A function that Adi highlighted in her introduction. I'll bring my email address up in a moment. But, in the hope that you do submit examples for consideration for inclusion in the briefing, it would be really helpful if you would indicate whether you wish those examples to be anonymised so the location of them is not identified, or identifiable, or whether you and your colleagues are, are prepared and have permission to put the examples that you are submitting into the public domain without being anonymised. Finally, a theme that Adi and I are very committed to is hearing the voice of lived experience and indeed the last webinar in March will include contributions from a number of experts by experienced people with lived experience of homelessness and, and indeed of adult safeguarding. So, similarly, if you have examples that you can submit with, or on behalf of, people with lived experience, they will also be gratefully received because we can learn a lot from, from human stories, from the experiences of people with, with lived experience.

 

So, strong encouragement from me and I'm sure also from Adi, please let us have examples of what is happening up and down England so that the briefing, the second briefing, can be a rich read for, for all of us. This is my email address, so, if you do submit things after today's session would you please use that email address and I promise that I will acknowledge every submission. And, just a reminder that when you do submit things, please let me know whether you want your submission to be anonymised and therefore confidential albeit within the briefing, or whether we can name the location from which the example comes. So, that's it from, from me. Please start thinking, please start writing. Please let us have your examples of positive practice. Okay, that's it from me, so, I'll hand back to Adi in the hope that Lydia and Kate have now joined us so that we can begin the rest of the session and 173 participants and counting. Really good. This is obviously a positive endorsement of the topic.

 

Adi Cooper: Thank you very much Michael. Thank you. So, real strong encouragement from me so that we can utilise and give credit to people's work in the second briefing if you want to share what you've been doing. So, very warm welcome to Katy and Lydia and thank you for joining us this afternoon in this session. Can I just hand over to you to start, start it off, and just remind people that we were planning to have a very short comfort break around 3.45 pm and then continue. Remind people also to put any questions in the Q&A and then we'll come to that at the end of the presentations if that's okay. But, if you want to manage that time yourselves, I'm perfectly happy for you to do that. So, I'm going to hand over to you, to introduce yourselves and, and to start the session. Thank you.

 

Lydia Guthrie: Thank you very much.

 

Katy Shorten: Yes, thank you very much Adi and hello everyone, welcome to this session and thank you for making the time in your very busy schedules to, to come and listen to us talk about homelessness and safeguarding trauma informed approaches and how reflective practice can help us to, to be the best that we can be. I'm Katy Shorten and I work for an organisation called Research in Practice. We're a national charity and we develop evidence informed resources to support practice improvement and development across the social care sectors.

 

Lydia Guthrie: Hi there, my name's Lydia Guthrie. I have a background in social work and probation. Since 2009 I've worked for myself for, in training. I also offer reflective supervision across a number of different settings including forensic mental health. And, I've just qualified as a systemic psychotherapist. I'm about to start work in CAMS as a family therapist. So, I'm really passionate about working across adults and children together. So, it's, it-, thank you so much for the invitation to be here today. Katy and I are very grateful. I'm going to share the slides now, so fingers crossed that this will work. There we go. I hope everyone's able to see that. Thank you Michael and Adi for the thumbs up. It's nice to know. If you can see them I'm going to assume other people can as well. So, this is the title of the work that we're going to be doing today with you and Katy's going to take us through an introduction.

 

Katy Shorten: Yes, great, so, what we want to hopefully achieve with you today is a bit of an exploration of trauma informed approaches, psychologically informed environments and how they apply to work in homelessness and safeguarding. So, hopefully that will resonate with you and in terms of your experiences of the people that you're working with. We're then going to talk a little bit about practitioner wellbeing and explore the value of reflective practice in the context of homelessness and safeguarding and what, what we've discussed previously around trauma informed practice. Hopefully throughout that will provide an opportunity for you guys to reflect on how your own perspectives on risks or rights impact on the people that you're working with and crucially identify opportunities for reflective practice with colleagues working across homelessness and safeguarding, being mindful that you're coming from, potentially coming from different cultures and backgrounds in terms of the breadth of organisations that work across homelessness and safeguarding. So, in order to do that, what we are going to cover is-, well, Lydia and I have, have, kind of, worked together to, to develop this session. We were going to do a bit of a double act but I think it's, kind of, turned out to be a bit of a Lydia first, then me second, but we're gonna interact with each other throughout. So, we're going to start off by an overview of definitions and approaches around trauma informed and psychologically informed environments. There's going to be a break, as Adi said, at about quarter to four. We're going to segue using practitioner, some thoughts and reflections on practitioner wellbeing into reflective practice.

 

So, hopefully giving you an opportunity to think about what reflective practice is and the value that that can bring to you in terms of supporting, supporting your practice with people experiencing homelessness and safeguarding. There is, I, as, as Adi said at the beginning, I'm sure, there is a Q&A box, so, please do write your, your reflections, thoughts, comments in that, as we go along. I'm-, we're certainly going to be providing you the opportunity at certain stages to, to, kind of, ask for your thoughts on those and it would be great, I think Michael is gonna be having a, having a look at that Q&A box and, and curating it a little bit so to bring out some of those key points at the end of the session.

 

Lydia Guthrie: So, just to set the scene a little, we're, we're very aware that in this seminar today there are people from a really wide range of different organisations. So, just, just to set the scene on the broad landscape, what we know from the research base is that traumatic experiences are a likely precedent for and an outcome of homelessness. So, thinking about the nature of trauma and the impact of traumatic experiences is, is of crucial relevance here. A study in 2017 for Crisis, reported that 80% of homeless people had experienced violence, verbal abuse or other antisocial behaviour in the previous year. And we also know that issues, complex multi-layered issues of social injustice and oppression might make it more difficult for people with experience of homelessness to access support in relation to their wellbeing and traumatic experiences which they may have suffered both following their experiences of homelessness or in the run up to it. In terms of homelessness and mental health, there's a lot of agreement in the literature that people experiencing long term homelessness are at significant higher risk of mental health difficulties than the general population. Ways of coping with psychological distress can include substance misuse which in itself can lead to additional difficulties and make it harder to access support. So, we end up with this, kind of, complex picture of multiple layers woven together of these different experiences and unmet needs are then compounded by the lack of accessibility of psychosocial support services. And so, an uncomfortable conclusion, this is from Buckley et al, published earlier this year, most front line homelessness staff have no clinical training yet support those who are most in need of psychologically informed help but least able to access psychological services.

 

So, I want to say at the beginning, Katy and I aren't going to be arguing that all front line homelessness staff need clinical training. We, we certainly don't think that that's the answer. What, what we are going to be arguing is that being sensitive to the impact of traumatic experiences on people's psychological wellbeing can be very helpful, can enable services to better use their relationships with individuals experiencing homelessness to support them and that if we're going to be asking staff to do that, we need to make sure that the staff themselves are taken care of and looked after. So, a, a great quote here from Finlayson, that I know Katy and I would both sign up to, is that the ultimate job of anyone working with people whose lives have been characterised by exclusion is to support them to have a good life and a good life is one that ensures human rights and nourishes people's abilities to build relationships and skills at deciding their own ways of being safe. So, we feel it's important to, kind of-, we're stating our case at the beginning. This is, this is what informs our position really when we're thinking about what's our job in terms of supporting people who have been socially excluded. And so, we, we think it-, a really good place to think about is the people we're working with who've experienced homelessness. How much time are we able to spend thinking about what their experiences might be? What might have led them to where they find themselves now? And also, what are their strengths, their goals, aspirations and what choices are open to them?

 

And it's our view that if we are to work with people in a psychologically informed way, teams and individuals within services need to be supported to think individually of the people they're working with and, and to spend time reflecting on these questions, ideally in conversation with the people themselves if, if they're willing and enable to have those conversations. So, we're going to outline a little bit about what a psychologically informed environment is and then, and then within that to go on to talk particularly about trauma informed approaches. So, some of you may be very familiar with psychologically informed environments. We know that it's a very mixed group of folk involved in this seminar, so, we are assuming nothing. So, a brief definition is that a psychologically informed environment is one that takes into account the psychological makeup, the thinking, emotions, personalities and past experiences of it's participants in the way that it operates and by doing this it aims to support staff to better understand the causes of a person's behaviour so they can adjust their responses. It also considers the psychological needs of staff, to feel supported, to be able to reflect and to feel that they are carrying on developing skills. So, it's not the same as saying everybody needs therapy. That, that, you know, that absolutely is not what we're saying. It's, it's more that the, the environment itself needs to be one which entertains and encourages conversations about the ways in which a person's behaviour might be reflecting their past stories and their past life experiences. And, so, five elements of a psychologically informed environment are that relationships are considered the principle tool for change.

 

So, having trusting relationships with, with the people we're working with, isn't just considered nice to have, it's considered as fundamentally the way in which we support people to make changes. In order to do that, staff need to be well supported and well trained. The physical environment and social spaces need to promote safety. Every part of the system is routed in this, in this same framework so that the system, the different elements of the system support each other and underpinned by a common framework and set of values. And there's a commitment to evaluation of outcomes for people. And, and so this is, this is quote that, that speaks volumes to me, it's from David Howe, a, a professor of social work in the forward to an excellent book on attachment theory when working with adults. And he wrote that, 'If relationships are where things go wrong, then relationships are where they are going to be put right'. And certainly in my practice in adult social care, in probation, in forensic mental health, I really can't think of very many people who I've worked with who've experienced homelessness, who didn't have as part of their individual narrative, stories of relationships going wrong. It's very often a precursor to periods of instability of an accommodation. And so what David Howe is reminding us here is that relationships are our principle tools for helping people to find strength, to understand themselves, to set goals for themselves and to make changes in their lives, to recover. So, this, this is one idea that is really key to both Trauma Informed Approaches and Psychologically Informed Environments and what this triangle is saying to us is that very often it-, we're-, we see a person's outward behaviour.

 

So, we see the top bit of this triangle or you might think of it like an iceberg, it's the bit that pokes above the water line. And very often in services we respond with a quick fix so in homelessness services, it might be that someone shouts-, kicks over a chair, shouts and storms out of a room. Or it might be repeated rule breaking of, of any kind. And most, most of us will be familiar with the kind of quick fixes. So, there might be, people might be refused entry if we're talking about a direct access hostel, people might be suspended for a period of time, people might be given a warning, you know, whatever the different sanction might be. Sometimes those quick fixes work, very often they don't. So, the idea that underpins trauma informed and psychologically informed approaches is that we need to get curious. What's lying underneath the water line that we can't see? What's-, and one way of doing that is to think about the pattern and the function. Pattern means when does this happen? Is it always on a Wednesday? Is it never on a Friday? Is it just when somebody's just received bad news? Is it when a particular member of staff is on shift or not on shift? Is it when a person has had, you know, has, has just met up with a particular friend or acquaintance? Is it linked to substance misuse? So, getting really curious about the pattern. And once we do that, we may get some more ideas about what the function of that behaviour is. And very, very often the function is about a way of meeting an unmet psychological need. A need for safety, comfort, proximity, predictability. Those are just some suggestions to what the unmet need might be.

 

So, if somebody, for example, if somebody was in a conversation with their key worker, got really angry, shouted and swore at them and then was told that they needed to leave the meeting, perhaps even leave the building for a period of time, one way that that might be a way of meeting unmet needs is about familiarity. I'm sure we will all have worked with people who find it really difficult to believe a version of themselves who is capable of trusting relationships or capable of making progress or capable of hearing praise. Very often praise can be something which is really difficult for people to hear if they don't feel that way about themselves. So, it might be 'Hey, this is the familiar. This is how this tune usually goes is I get kicked out of places and I'm not liking this new tune. It doesn't feel-, I can't trust it'. So, that would be an example. And other behaviours might be about safety or proximity. It might be proximity of,'If I get kicked out of here, I'll go and I'll, I'll find on the streets the people who I really feel connected to. There might be some comfort and a sense of safety there'. So, that, that would be an example. I use this model a lot in my own practice and and in supervision when we're really puzzled by someone's behaviour. When we're asking ourselves the question, 'What's going on here?', because it's really hard to understand'. This model can be a really great way of encouraging curiosity. So, so yes, we'd like to offer you that as a starting point. Something, a point that we can really usefully address is what's the relationship between a Psychologically Informed Environment or a Trauma Informed Approach or Trauma Informed Care because they're not exactly the same thing.

 

A Psychologically Informed Environment is routed in an explicit psychological theory or more than one theory and each service suggests-, selects the different theory base that they think is their best fit. And there are many different theories that could involve-, inform a Psychologically Informed Environment. Some of them would be attachment theory, psychodynamic theory, Dialectical Behavioural Therapy or DBT. That's particularly used for people with a personality disorder diagnosis. Mentalisation Based or Trauma Informed Care. So, for example, some of you might be familiar in forensic settings, so funded by probation or prisons. There are lots of Psychologically Informed Environment projects that have Dialectical Behaviour Therapy as their-, and attachment theory as their underpinning therapeutic, kind of, models. So, Trauma Informed Care is one of those models so that's the relationship. Trauma Informed Care is kind of a subset of Psychological Informed Environments, just to clear that up for you folks (ph 32.01). That's how we see it anyway, there might be other explanations but that's one that works for us. So, we'll move on to think about a definitions of trauma, what it is, what it isn't, what we-, what we mean by that. I'm just keeping an eye on the time. So, this is a great definition from the substance abuse and mental health services administrations which is an American body in 2014, and later on in the slides we have a set of resources and links for you and there's a link to a lot of their work on that resources so I really recommend that. It's a very thoughtful piece of work.

 

They define trauma as 'an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening, that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional or spiritual wellbeing.' So, if this was a different forum I'd be asking you all now what do you like or not like about that definition, but we can't do that so I'm just going to tell you some of the things I like about it. It's very inclusive so it isn't prescriptive about the kind of event or the kind of circumstances and it's very inclusive about the impact of that event that it can-, it can affect an individual in a lasting way, in all of these different, kind of, aspects of self really. And people will have very different definitions of trauma, we would encourage affording each person the dignity of being able to describe their distress in language that makes sense to them', and we think that definition gives enough room for doing that. So, a Trauma Informed Approach is defined as a framework-, it's a strength-based framework, grounding in an understanding off and responsiveness to the impact of trauma, emphasising physical, psychological and emotional safety for both service providers and survivors that creates opportunities for survivors to rebuild a sense of control and empowerment. Again, that's a very holistic definition. We like the fact that it names the fact that it's strength based and that it's routed in safety, physical and psychological and emotional safety. It's also routed in the way that people define what makes them feel safe because that will be different between different people.

 

SAMHSA again, these are how they define the essential qualities of a Trauma Informed Approach. The realisation of the extent and impact of trauma. So, extent meaning that particular thinking about a population of people who have got experience of homelessness, there's likely to be a very high extent of having experienced trauma. And a realisation of the different ways that that can impact people. A recognition of a very wide range of impacts that trauma can have on behaviour. A recognition of the need to respond with sensitivity to the presence of trauma and resist re-traumatisation, both of staff and of those who use the service. This is a really important point that sometimes, without thinking about it, services can unintentionally re-traumatise people by almost creating an environment which evokes or reminds them of the circumstances under which they experience trauma. So, I can give you a quick example of someone who in mental health services was offered counselling in the same building where they were forcibly detained under the Mental Health Act and forcibly medicated against their will. They were then labelled a 'treatment refuser' because they didn't want to attend that counselling. So-, to-, my assessment of that would be that it made things worse for them even though the service's intention was to be supportive. There was a conversation missing about 'Why can't-, why don't you want to make use of this counselling?'. In terms of principles of a Trauma Informed Approach, I won't go through each of these, I'll just pick out some of the more important ones. Safety comes first, it's the absolute route of a Trauma Informed Approach. Physical, emotional, relational safety. 'What do you need to feel safe here?'.

 

And it might take a long time before someone can answer that question. We might be able to help someone to answer that question by noticing and helping them to notice when they feel calm, when they feel less calm. There needs to be trust and transparency. Most experiences of trauma will involve a breach of trust and a misuse of power so being transparent and building trust is absolutely fundamental. Using language carefully and, and allowing people to tell us what they think about the language we're using. Safe and respectful relationships, encouraging people to support each other, working mutually. I said I wasn't going to go through all of these and now I am. Hey, there we go. Cultural, historical and gender issues so events will have a different impact on people according to who they are as people. So, for example as a white woman watching videos on social media of the death of George Floyd was very difficult-, they were very difficult videos to watch for me as a white woman but had I been a black woman or a black man watching that video, it would have had a very different impact because it would have said something about me and my family and what I felt at risk of. So, we need to really pay attention to issues of social identity, culture, race, history, gender, religion. All of these things are relevant and need to be centrally-, given central importance in a Trauma Informed Approach. There needs to be empowerment and then avoiding re-traumatisation. And none of these is easy, all of these are going to take work, but there-, we can also build a momentum so work on any one of these boxes is very, very likely to have a positive impact on others often as well.

 

This is a graphic from Dr. Karen Treisman. Her website is here, Safe Hands and Thinking Minds, and her website is an absolute wealth of resources for thinking about how to work in trauma informed ways. She's reminding us here of some of the really important things we need to pay attention to. The physical environment, how, how staff are supervised, this notion that every interaction can be an intervention, thinking about how people are greeted at the door. How long is it before they're offered a cup of tea? Even those very simple day-to-day interactions can be really important interventions which can either help or hinder and I'm really paying attention to that and putting a huge focus on staff wellbeing and self care which we will-, Katie will be talking lots more about after the break. But there are, there are very common misconceptions about Trauma Informed Approaches. Lots of it sounds like common sense, lots of it sounds like things that can only be good things but there are some, kind of, concerns expressed sometimes about Trauma Informed Approaches. And so here are some of the misconceptions, that Trauma Informed Approaches don't claim that everybody experiencing distress has experienced trauma. We're certainly not saying you should be sitting down with every one of your-, the people you support and saying 'So, what happened to you then?'. You know, that really would be appropriate. Trauma Informed Approaches are not medical treatment, they're not psychological treatment. We're certainly not saying that all practitioners need training to become therapists or mental health clinicians in any way. We're certainly not saying that we should be asking everybody what happened to you.

 

They're not just concepts or ideas, they're concepts or ideas which are very, very clearly linked to practical steps and practical actions. Then it doesn't already happen, so even the best run service in the world will not be trauma informed by accident. It's very hard and very deliberate work which takes patience and it takes teamwork. So, there might be parts of every service which, which would be very positive in terms of supporting people who've known trauma but to develop a thoroughly trauma informed service takes an active commitment at every level of the organisation from trustees, senior managements, EOs, front line staff, at every level and every grade. Certainly I trained recently all the staff who worked in a children's home and my perception was some of the most useful trauma informed conversations that were happening in that home were happening between the cook and the young people because of her very humane approach to human relationships and because of the time she took to speak with each person about themselves and their needs and their wishes. So, it's very deliberate and it takes a commitment at every level of the organisation. And what the, kind of, golden thread that runs through Trauma Informed Approach is that trauma requires relational repair. So, repair and recovery happens within the context of interpersonal, safe relationships. That does not mean therapeutic relationship necessarily, sorry to bang on about that, I'm really emphasising it because it's really important. But this can just be safe interpersonal relationships of trust and mutual respect where service users or people who are experiencing homelessness make choices about what they choose to talk about and who with.

 

But there can be sometimes very strong interpersonal difficulties between people and the people supporting them because they may well have histories of lack of trust, they may well have experienced abuse of power, misuse of power, so people may make steps towards safe relationships and then pull away. There might be some push, pull and some rejection going on which is why super-, staff supervision can be so important. That's the kind of thread that ties these together. So, relationships that we build in Trauma Informed Approaches are non-judgemental, empathic, warm and safe. They use the straightforward language of human experience, that we're not looking to diagnose people or assign them to categories or get all Freudian on them and, you know, and talk about their dreams or anything. It's about straightforward language. What makes you feel safe? What makes you feel less safe? How do you know when you feel safe? How do-, certainly speaking, I spend a lot of time with young people and helping them find language to describe bodily states. You know, helping people to talk about 'My head felt fizzy' or 'My tummy was a mess. I had knots in my stomach. It was like I'd swallowed a bees nest'. You know, helping people to find words that make sense to them to describe their experience. And acknowledgement that we cannot fix or rescue people. That we can support, we can offer opportunities, we can encourage but it's not for us to rescue people that, that-, we're not-, that what matters here is (ph 43.44) mutuality and power sharing. What are your ideas about what you think would work for you? And how can we find ways with fitting that together with what we can offer.

 

And also considering more hidden forms of power, size, age, gender, race, levels of education and neurodiversity. So, all of these needs to be really taken into account in terms of Trauma Informed Approaches. And so that takes some pretty special staff who have these qualities and many of you will work in services where your staff are great at loads of these things. We need to get very deliberate at it in, in promoting these qualities, in rewarding these qualities in our systems and in our supervision. Again, I won't read them all out but thinking about empathy and compassion. Staff who notice their own coping, so staff members who notice, you know, 'I really need five minutes right now or I'm going to lose my temper and if I lose my temper it'll take me a long time to recover that with this person, so actually I'm better off going away for five minutes'. Staff who are comfortable with the unknown, who are willing to support people in the way they need supporting. Staff who are willing to connect emotionally with clients in safe, boundaried ways, who are willing to see the world as the client does and are able to notice and regulate their own emotions and able to listen. So, so we would argue that these are some of the characteristics that if Trauma Informed Approaches are to be successful, these are some of the staff characteristics that we need to deliberately design systems to promote. And supervision and reflective practice is a very key part of that, perhaps the most important part. And this, this list is from the Trauma Informed Toolkit. Again, in the slides which you will receive afterwards, there are links to that in the resources section.

 

So, at this point, I'm going to pause and check in with Katie about first of all, is there anything you wanted to add, Katie, before I hand over to you?

 

Katy Shorten: No, thank you Lydia. I'm conscious-, I am conscious for people listening in that that's a huge amount of information like, and an exploration of the topic and I'm sure much of it will have resonated with you. I can see there are some comments in the chat box coming-, in the question and answer box coming through so please do take the opportunity to, to think about your reflections on that and pop things into the chat box because we will, we'll be able to answer and share reflections as we go on. The only thing I guess I would be interested to hear about from colleagues listening in is how it resonated. How what their have heard today is resonates with their experiences and thinking about any barriers or enablers to working in a Trauma Informed way across different organisations working in homelessness and safeguarding. You know, it's a-, there's different, different cultures out there so interested to see what different part of the system's experiences are around Trauma Informed Care, Psychologically Informed Environments and the barriers/enablers to that.

 

Lydia Guthrie: Great point there Katy and perhaps, perhaps in the final sessions of the questions and answers we'll be able to begin some of those conversations.

 

Katy Shorten: I wondered whether we take a break now. We're a couple of minutes over and then we can go into the wellbeing and reflective practice one a little bit more after that.

 

Adi Cooper: So, thanks Katy and thank you so much for that, Lydia. So, our suggestion is that if people take a break, don't go away in that don't close down your screens, just walk away for ten minutes for a comfort break, make yourselves a cup of tea or whatever and we'll come back together at-, let me just see what time it is, in ten minutes. Is that okay with everybody? So, that would be about two or three minutes to four, is that okay Katy and Lydia? So, take a ten-minute break, we'll come back together in ten minutes and then please think about what you might want to say in the Q and A. It doesn't have to be a question, it can just be a reflection on any of the comments that have been made from the presentation. So, see you in ten minutes everybody.

 

Hi welcome back everyone. So, Katy are you going to do the next section now?

 

Katy Shorten: Yep, I am gonna lead in the next session.

 

Adi Cooper: You show your slide (ph 48.21)? Shall we-, the questions or the comments coming in the chat really well but can we come to them at the end, Michael, you'll help to manage those. So, I'm going to hand over to Katy for the second half of the presentation. Thank you.

 

Katy Shorten: Yep, okay, thanks Adi. And welcome back everyone, I hope that you did manage to get a break from your screen and weren't tempted to check those emails. I-, I'm, I'm going to move on now to thinking about working-, working in the homelessness and safeguarding sectors and your impact as practitioners in a supporting role. So, first of all, just really wanted to acknowledge that working across these sectors can be challenging and that's for a lot of very different reasons. So, we're working with people, people who've had many different experiences and are facing challenge in lots of different areas of their life. So, it demands knowledge of a range of issues and topics so including, kind of, areas of support that you'll be working with people on including welfare, health, social care, kind of, knowledge around rights rights-based practice and legislative backdrop etc. And then also of course, we're working with people, lots of different experiences and lots of different colleagues across the sector, so skills in terms of partnership working and those relational skills that Lydia talked about in the last section around Trauma Informed Care. So, so, it can-, it can-, it doesn't always feel neat and tidy so you're never, you're never going to know what it is you're going to be facing every day. So, there-, acknowledging that is a challenge but also there's the sense of that same study by Martin et al in 2012 talked about, you know, people, people working in the homelessness and safeguarding sectors are driven and motivated out of a desire to help others often and do something that's worthwhile, so that sense of purpose. This is a hugely-, a huge strength and enabler and responds to lots of things that Lydia was talking about earlier.

 

However, what some of the research and evidence suggests is it can feel tricky when that value's driven practice can come up against some of the challenges in terms of resources or systems or priorities in targets that, that the system is expecting of people and practitioners working. And I noticed in the chat box, it was really good to see this being supported really. Gill from St Mungo's, you were saying about how balancing a Trauma Informed Approach whilst also being responsible for Compliance. So, sometimes when working in the homelessness and safeguarding sectors, it's that you can come up against like this, this conflict which can make it a challenging area of work. And then of course, the emotional impact. So, a, kind of, already, as we've already discussed, people being supported have often experienced trauma and exclusion and this can take its toll. So, across both homelessness and safeguarding sectors, Stevens et al in 2018, talked-, described that sense of responsibility that safeguarding practitioners can feel for ensuring safety of people that they're working with. People may also-, practitioners may also feel triggered by, by what they're seeing and hearing as a result of their own experiences. But in terms of the emotional impact, we also wanted to acknowledge it can work in the other direction. So, Phipps et al in 2017 identified in their study of Psychologically Informed Environments. They reported that practitioners were reporting distress when thinking about the people, the trauma that the people they're working with have experienced but also particular reward when people were doing well. In particularly against the odds.

 

So, the sense that it-, the emotional impact of the work can be-, could be strong on-, can be strong and impactful however it's very powerful as well in terms of reward when people are doing well and responding to the care and support that's being offered. So, we-, this is rule one of resilience. So, your wellbeing is hugely important and this is a well known term, certainly in, across social care sectors, is about securing your oxygen first. If, if, if you are well supported then you will be much more able and likely to deliver the good support that you can. And so your wellbeing is important and we're going to talk a little bit about that and then also how reflective practice can contribute to, to that sense of wellbeing. So, your wellbeing is important in its own right because, of course, everyone, we want everyone to feel well and happy in their role and in their lives. But also, ultimately it's-, your wellbeing is important because a well, a well supported and resilient practitioner equals a well-supported person and Fitzpatrick (inaudible 53.51) 2018 described the link between practitioner wellbeing and the support that they receive with the success of homelessness interventions. So, it's in everyone's interest that practitioners are well-supported and feeling well in their role. So, creating the conditions where practitioners are able to work together in a relational way with people, with people who've got, had complex lives and experiences is fundamental and reflective practice is an essential part of this.

 

We feel it supports practitioners and people to think through, unpick, explore situations, the feelings that may be brought about by them and the impact of those feelings and in order to develop that, in order-, ultimately, that exploration develops a shared understanding and growth and development. So, making sure that we are on a continual, continually improving pathway. And Tony Ghaye in 2000 suggests that maybe reflexive practices offer us a way of trying to make sense of the uncertainty in our workplaces and the courage to work competently and ethically at the edge of order and chaos. So, I don't know whether that feels familiar to you, kind of, the sense of being on the edge of order and chaos and the sense of working in uncertainty in our workplaces and what we're hoping to talk about today is how reflective practice can help to make sense of that and, and support you to do the work that you are doing. So, this is-, we can't, we can't, kind of, talk to you or hear your thoughts and views but please do-, we wanted to just pop this in as a reflection opportunity to think about what do you, what do you find helps keep you well as a practitioner? And so, if there's anything, hints or tips, that you could pop into the question and answer box I'm sure that will be well, well-received by colleagues listening in. Any hints and tips are well-received these days and in this time.

 

So-, but also, what we wanted to explicitly mention here on this slide is that of course everyone is aware of and thinking about individual ways of how we can look after ourselves, particularly in these times when everything's happening virtually and there's a huge amount of uncertainty in the world but also, we, we wanted to explicitly talk about the fact that your wellbeing as a practitioner, your resilience as a practitioner is absolutely not your, an individual responsibility. It isn't about what you can-, It isn't something that you've got or you haven't got and it isn't something that, that you can, that you can turn off or on. There is-, It's about how we create the conditions around practitioners to build a resilient team. So, what are the things that happen in your team to enable you to explore, work together, gain support from colleagues and peer support from colleagues. But also as a whole organisation. And later on in the slide deck there's a slide and resource list and references around the Social Work Organisational Resilience Diagnostic or SWORD and that was something that Research in Practice developed alongside Louise Grant and Gal Kimmen (ph 57.27) from the University of Bedfordshire, which really sets out that, the role and responsibility of organisations in terms of developing resilience of teams and staff. And the five domains that they identified in terms of organisational resilience was a secure base, so creating that sense of protection and safety and the ability and confidence to be able to provide constructive challenge within an organisation. Secondly, a sense of appreciation. So, enabling and supporting practitioners to feel valued and appreciated.

 

A learning organisation, so where shared goals, beliefs, where the opportunity for reflection and subsequent learning results in change and that's part of the culture of the organisation. Mission and vision, so where there's a clear and understood direction, direction of travel and where the heart-, and finally, where the wellbeing of people working in the organisation is prioritised. And I can see some great hints and tips coming in to the Q&A box which I'm really excited to, to share as we go on.

 

Lydia Guthrie: Katy, can I also just interject briefly and say, and remind everybody that the link to the SWORD resource pack will be on the slides.

 

Katy Shorten: Yes.

 

Lydia Guthrie: So, Katy's just outlined it. It really is very valuable. There's a lot of great stuff in there. It's all open access and you will receive the link as part of the slides.

 

Katy Shorten: Great. Okay. So, when thinking about that, that Tony Ghaye quote and this idea of making sense of uncertainty and trying to make sense of what's happening, it can be useful to remember all of the different things that are going on for you and the context in which that you're working and the context in which the decisions that you're making are being made. So, when you look at this, this slide, you really do start to, to realise all of those, the dynamic, the complex dynamic and things that you're negotiating all the time. So, human behaviour, whether that's your own, your own behaviour, the people that you're working with or partnerships, the behaviour of colleagues across partnerships. Negotiating-, which is underpinned by different people's personal identity and the values that are driving and sitting behind the way that they're working. In terms of professional cultures, thinking about Safeguarding Adults Boards, looking across the organisational membership of Safeguarding Adults Boards and the different, the different types of organisation and the different backdrops and priorities in tasks of those organisations really starts to, really start to underscore and underline those, the cultures within which we're negotiating in our day to day practice. The broader social context. So, what's going on at large and I mean, you know, this current moment in our history there's a huge social context in terms of the pandemic and how that's impacting different areas and parts of society differently and that's all, that's absolutely, kind of, at large within homelessness and safeguarding. Another thing which is another part of the context in which, which, which is impacting on our decisions and impacting on our work and being part of our considerations is the legal frameworks.

 

So, again, looking at those, that list of different, of different organisations across the Safeguarding Adults Board, you know, we're being driven by different legislative backdrops all the time. So, all of that makes for, can make for a fairly complicated and complex picture with lots of things going on for you as your, as your, in your day to day working lives. So, reflection can help. So, this slide-, reflection-, so thinking about that and thinking about the opportunity that reflection presents. Reflection-, there is no one way of doing or completing reflection and the important thing when you're thinking about what you want to achieve is that it's proportionate and situational. So, reflection can happen, kind of, ad hoc, spontaneously with a colleague, something's on your mind and you're going into the kitchen-, well, in those halcyon days when you might be working together in an office and making a drink together and there's something on your mind and you ask the question and you complete a-, a very quick, sharp process of reflection and the penny drops and you think 'That's what's going on here. I understand now, I've said something out loud and it suddenly makes sense.' So, that's-, it can be that or it can be a planned session where you want to go in, you want to focus in on the situation or you want to focus s on a particular challenge and really unpick what might be happening. So, Ruch in 2005 describes and talks about those four levels of reflection. The first one, at a very, kind of, foundational level is technical reflection.

 

So, this is very pragmatic, you know, transactional in that it looks at what needs to be, what needs to be done, what should be being done in a particular role or in a particular situation and what actually is happening and unpicking what those differences may be. Practical reflection is the next stage, which is, kind of, really starting to unpick and think about and make sense of that situation, what might be happening there. Critical reflection, that third level, is much deeper and it includes thinking broadly about the contexts in which this situation is happening. So, what's happening in terms of power relationships, what's happening in terms of social contexts, what's happening to drive this different behaviour, what might the experiences of this person have been or my experience, what am I bringing to this situation? And really trying to unpick and explore that. Process reflection is the deepest level of reflection. So, thinking beyond, beyond the conscious and going deeper into what, what is underpinning my behaviour? What are those unconscious aspects that I've learnt and I maybe perhaps aren't aware of that is driving and shaping the decisions that I'm making or the way that I'm working? And those two, those two, that third and fourth layer of reflection is something that, that would need a facilitator to draw out. They're not, they're not really things that you can do on your own. It might be that you can technically or practically reflect on the situation and try and make sense of it but if you really do want to understand what's happening then it does need an ex, someone else to be supporting you to understand what might be at play, what might I not be aware of? Or what's interacting there?

 

So, so a place that reflective practice can happen is in supervision. So, reflective practice in supervision arguably, and I mean, you know, the people on the call here might have a different view, but arguably are fairly well-established disciplines within adult social care and safeguarding. So, it may not be done consistently, may not be done in exactly the same way or the purpose understood in the same way but certainly, it feels to me, that it's universally seen as a good thing. And I just wanted to acknowledge from some of the, some of the research that I've read is that it can, it can-, when working across the sector of homelessness and safeguarding it can be worth being mindful of the different cultural backdrops and approaches to reflective practice depending on where you're working within and across that sector. So, in that same Phipps et al (ph 01.05.43) study, 2017, they identified that perhaps people in the voluntary, voluntary sector culture were seen as doing things and supporting people as a privilege and thinking about your own feelings was potentially seen as an unnecessary luxury. So, it's just worth being conscious and mindful of the different-, when we're, when we're encouraging or supporting reflective practice that we might be coming from different places. But-, and hence why it can be useful to think about a model of supervision, to unpick what might, what might be happening and what the purpose is of it. So, this is Morrison's 2005 model of reflective supervision. So, if everyone-, for people who aren't familiar with it, that outside circle talks about the functions of supervision, what is supervision there to do and achieve?

 

And those four functions include management, so that, kind of, area of practice discussion and what is, what is and isn't happening and what should and shouldn't be happening in terms of practice, the opportunity to think about development and reflect on what you're learning needs may be and how to meet those. We're working in a relational way in this sector and across this sector as we've heard already so, so, this function of supervision in terms of understanding what those relationships may be and mediating between and across them. And then finally, that fourth function of supervision being around support. So, that provision of safe space for and contained space to explore what might be happening for you. What are you struggling with? What's difficult? What support can you be given in order to enable you to grow and develop? And within the middle of that four by four, the four model is the reflective cycle. So, underpinning an essential part of supervision and reflective supervision is this process of reflection. So, thinking about the experience and what's happened, reflecting on the impact of that and how, how, how it's affected you or the people involved in the situation. Then completing some analysis, so actually exploring what might have happened, why has that situation occurred? Before then finally going onto that planning and acting stage and understanding and identifying the next steps. So, supervision can happen at all, lots of different types of situations. It can be part of a group or peer group support or group supervision across a number of different organisations and practitioners working across different areas of the system.

 

It can happen on an individual level or it can also happen, kind of, ad hoc and spontaneously. Those different functions happen in different areas of working life. So, I am really interested to hear from you guys in the chat box, particularly again describing which part of the homelessness and safeguarding system you come from and just letting us know whether you receive supervision and what form that takes. So, from what I've described it might be that you don't call it supervision but those functions are completed, or achieved for you, in a different way or in a different-, it might be called something different. Either way, reflection is essential and at the heart of supervision so, where do you get to reflect? Do you receive supervision? Where do you get to, to, that support to make sense of things, to slow down and unpick and explore, grow and learn? So, really interested to hear different parts of the system whether that is something that you feel is familiar to you. So, this next slide really underpins and provides that reminder of the importance of relationships and role-modelling within and across our practice. So, it, it's, kind of, a-, it's a bit of a parallel and, kind of, reflection, mirroring of a way that we want to work with adults or carers or people, people that we're supporting. You know, Lydia absolutely, made it absolutely clear in her first session around the importance of relationships in terms of supporting recovery from trauma and actually, if we want to support practitioners who can work in a relational way, we need to be supporting people in a relational way ourselves.

 

So, this slide just really describes the cascade from reflective, emotionally literate, collaborative leaders who provide high quality support and supervision with that opportunity to reflect and how that then cascades down into supported confidence staff who are, who are delivering and providing relationship-based, strong, confident relationship-based work with our adults and families. So, just essentially that direct impact of reflection and how it, how it improves the outcomes for adults and carers that we're working with. Okay, so, we're going to-, we haven't rehearsed this particularly but we thought it might mix up the session and make it a little bit more interesting if we modelled, Lydia and I modelled a potentially, a reflective conversation. So, it won't take very long and it will, we certainly won't be getting into the process reflection level I don't think Lydia but we can, but we can give it a go. So, hopefully, just for people who aren't familiar with that reflective cycle then just give people a sense of what it can look and feel like. So, are you ready Lydia?

 

Lydia Guthrie: Yeah, should I give a quick summary of, of the situation?

 

Katy Shorten: Yeah, why not.

 

Lydia Guthrie: Might be a good idea. So, Katy and I thought we would keep it simple because we're aware there are lots of people in this seminar from a very wide range of backgrounds. So, we're going to have a very simple example. I'm a worker and Katy is my manager. I'm a key worker for an adult male who has been engaging in a drug withdrawal programme, he's been making some really good progress. I've been feeling really optimistic and thinking it's all going really brilliantly but he's recently relapsed. He didn't tell me the truth. He, he told me things were going fine but he's now been arrested for drug possession and Katy, my manager, came into the staff room and heard me saying some very critical things about this man, using very negative, critical language about him, which is out of character for me as a worker. So, it's, you know, we've tried to keep this to a reasonably every day thing that you might be able to imagine within your own setting that you're working in. So, Katy as my manager is going to take me through a reflection process.

 

Katy Shorten: So, okay. So, hi Lydia. I noticed in the kitchen there might be something that has, would be worth exploring from the work that you're doing with this man. What would you like to talk about? Would you like to tell me a little bit about what happened?

 

Lydia Guthrie: Yeah. I'm really embarrassed that you walked into the kitchen and heard me speaking about Bill in the way that you did. It's not how I would usually speak, I think I was just letting off steam. So, I am sorry. I shouldn't have spoken about him in that way and I feel bad about it. But, I was just disappointed and a bit angry when I found out that he'd been arrested again. When I got that, when I got that phone call from the police station again saying that he was there again, it just felt like all that progress that we've made over the last six months was meaningless and I just lost my temper.

 

Katy Shorten: Okay. So, you said that you're feeling disappointed, or we've heard that you're saying you're feeling disappointed and quite angry. Is there anything else that you would like to, more to say about that why that might've impacted on you in that way?

 

Lydia Guthrie: Well I really thought that we were getting somewhere, you know? He'd really opened up to me. He just looked so much better in himself and, you know, we'd started to talk about his dreams and his ambitions and his goals and I just, you know, I guess I hadn't, I hadn't anticipated this. It feels like a bit of a slap in the face.

 

Katy Shorten: Okay. So, I'm wondering about what, what you think, from what you know about him, what you think that experience might be like for him? What you think might be, the impact might be happening on him at the moment?

 

Lydia Guthrie: Yeah. I, I think he probably feels bad. I think he probably feels that he's let us down, maybe even let me down. I think, I think he did enjoy our key worker sessions. I think maybe that's why he lied and told me that he was doing okay. And that makes me feel bad, maybe he'd start to think that he couldn't let me down, maybe he started to think that it mattered too much what I thought of him and I wish he had felt able to tell me he was struggling again.

 

Katy Shorten: Okay. So that's-, that, kind of, starts to explore and understand what was behind that decision, what was behind that behaviour from Bill. What do you think the next step might be for you in considering all of that?

 

Lydia Guthrie: I think now that I've let off steam about it and talking about it with you, I think, I think I need to have a conversation with him about how we might ask for help in the future. You know, thinking about Bill and his life, he's never really been in a situation where he could ask for help and trust people to help him. So, I think I probably need to talk to him about what he wants to learn from this. That idea of it being a relapse rather than going back to square one and I think I need to-, I need to talk to him about that I'm not his parent, you know? It's okay for him to tell me what's going on and that I can cope if he's struggling and it's my job to try and support him whatever's going on for him.

 

Katy Shorten: Okay. Thank you very much for sharing that experience Lydia. I'm just going to-, so, I think what really struck me about that and it will have probably felt, or sounded contrived to people, but it just really, from the way that you moved Lydia from being angry and disappointed and some of those potentially, arguably potentially, unhelpful emotions through to thinking about, kind of, that, that response, what might have been happening from him and his perspective, thinking about what that meant and then going through it a fairly, put constructive, constructive plan of action with Bill. So, thank you for sharing that. Hopefully that's given people, kind of, an idea of what a reflective cycle could look like on a very, very surface level. So, just, just the last couple of slides now. So, kind of, as we described earlier, reflection, reflective practice and practitioner wellbeing is not your responsibility as individuals. There are enablers to reflective supervision and conditions that can be created to enable that to happen. So, thinking about permission. These are enablers that we've identified through our practice at Research in Practice. So, thinking about permission. Both from the organisation. Both from yourself and colleagues that you're working with that this is something that we do here, this is okay, it's okay to talk about what's going on and to make ourselves vulnerable in some way. Attention to the relationship. So, reflection is not going to be possible unless there's a sense of safety and trusting relationships between you and the people that you're reflecting with. So, attention to that relationship, how do we make people feel as comfortable as possible with this idea?

 

Consistency and continuity. So, again, in a similar way to what we were talking about earlier with, with trauma informed care, doing what we say we're going to do, thinking about those conditions for developing trust are really important. So, if we're going to say there's space for reflection at this time and this point then making sure that that is available. Accountability. If reflection is about learning, sharing, growth and development, who is it that's going to take responsibility for that, that change that can happen and growth and development as a result? Space and time. You might not have a lot of space and time to do reflection but, but actually making sure that that is protected is really important. The ideas of contract, clear purpose and model. Again, that's the framework and the, the, the, kind of, conditions that are being created. So, if we know and understand what the purpose of supervision is, the contract helps us to understand what to expect and the model helps us to understand what might be happening. Facilitation is really important for those deeper levels of reflection. So, thinking about how that can be enabled is part of good reflective supervision and practise. And so, Lydia and I, and, are obviously advocates of reflective practise. Hopefully that's come across in the session today but I also wanted to share some experiences from the homelessness and safeguarding sector. It does happen across homelessness and safeguarding, so this is just some findings from research of the benefits that people have found.

 

So, Woodcock et al in 2014 acknowledges the emotional impact of work, particularly with homeless young people. And, in their research they encouraged practitioners to explore, explore their felt experience and identify that awareness, that honest exploration of the challenges, and time to think about our own personal emotional responses and the challenges of the work, really supported their practise. In these contexts there are also examples where practitioners teams develop their own bespoke, informal, flexible, compassionate support for each other, including immediate managers where there's a safe place to explore, and the idea of being able to think through your own emotional responses was highly valued. The sessions prove that opportunity to step back from everyday tasks, thinking about in detail what might be underlying behaviours of people we're working with, or our own behaviours, and allowing practitioners to see the bigger picture, appreciating those different perspectives. Reflective practise and supervision and evaluation are essential tools in developing that learning, learning organisations, and it is one of those principles of psychologically informed environments as well. So, where the work of an organisation needs to be seen in the context of what's happening through individual practitioners and using their learning to grow and develop. And then, kind of, in their study investing professional, investigating professional curiosity in safeguarding, Thacker et al 2019 identified that participating in reflective supervision supported, supported professionals of different agencies working together with the same person to consider those different perspectives, and that increases the likelihood of the holistic picture emerging of what's going on for that person.

 

So, we are now coming to, this is-, there are some resources and reference slides to follow but this is the final slide of the presentation. So, we love this quote from Anderson in 1992, so reflective practise has been happening for a while. 1992 is quite a while a go now. But, this idea of 'when I talk to others, I partly talk to them, I partly talk to the others, but partly with myself as well'. That sense of, when you give yourself time and space to reflect, saying something out loud, even if it's been in your head for a while, is about, is enabling that growth and development, and enabling that different perspective to emerge. So, we've just made some suggestions around what you might like to reflect in the Q and A box. I haven't had my eye on it but I know, Michael, you have been. But, if you haven't managed to write anything yet or you're wondering what questions to ask, then here are some prompts. We're interested to know whether you have supervision, where you do your better reflecting and who with and what would support more reflection. But, also we don't forget to ask questions about the trauma session that Lydia did earlier as well.

 

Lydia Guthrie: Thanks. Katy.

 

Adi Cooper: Thank you. Katy.

 

Lydia Guthrie: And just to let everyone know, these are the resources that you're gonna get. So, a link to a whole programme, the Practise Supervisors in Adult Social Care Supervisor Development Programme, which is a wealth of open access resources on supervision that, that you can download and see what fits your organisation. The SWORD Resilience Diagnostic tool that Katy spoke about earlier, that's all there. It's all open access. And there's a couple of videos here. A really great video made for Police Scotland, a nine minute clip about trauma and the brain. Some self help guides from various sources. Some useful books if you're curiosity has been peaked and you wish to read more, and then several slides of references. So, every study that we've referenced, we've given you the ways of finding it at the back. So, just to let you know that.

 

Adi Cooper: Thank you so much, Katy and Lydia. I'm gonna hand over to Michael, who's been monitoring the Q and A for questions, to sort of manage them and manage the next part of this afternoons programme. So, over to you Michael.

 

Michael Preston-Shoot: Thanks Adi and Katy and Lydia, thank you very much. Really stimulating and informative, lots of food for thought. I'll give you just a moment or two to catch breath by actually answering one or two things in the Q and A box myself before I come to you. There was a comment observation very early on about people in the UK, from the EU and the UK, needing to make applications to remain before the 30th of June this year. We will pick that thread up in the fifth of the webinars which is on no recourse (ph 01.26.01) to public funds and legal rules more generally in relation to homelessness. Somebody put in the chat box that we need to learn from children's services about the importance of chronologies so that we don’t expect people to really tell their stories time and time again, and, indeed, so that we don’t lose sight of people's journeys, which was something, Lydia, that you identified very early on in your presentation. I thoroughly endorse that comment from my reading of safeguarding adult reviews, and, indeed, writing of safeguarding adult reviews. We know far too little about the individuals we're working with, so I think that's a very important observation in the Q and A. You've emphasised throughout, Lydia and Katy, the importance of staff wellbeing, and I just thought I would highlight, and we may return to this in the session, in the webinar on law, later on in the series, that there is case law that supports the primacy under certain circumstances of staff wellbeing, even when there are statutory duties to be met in relation to individuals receiving services. There is case law to support the importance of ensuring that staff are safe, so that might be useful for people.

 

And then, lastly, there was an observation which Adi and I have heard many times before, that not all people who experience homelessness, or who indeed who sleep on the streets, have care and support needs, and that therefore, not all individuals will become a focus for adult social care assessments and interventions, and that we mustn't overpromise what safeguarding adult boards have a mandate for. It is true that not all people who experience homelessness will have care and support needs, and so I make a distinction between adult safeguarding with capital letters, which are the adult safeguarding duties and powers within the Care Act, and particularly Section 42, and adult safeguarding with small letters, which, and that type of adult safeguarding with small letters is everybody's business, just in fact, as adult safeguarding with capital letters is. So, even if for some people who are homeless, who do not have care and support needs, even if that is the case, housing directorates and other services have an adult safeguarding, certainly with small letters, possibly also with big letters, and it's why Adi and I, in our conversations with SABs, emphasise the responsibility that SABs must have governance conversations with homelessness reduction boards, community safety partnerships, health and wellbeing boards etcetera, about where the governance for homelessness sits, and where the responsibility for our focus on adult safeguarding with small and capital letters also sits. And, I wouldn’t be at all surprised if Adi wants to chip in at some point about that, but she's shaking her head at the moment. So, that's it from me at the moment.

 

So, questions to Katy and Lydia. How do you set up a culture of trauma informed approaches, for example, in health settings or in hostels, where there are issues to do with compliance, concordance with medication, you know, and so on? How do you manage to introduce a trauma informed approach in, into settings where there are also other imperatives that have to be considered? So, I don’t know whether you've got any thoughts on that.

 

Lydia Guthrie: Yes, it's a, a great question. I can see that you very skillfully woven together, Michael, several threads of question there. So, yes, thank you. It's a very useful set of questions. And, I think, you know, I'm a systemic psychotherapist. It's not going to surprise anyone when I talk about a whole systems approach. That it's impossible to, for one part of the system to make system wide changes on its own. That this needs to start at the top with commissioning. We need, my view would be we need trauma informed commissioning. There's that age old adage that what is measured gets done, and there's some truth in that. So, how can we better support commissioners to understand the complexity of the work that we are undertaking with people who have experienced homelessness, in order to support them to make changes? How, what responsibility do we have to feed upwards to commissioners? How can we promote two way conversations and learning? I'd be very interested in people's ideas on that. What kinds of conversations can commissioners have with each other and with the people they're accountable to, about changing the culture around commissioning? How can we, how can we promote safety in the whole system? So, if services are commissioned for five years' at a time, for example, how does that promote safety within the system if the staff don’t know from period, commissioning period to commissioning period, if they're going to have a job, or what name they'll be using, or how they'll be managed?

 

So, this isn't a responsibility on their own of individual staff or individual managers or individual organisations. We need to think very holistically about trauma informed systems and to think about how we can promote these principles of safety, connection, trust and relationship, right across the whole system. And, that might sound like a pipedream, you know, it's, but for me that's, in terms of having a values based approach to this, I think we need to settle for nothing less than that, and we might need to take tiny steps towards it.

 

Michael Preston-Shoot: Yes, and tiny steps I guess, Lydia, in the context of something that was put in the Q and A, which is actually directly about commissioning, which is the 'whilst we might all subscribe to the principles and practises of being trauma informed, we have to recognise that commissioners and providers are operating in a, in a context of increasing requirements on providers, and decreasing funding'. And, as we heard in last weeks seminar, very often an emphasis on short term funding, rather than longer term continuity. So, it is a challenge isn’t it, in that context?

 

Lydia Guthrie: Yes, absolutely, absolutely. And, it's, you know, the analogy of casting seed upon the ground, that we need, we need first of all to prepare the ground, and till it, and water it, and fertilise it, rather than casting the seeds on dry ground and saying that there's something wrong with the seeds. It, you know, it's not an easy answer. I think there are, there are things we can do at the level of individual conversations. I saw a question about working in a health context, and it really brought to mind an example for me where a man who had, under influence of a psychotic illness, he'd committed a very, very violent act that he could not speak about. He developed a post-traumatic stress disorder following this very violent act, and he was told by a psychiatrist that he would never move on because he was in denial and he had no insight. And, that then created all kinds of difficulties for him and for the staff who were working to support him. So, I think there are things that within the systems that we have at the moment that we can do differently. Language is a great place to start. And, certainly I was working with that team and helped the psychiatrist to find some language that he was happy with, but also that was, in my view, less harmful and more strength based for this man. So, there, even though I'm saying that we need to intervene at the whole systems level, it's a both act. We can, at the same time, make small changes, which can be as simple as, what do we call our forms? How do we greet people at the door? What language do we use when we're describing people's behaviour? All of these are, are important as well.

 

Michael Preston-Shoot: Absolutely. You, the two of you, emphasised very strongly staff wellbeing and that's great, and you asked for some examples in the chat box, particularly around supervision and staff support. And, indeed, the Q and A does have examples, reflective supervision, ways, different ways of managing team meetings. Something that I've actually also heard in a COVID pandemic context on the news, when teams of NHS staff are interviewed about a family feel dynamic, you know, 'we're a kind of family and we're in this together.' Sharing achievements. Celebrating small victories, that's something that I’ve come across in the context of self-neglect work. A secure base. Constructive challenge. I wondered whether you've got any examples from your own practises about what can make the difference for staff wellbeing, in hard pressed organisations, not least at the moment.

 

Lydia Guthrie: Absolutely.

 

Katy Shorten: Yes.

 

Lydia Guthrie: Go for it, Katy.

 

Michael Preston-Shoot: Come on, Katy.

 

Katy Shorten: Well, I mean I think there's something about, kind of, I just want to reiterate really that sense of responsibility of an organisation to support and enable its staff to be well and resilient, in the, particularly in these times. So, an example of that from Research in Practise, my organisation, is we have a weekly, a weekly all staff meeting on, on virtually, and we've used some of that time to share how we're all feeling about the situation and what, what is working well for us. And, it just enables that sense of connectivity across different individuals and different team members. So, we're not kind of feeling as alone as we might otherwise have been, sitting in, in our, in our various different homes and offices. So, just, and I think that’s that creation of an environment where there's mutual support and that, that ability to and permission to express what's going on for you and feel supported and that you belong. You're, you're still belonging, you're still part of something. Certainly something that’s been working for us as an organisation.

 

Michael Preston-Shoot: And the sense I've had over more years' than I care to remember in social work, is that we're not very good at it. We're still not very good at it. I mean I can remember when I qualified back in 1978, there were reports criticising the absence of supervision, let alone any other kinds of reflective spaces. And, we had the Social Work Task Force and Reform Board 2009, 2010, talking about exactly the same thing, and it comes up quite often in safeguarding adult reviews. We're not very good at it, are we? Looking after each other.

 

Lydia Guthrie: Yes, very much. I would echo everything that Katy has said. Promoting the importance of connection and belonging. Promoting just basic human relationships, basic human kindness, amongst colleagues, as well as with the people we, we support. Some, my practise in supervision, when I'm supervising teams, is to be, is always to ask teams, 'what's something that you're proud of? Since we last met, what's happened that you're proud of?' And, that might be something to do with their own practise, or it might be something, an achievement of somebody they're supporting in their job, and just asking that question tends to spin off into lots of other celebratory conversations, sometimes about tiny things. But, so, trying to focus on our achievements and what we're proud of, as well as the things that we want to do better.

 

Michael Preston-Shoot: Yes. That reminds me actually of when I, once upon a time when I was having a really hard time at work and a colleague took me aside and offered me some time, and one of the things she asked me to do was to think of 35 things I was good at. Now, I'm not wedded to 35 as a number, but I think it reinforces what you're saying. It's so easy in challenging times to, to lose our compass, and to lose the sense of actually what we are good at, and that was just one way of reminding me, in a particular context. There was something in the chat box too about the need to make training on trauma informed approaches and reflective supervision more, more widespread, more widely available. Adi's just reminded me that we, we need to move onto the final slides, but just before I do, Adi, I wondered whether Katy or Lydia had got any helpful signposts in relation to training.

 

Lydia Guthrie: Yes. There are lots of training organisations around. I, kind of, I offer trauma informed training, which I feel bad about saying, so do Research in Practise.

 

Michael Preston-Shoot: That's alright, we won't charge you.

 

Lydia Guthrie: Yes. Lots of different organisations do. I think my main point here, rather than selecting the right training organisation, is to have the right training strategy, that training on its own will be limited benefit. It's that idea of paying a lot of money to use an external organisation for seeds, and that casting them on untilled ground. So, training on-, There's that brilliant phrase, that 'organisational culture eats training for breakfast.' So, training is part of a solution. It's not an entire solution. So, first of all, do a skills audit of your team. Consult with your team about, what would you find useful? Consult with your team about, how would you like to learn? Work with a training organisation about what it is that you want and what your goals are. Don't just commission them blindly. I speak from experience. And then, work with your training organisation to tailor make training for your team and your setting, and then reinforce it in supervision. Reinforce it in policies. Reinforce it in what gets rewarded. Use peer or buddying systems, you know, it doesn't have to be very expensive and it doesn't have to be all commissioned out to fancy consultants. You know, you, just use the people you’ve got to reinforce the learning, would be my guidance.

 

Katy Shorten: Absolutely, and I could just reiterate and support that. Just drawing that parallel around coproduction. So, if we're working-, strength-based working, coproduction, this, the paradigm and approach that's being promoted around working together in a collaborative and mutual way, with adults and carers, or people who are homeless, or experiencing homelessness in terms of, what are their goals and aspirations? What do they want to achieve? Reflecting that in terms of how we want to be in practise, what we want to be, you know, and thinking about that mirroring throughout our whole organisation, from leadership through to practise through to, through to work with adults and carers, is when you're thinking about what you want, how you want to do something. I want to change a culture. Just drawing from all of those different elements.

 

Michael Preston-Shoot: Okay. Lydia and Katy, virtual applause from all 136 people still in the room. You had 174 at one point, which is the highest number I think we've had, but certainly more than last week anyway. So, at the risk of parody (ph 01.43.36) and Bruce Forsyth, you are my favourites, at least for this week. So, thank you very much. It was a brilliant session. Just before I hand back to Adi to sign off, I'm going to share my slides again, just to remind people of what we have coming up. If things work, yes, they do. So, 25th of January, next Monday, 10 O'clock in the morning, we're going to be looking at COVID and what we can learn from the pandemic, and then you can see the sessions, two sessions in February, and two sessions in March. And, I hope that you will join as many of those as is possible for you. And then, skipping the slides I talked about earlier, reminder that the landmark study on the first national analysis in England of safeguarding adult reviews is now available on the local government association website, and on the Research in Practise website are the slides and the recording of the launch event that we had in December. There are some Making Safeguarding Personal resources that are available, and forthcoming webinars and, again, details of those are available. There's some work going on collecting data about the impact of the COVID-19 pandemic on safeguarding adults and particularly of the referral of safeguarding concerns and the number of safeguarding enquiries as a result, and there are links there to resources which are available. So, that's it from me.

 

Adi Cooper: Thank you, Michael.

 

Michael Preston-Shoot: And I'm going to pass over to Adi to conclude the session.

 

Adi Cooper: Thank you very much, Michael. Thank you. My thanks to Lydia and Katy and to the events team, the colleagues who have supported us this afternoon to make sure that this session has gone ahead really smoothly. That's all we've got time for now. Thank you everybody for joining us this afternoon. We really hope that you’ve found it useful. Just a reminder, there are presentations and the record-, will be on the LGA (ph 01.46.13) website within the next 48 hours, and the recording will be available. There is a very short survey that will be sent out. Please complete it. Give us your feedback. We've got more sessions. We can learn and we can improve. Thank you again to everyone who's joined us this afternoon and stay safe and keep well over the next period of time. I'm going to leave. Bye, everybody. Bye, Bye.

Presentations

Trauma-informed and reflective practice in safeguarding people experiencing homelessness
Katy Shorten, Research and Development Manager, Research in Practice
Lydia Guthrie, Independent Trainer