Psychologically informed environments: A systematic review of qualitative studies of staff experiences and recalled early adversity and post traumatic stress disorder in a youth homeless population

This thesis is made up of two papers: a systematic review and an empirical study. The systematic review aimed to synthesise the evidence regarding staff experiences of Psychologically Informed Environments (PIEs), which is an initiative that aims to transform services for homeless people and enable service providers to engage them in a more psychologically informed way. It is well documented that people who are homeless often have comorbid mental health difficulties, a higher rate of engagement with the criminal justice system and can display behaviours considered challenging, such as emotional dysregulation or the use of illicit substances. It is also recognised that working with this client group can have an emotional toll on staff members who are often exposed to stories of trauma and are expected to manage high risk behaviours. PIEs were introduced in 2012 as a more informal way of working with homeless people with the aim of improving the engagement of this hard-to-reach group, but there exists no current review of its effectiveness. This systematic review aimed to synthesise research regarding staff experiences of working in a PIE. Searches were conducted using the databases Scopus, Psycinfo, Web of Science and Medline, alongside additional searches of reference lists, Google Scholar and citation searches. Articles were screened and assessed for quality by the first author. Nine papers were included in the review, consisting of both published research and service reports, which ranged in quality. As such little evidence exists on this topic, all papers were included in order to be as thorough as possible. Thematic synthesis allowed for new interpretations to be drawn from the collation of the data. Seven analytical themes were developed, and the findings were generally positive, though the barriers and challenges to implementing a PIE were identified as a key theme. The review synthesises the current evidence base for the use of PIEs, but the service user voice was noticeably absent from the analysis, as is a common shortcoming in research with the homeless population. More robust studies are needed in order to draw more conclusions regarding the effectiveness of PIEs. The empirical paper is a quantitative study that aimed to explore the relationships between adverse childhood experiences (ACEs) and PTSD symptoms in a young homeless sample. This study used archival data and built upon research already resulting from the same dataset, which had noted high rates of loneliness and low rates of self-mastery among those in this sample who also scored highly on a measure of PTSD symptoms. A moderation analysis was conducted to explore whether these two variables were acting as a moderator on the relationship between ACEs and PTSD symptoms. Statistical analyses showed that experiencing multiple types of adverse childhood adversity was a predictor of higher scores on the PTSD symptom measure, with each additional type of adversity showing a dose-response effect. An odds ratio analysis demonstrated that the experience of sexual abuse particularly increased the risk of meeting the clinical cut off score on the PTSD symptom measure. A hierarchical regression, where adversities were entered as sexual abuse, childhood maltreatment or household dysfunction, showed that sexual abuse had the greatest predictive effect, followed by household dysfunction, of scores on the PTSD symptom measure. Several categories of childhood adversities were correlated with self-mastery and PTSD symptoms. Of a larger dataset, only 84 participants had completed the PTSD symptom measure, which meant that the moderation analysis was underpowered, perhaps explaining why no significant effects were detected. This study adds to the understanding of the effects of ACEs on young homeless people, especially in terms of identifying which types of abuse make young people particularly vulnerable to post-traumatic symptoms. This could be beneficial to third sector support services working with this population, in informing how they screen for different types of abuse and thus tailor psychological interventions