'There's psychological masonry flying everywhere': a mixed-methods systematic review of ‘Psychologically-Informed Environments’ interventions for staff working in homelessness services; and, An empirical study of factors contributing to the development and maintenance of work-related distress in frontline workers in homelessness services

Abstract

AIMS: This thesis aims to further the existing evidence on the mental health and wellbeing of frontline workers in homelessness services. This included reviewing the literature related to the implementation of the ‘psychologically informed environments’ (PIEs) framework with staff and exploring the organisational and individual determinants of work-related distress in this population.

METHODS: A mixed-methods systematic review was conducted on the implementation of the PIEs framework with frontline staff. Of the 25 papers included, six were peer-reviewed and 19 were grey literature produced by third-sector services. A convergent integrated approach to analysis was taken. Further to this, a cross-sectional survey-based study using validated outcome measures was conducted with 139 frontline workers to examine organisational and individual factors related to three related but distinct facets of work-related distress: post-traumatic stress disorder (PTSD), secondary traumatic stress (STS), and burnout. Hierarchical multiple regressions, mediations, and moderated mediation models were used to investigate the relationship between organisational culture, individual coping style, compassion satisfaction, and work-related distress.

RESULTS: The systematic review indicated that PIE staff interventions show promise for improving both staff and service user outcomes. A theoretical model suggesting potential mechanisms linking staff and service user outcomes was proposed, and multiple barriers and facilitators to implementation were identified. Results from the empirical study indicated that 23.2% of the sample met diagnostic criteria for PTSD and that this population is frequently exposed to potentially highly distressing workplace incidents. Trauma exposure was a strong predictor of work-related distress; however, while organisational culture was the strongest predictor of burnout, the use of ‘maladaptive’ cognitive coping strategies was a greater predictor of both PTSD and STS. Compassion satisfaction mediated the relationship between trauma exposure and both burnout and STS.

CONCLUSIONS: Results from both studies add to our understanding of the difficulties experienced by frontline workers in homelessness services and potential interventions to support this population. The systematic review highlights the impact of PIE interventions on staff wellbeing and practice and lends support to the findings from the empirical study regarding the importance of organisational culture. Implications for practice, policy, and further research are discussed.