TIC and PIEs - what is the difference?

We are often asked what is the difference - if any? - between PIEs and TIC - Trauma Informed Care.  Some people will regard them as practically interchangeable - and in fact, that was largely true in the past. Some are simply confused or curious.

TIC and PIE do have very many points in common, besides that middle letter 'I'. Both sprang from a growing recognition of the high levels of trauma in the population of those who found themselves homeless, and were 'informed' by that. Both advocated a recognition that many homelessness services were developing new ways of working, to meet these more complex needs.

Originally PIEs and TIC had developed separately, but in parallel. The first developments in services and in thinking in the UK, and the first accounts of a psychologically informed environment, were contemporary with various new approaches and thinking developing then in the US and Canada. Initiatives and ideas such as Trauma Informed Care, Housing First, and also "Pre-treatment" all come about around the same time, in response to new thinking about what were often largely the same needs.

(For pages on Housing First as a PIEs approach, see: HERE; and for Pretreatment, see : HERE)


Common ground and later divergence

In the earlier, 'PIEs 1' formulation of what makes for a PIE, there was a great deal of overlap between these two slightly ways of describing much the same responses in some of those more responsive and more creative services. Both set about recognising the same issues and responses arising in a wide range of services; and both responded to the need for a way of describing that made constructive links between all these different services and sectors.  It is only with the up-dated 'PIEs 2' formulation that TIC and PIEs began to diverge more.

PIEs 2.0 has broadened the canvas, to encompass a far wider range of issues, including tackling the wider funding and cultural systems that inhibit development. (See: A single framework : HERE).  But that inner core of TIC is still very much there, within the wider PIEs approach. In PIEs terms, trauma is simply taken to be the psychological model, from which all the other issues are to be derived. It's just that trauma is not the only psychology that we need. (See Trauma-Informed Care in summary, below


Other psychology, and systems awareness

One possible difference between PIEs and TIC is that the PIEs framework is explicitly open to being informed by any branch of psychology, including schools of thought that pre-date by many years more recent understandings of trauma. Yet in practice, we do actually see a much broader 'awareness' both encouraged and used, in TIC.

There is also more scope, in the PIE framework, for organisational psychology, the understanding of social systems and the impact on services of ways of thinking about excluded people, as a societal problem as much as an individual one. Yet all these additional sources of insights can in principle be incorporated into the TIC framework.

Another difference - one that has emerged more clearly in recent years, with the PIEs 2 framework - is the attempt with PIEs 2 to consider and pro-actively engage these wider networks, the pathways in and through a service. This difference too may reflect the current more advanced state and greater coherence of homelessness policy in the UK and Europe.

(It has been suggested more recently that we might one day need another version of the PIE approach that is quite specifically geared towards system change. For a discussion on this, see 'Will there be a PIEs 3? : HERE)


Being 'informed'

A very useful distinction made in some of the earlier descriptions of TIC was that between 'trauma-focussed' services, and 'trauma-informed' work.  Trauma-focussed services, it was suggested, need a full professional training, competent supervision etc.  But trauma informed work is something we can all be engaged in.

This distinction reflects the comparable distinction we now make between PIEs 1, in which 'being psychologically informed' was all too easily interpreted in the rather narrow sense of 'having psychologists in the team'; and being 'psychologically aware', which is - and needs to be - pervasive, and supported, throughout a service.

See, for example, "Does it take a psychologist to make a PIE?"

Also the forum discussion summary on 'Roll out and top-to-toe embedding' : HERE


Trauma-Informed Care in summary

To sum up briefly: where the PIEs approach talks of encouraging 'psychological awareness', developing reflective practice, creating and using 'space  of opportunity', staff training and support etc, Trauma Informed Care stresses (see: Hopper et al) the need to promote, in services:

  • a safe and predictable environment
  • support personalised to the individual
  • a focus on strengths
  • gaining a sense of safety and control

In a slightly different formulation - but clearly compatible - the 'Creating Cultures of Trauma-Informed Care' approach to organisational change (see column right, by Fallot & Harris) is built on five core values of:

  • safety
  • trustworthiness
  • choice
  • collaboration, and
  • empowerment

As they say:

"If a program can say that its culture reflects each of these values in each contact, physical setting, relationship, and activity and that this culture is evident in the experiences of staff as well as consumers, then the program’s culture is trauma-informed."

In this formulation, then, looking at the organisational culture as a whole, the parallel with the PIE concept is clearly very close. In that last comment on whole programmes as trauma-informed, we are also seeing TIC reaching out towards the greater breadth of the PIEs 2 version.


Further background reading/listening/viewing

PIElink pages

Working with trauma : HERE

Trauma-informed design (Q&A) : HERE


Scotland's information on trauma informed practice is careful to make a distinction between services (and staff) being trauma-aware, trauma-informed, and trauma-focussed.


Library items

Does it take a psychologist to make a PIE? : HERE

An introduction to Psychologically Informed Environments and Trauma Informed Care: a briefing for homelessness services from HomelessLink : HERE

Core skills of engagement - pre-treatment, trauma-informed care and psychologically informed environments :   HERE

Rainbow services: Trauma Informed Care and Psychologically Informed Environments with Intimate Partner Violence services in Los Angeles : HERE

Person-centred, holistic, psychologically informed : the Young Women’s Housing Project approach HERE

'Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and Planning Protocol'   by Roger Fallot & Maxine Harris

Shelter from the Storm:   Trauma-Informed Care in Homelessness Services Settings  by Elizabeth Hopper, Ellen Bassuk & Jeffrey Olivet     (See in particular the excerpt: 'How Common Trauma Reactions May Explain Some “Difficult” Behaviors or Reactions Within Homeless Service  Settings' [Table 3] - a useful tool.)

Principles and practice in psychology and homelessness: Part One, Johnson (2016)  for an overview

Jo Prestidge's account of an exchange visit to New York is based on a weblog from the Transatlantic Exchange programme, by Jo, now at HomelessLink, but then a worker from an outreach service in London. She describes in some vivid detail her impressions of TIC, and what might be learned from this approach, in her own work.

(There is also a short video interview with Jo now in the Voices collection in the Library.

Connecting paradigms: Talking trauma across the Atlantic with Jay Levy and Robin Johnson  (Episode 55) :  HERE

"Psychologically Informed Environments and Trauma Informed Care" - webinar records an on-line discussion, with questions from the online listeners, with Jo Prestidge and Claire Ritchie of No One Left Out Solutions.


For more on Trauma Informed Care and 'domestic'/intimate partner violence, see the website of Susan Hess, another on the Transatlantic exchange programme.

Also more from Elizabeth Eastlund - Director of Programmes, Rainbow Services (website) - on the tensions between domestic violence programs and the current application of Housing First in the US context. Intersections between the Domestic Violence and Homelessness Programs

There are no comments