Skip to content

Workforce Development Lead at Fulfilling Lives has chapter published in innovative transatlantic book

Ray Middleton, Workforce Development Lead for Fulfilling Lives Newcastle and Gateshead, has a chapter published in a new book sharing pioneering approaches from the UK and US addressing the underlying issues around complex needs and homelessness.

‘Cross-Cultural Dialogues on Homelessness: From Pre-Treatment Strategies to Psychologically Informed Environments’ has been published this month, presenting innovative approaches toward the traumas that can underlie homelessness. The text is the first to explore what the US and UK can learn from one another to better support people experiencing homelessness, or at risk of becoming homeless.

The book covers an understanding of the principles of pre-treatment and PIEs and promotes productive dialogue on all levels: with people experiencing homelessness, with clinicians, with advocates, policymakers, researchers, and more.

Underlying common processes of effective engagement are explored and promoted by comparing Jay Levy’s approach of ‘Pre-treatment’, Trauma Informed Care (TIC) and the British model of PIEs. It also details how crucial relationship-building is for street outreach teams.

Ray Middleton contributed a chapter on Psychologically Informed Environments (PIEs) to this new book, following our pilot into PIEs across Newcastle and Gateshead in 2016. Ray experimented with new livestreaming technology to enable live online discussion between the USA and UK, during which he was introduced to Jay by Robin Johnson.

In his chapter, Ray describes how each of the PIE areas were developed and adapted to meet the needs of ten local services. Staff were trained to run reflective practice sessions and YouTube PIE training films were co-produced with our experts by experience – to be used within reflective practice sessions to help develop staff skills. Ray also outlines his psychological framework, Ladder4Life, which is in plain English and easily understandable by clients and staff.


The editors Jay Levy and Robin Johnson also contribute chapters to this book, in addition to chapters by John Conolly and Suzanne Quinney on their innovative work.

In his chapter, John Conolly describes how he adapted the Pre-treatment approach for people using the Westminster Homeless Health Counselling Service. Suzanne Quinney’s section of the book describes how she has applied Appreciative Inquiry (AI) to fit into the PIE framework and found it to be a very effective combination when helping King George’s homeless hostel develop their service, with support from Westminster City Council.

Jay S. Levy has spent more than 30 years working with individuals who experience homelessness. Jay developed ‘Pre-treatment’ as an approach to helping people without homes and to promote inclusion.

Robin Johnson is the founder of the Psychologically Informed Environment (PIE) model and the editor of PIElink, an online community of practice for all those interested in developing the practice and theory of psychologically informed environments.

‘Cross-Cultural Dialogues on Homelessness: From Pre-Treatment Strategies to Psychologically Informed Environments’  is now available to purchase in hardcover, paperback, and as an e-book through Amazon here.