Person-in-Environment System: The PIE Classification System for Social Functioning Problems

I’ve developed a respect for social work in ways that I never had.  It was hard for me to differentiate social work from coaching and navigation on the one side and psychology on the other.  Some of this was my ignorance and some was the blurring of lines.  One of the things that social work needed – and needs – is a unifying framework to bring the work of social workers together.  One proposed system is Person-in-Environment System: The PIE Classification System for Social Functioning Problems.  While labeling has inherent concerns of dehumanizing people, categorization makes it possible to more effectively support and serve.  We cannot avoid attaching labels to people, because our measurement systems (or payment systems) require it.  However, we can choose labeling frameworks that honor their entire experience – like PIE.

The Four Factors

The PIE system seeks to classify a person’s situation with four factors and sub-factors as follows:

• Factor I: Social Functioning Problems
  • Social role in which each problem is identified (4 categories)
  • Type of problem in social role (9 types)
  • Severity of problem (6-point indicator)
  • Duration of problem (6-point indicator)
  • Ability of client to cope with problem
• Factor II: Environmental Problems
  • Social system where each problem is identified (6 systems)
  • Specific type of problem within each social system (number varies for each social system)
  • Severity of problem (6-point indicator)
  • Duration of problem
• Factor III: Mental Health Problems
  • Clinical syndromes (Axis I of DSM-IV)
  • Personality and developmental disorders (Axis II of DSM-IV)
• Factor IV: Physical Health Problems
  • Diseases diagnosed by a physician (Axis III of DSM-IV, ICD-9)
  • Other health problems reported by client and others

While this seems like a lot to take in all at once, it provides a more or less comprehensive view of someone’s current situation – which requires coverage of multiple aspects and dimensions.  Too often, people are reduced to their mental health diagnosis (Factor III).  In doing so, we necessarily ignore the social, environmental, and health factors that lead to this diagnosis.  The beauty of social work as a profession is the ability to see the full picture and to look for the ways that the person’s challenges and dysfunctions are a product of both their internal workings and the environment they’re in.

Lewin

Before exploring PIE in more depth, it’s helpful to go back and review the work of Kurt Lewin.  Among his contributions is a statement that behavior is a function of both person and environment.  When Lewin said it’s a function, he meant that the interaction between the person and the environment can’t be fully understood.  (See A Dynamic Theory of Personality.)  We know we can induce most (if not all) people to behaviors if we change the environment.  Similarly, we know that people will resist behaviors even when their environments are changed.  While it’s not a comforting answer to the specifics of the interaction between person and environment, it’s clear that it happens.

With this simple start, we see the growth of social work and the divergence from psychology.  Where psychology is concerned with the internal worlds of people and their outward expression of it (behavior), it fundamentally misses half the equation.  It fails to realize how environment matters.  In Change or Die, Alan Deutschman shares about Dulaney Street and how it’s successful at helping people with substance use disorder – as well as the ways that it fails.  We know that recovery happens best in community – that is, it happens best when you change the environment.

Factor I – Social Functioning Problems (Relationships)

It’s hard to have any kind of problem without it impacting your relationship with others.  You can’t be struggling without those who care about you and interact with being impacted.  Kernan Manion, as quoted in Your Consent is Not Required, says, “A human being has a variety of connections, of moorings, that hold that human being in place. A marriage or significant other. Friends. Family. Community. Neighbors. Church. A job, income. In other words, all of this is the tapestry of one’s environment. And what the Stasi [German Secret Police] decided is that the way that you can annihilate someone is to cut those moorings, one at a time, cut them off from each of them.”  He continues by saying there’s a more effective way of doing that than causing them to suspect you’ve gone mad.

Manion’s comment exposes just some of the ways that we relate to others.  And each of these relationships has the potential for dysfunction.  The PIE system describes these dysfunctions as power type, ambivalence type, responsibility type, dependency type, loss type, isolation type, victimization type, mixed type, and other type.  These are associated with an intensity and duration before evaluating the person’s coping skills to round out the coding of the first factor.

Factor II – Environmental Problems

Beyond the relationships, we have material needs that must be met.  Problems are first categorized by the social system that they occur in: Economic/Basic Needs System; Educational/Training System; Judicial/Legal System; Health, Safety, and Social Services System; Voluntary Association System; and Affectional Support System.  You may notice that there aren’t clean lines, as the environmental problem may be that the person isn’t receiving enough affectional support, a Factor I item.  However, the small areas of overlap help to ensure that there aren’t problems that cannot be coded using the system.

Factor III – Mental Health Problems

For mental health problems, PIE defers to the DSM (Diagnostic and Statistical Manual) of the APA.  There are numerous problems with this – but it’s a necessary compromise, because DSM is used for coding treatments outside of social work and for billing.  It’s essential to have a system that is compatible with billing for sustainability of the profession.  (See Your Consent Is Not Required and Warning: Psychiatry May Be Hazardous to Your Health.)

Factor IV – Physical Health Problems

These are the sorts of things that one sees a medical doctor for.  They’re categorized by International Categorization of Diseases (ICD) codes.

Causes of Problems

Sometimes, the focus goes to the degree to which someone is impacted by mental illness without evaluating the factors that might lead to mental illness.  We tend to think about mental illness differently than physical illness.  While physical illnesses have external factors such as genetics or pathogens, we expect that mental issues are somehow indicative of the person.  We think about physical illnesses being mostly temporary in nature as responses to injury or intruder, yet we believe that once someone has a mental illness, they’ll have it for life, like an albatross hanging around their neck.

This makes it difficult to see mental illness as a predictable outcome of trauma – whether it’s continuous or episodic.  While this seems to challenge the prevailing views, it’s consistent with what the research says.  The environmental and external nature of the drivers of mental illness is one of the reasons why the social work approach (whether using PIE or not) is so vital.

If you want to make real change and real improvement, you may need a system like the Person-in-Environment System.