Supporting Hospital and Paramedic Employees during and after Covid (SHAPE)
Latest research shows that improving the health of doctors, nurses, ICU staff and paramedics improves the delivery of patient care. Before the pandemic, we had developed an evidence-based intervention that halved rates of PTSD and depression in paramedics. During the pandemic, we modified it to target risk factors that are specific to healthcare workers. Called SHAPE, the programme achieves reliable recovery rates of 94% for PTSD and 65% for depression in just 6 weeks. We're evaluating whether our training for new wellbeing coaches across the south-east is good value for money and effective.
COVID led to ongoing hospital admissions, ethical dilemmas, and deaths, increasing risk for PTSD and depression for frontline nurses, doctors, ICU staff and paramedics. Our research (Wild et al., 2021) was the first to quantify rates of these problems among healthcare workers during the pandemic utilising gold-standard methods of clinical assessment, advancing prior research. We discovered that healthcare staff had exposure to trauma before and during the pandemic with high rates of PTSD and depression, indicating the propensity of this workforce to face significant stressors at and outside of work. Our finding underscores the need for accessible interventions for this at-risk population.
“Work-related stress has been an all time high for me and my peers due to the COVID-19 pandemic. Fortunately, though, my weekly calls with my well-being coach have mitigated that stress significantly. For this, I am eternally grateful. I feel very lucky to have had this support.”
-A paramedic who had SHAPE over 6 weeks
SHAPE is an evidence-based intervention that we first developed to prevent PTSD in paramedics and then modified to target persistence of PTSD and depression in healthcare staff. SHAPE achieves significantly greater recovery than a monitoring-only approach to symptom management. To date, SHAPE delivered by our research team over 6 weeks on the telephone has achieved reliable recovery rates of 94% for PTSD and 65% for depression. NHS England and NHS Improvement facilitated the roll out of the intervention across the South East of England. Our work hopes to discover:
- Do wellbeing coaches whom we train and who work at our collaborating sites achieve outcomes similar to the research team?
- How much supervision is the right dose?
- Is the supervision approach cost effective?
The answers to these questions will inform the scale up and implementation of SHAPE across the UK so that this process is guided by evidence. We will also discover whether the steps we took to update the original intervention to fit for busy healthcare workers was successful and whether this approach could be applied to modifying the intervention for healthcare staff and other at risk populations in other countries, informing an evidence-based pathway to global impact.
How we are involving patients and the public
We held a user advisory group before we started the study with healthcare workers from diverse backgrounds, some of whom had completed internet-delivered cognitive training in resilience (iCT-R), the precursor to SHAPE. For frontline healthcare workers who had experience of iCT-R, we invited participation from people who did and did not engage with the intervention. With the whole group, we ran through questions focusing on what would work and not work for them. We also invited feedback on our Participant Information Sheet (PIS) and consent forms. We had our PPI group complete the baseline questionnaires and incorporated their feedback to remove repetition in the questionnaires, to include an image in our PIS showing the flow through the study, and to deliver content over the phone rather than through a digital intervention. We have met with our group at various points during the study to feedback on study progress and to generate ideas to reach healthcare workers from diverse backgrounds. We have followed these recommendations, such as contacting influencers on social media to promote the study as well as reaching out to MPs with an interest in mental health, such as Rosena Allin-Khan. Dr Allin-Khan has emailed to confirm her interest in SHAPE and will be a valuable contact for the programme going forwards.
How we are planning to implement the research outputs
We will work with our 7 NHS Trusts to co-produce materials specific to each Trust on guidance for sustaining and embedding SHAPE as a standard offering whilst they continue to employ wellbeing workers.
We will meet with our user advisory group to present the overall findings and co-produce slides for wider presentation that we will use when meeting with commissioners, patient groups and voluntary sector organisations.
We will reach out to nursing charities and initiatives, such as Nurse Wellbeing Mission, who we are already working with as well as Cavell’s Nurses’ Trust and other charities to disseminate our findings on podcasts and blogs.
We will reach out to our social media influencers in healthcare to share the findings.
Once the project has determined best methods for implementation, we will seek further funds to extend SHAPE to the north of England and to other countries where we are already working in a collaborative capacity (i.e., Singapore, USA, Canada and Australia) as well as to other at-risk populations, such as care home staff and emergency service workers.
ARC OXTV ASSOCIATED PROJECT.
Associated projects receive some funding from NIHR ARC OxTV, and/or may be supported by us in other ways. For example, through providing researcher time, or other resources and expertise.
This associated project is funded by:
Expected project end date
Partners on this project
- We are committed to improving the health and wellbeing of frontline healthcare staff with the best science.
- We aim to achieve recovery from PTSD and depression for healthcare workers living with these problems.
- We aim to determine whether the intervention and our supervision approach is good value for money.
- We will deliver evidence to guide sustainability and scalability of the intervention.
- We aim to develop an evidence-based pathway to global impact.
- Improved mental health outcomes of healthcare staff
- Data that allow conclusions to be drawn regarding the dose of supervision required to achieve clinical outcomes similar to that of the research team
- Data on the cost effectiveness of the supervision approach
- A healthy workforce with tools to support good mental health
- A new model of outreach: evidence-based wellbeing coaching to reduce PTSD and depression among the healthcare workforce.
- Among wellbeing coaches we train, we expect to achieve rates of recovery of over 90% for PTSD and over 60% for depression.
- The precursor to SHAPE called internet-delivered cognitive training in resilience (iCT-R) reduced rates of mental health disorders among paramedics by 50%.
- We expect to improve the lives of over 200 healthcare workers by the end of September 2022 and with further funding, over 400 in the next year.
- Studies have demonstrated that improving the health of frontline staff improves the delivery of patient care, meaning that the impact of a healthy hospital workforce directly benefits the general population through earlier physical health recovery and return to work after hospital treatment.