Art therapy-based interventions to address burnout and psychosocial distress in healthcare workers-a systematic review

Background Burnout and psychosocial distress are serious and growing issues for healthcare workers (HCWs) and healthcare systems across the globe. Exacerbated by changes in healthcare delivery during and following the Covid-19 pandemic, these issues negatively affect HCW wellbeing, clinical outcomes and patient safety. Art Therapy has demonstrated promise as a suitable but under researched intervention, warranting further investigation. This systematic review aims to ascertain what art therapy-based interventions used to address burnout and / or psychosocial distress in HCWs have been reported in the health and social care literature and how these have been evaluated. Methods Six databases (PubMed, PsycINFO, MEDLINE, EMBASE, CINAHL, ProQuest Central), Google Scholar and three clinical trial registries (CENTRAL, ICTRP and ClinicalTrials.gov) were searched for studies using art therapy-based methods to engage with burnout risk or psychosocial distress in HCWs. Following screening for eligibility study characteristics and outcomes were extracted by two reviewers independently. Studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Outcomes were grouped for analysis. Quantitative and qualitative results were synthesised and integrated using narrative synthesis. Results Twenty-seven studies, drawn from thirteen countries, spanning five continents were selected for inclusion. Fifty percent were published in the last five years, indicating growing global research in the field. Fourteen studies used quantitative research methods and thirteen used qualitative methods. A total of 1580 participants took part in the studies, with nurses most broadly represented (59%). Interventions were mostly delivered in groups (95%) and by an art therapist (70%). Heterogeneity and insufficient randomised controlled trials precluded the possibility of meta-analysis. However, a review of available data showed evidence of medium to large effects for emotional exhaustion (burnout), work-related stress and common mental health issues. A content analysis of qualitative data of perceived effect complemented quantitative findings. Conclusion Global research into the use of art therapy-based methods to address burnout and psychosocial distress in HCWs is growing. Whilst further high-quality evidence such as randomised controlled trials would be beneficial, findings suggest that art therapy-based methods should be strongly considered as an acceptable and effective treatment for symptoms of emotional exhaustion (burnout) and psychosocial distress in HCWs

Therapist perceived active ingredients of school-based dramatherapy for children and young people with emotional distress

Dramatherapy, a creative form of psychotherapy, is used as a treatment for children and young people (CYPs) who have common mental disorders including anxiety, depression and trauma. Although widely used, particularly in schools, little is known about the active ingredients of this intervention. A qualitative approach, triangulating both semi-structured interviews (N = 11) and a focus group (N = 5), was taken to elicit dramatherapists’ perspectives on the active ingredients of school-based dramatherapy. 11 active ingredients were identified. That dramatherapy fosters autonomy, freedom and agency (1), that experiences are processed creatively (2), that CYPs experience and express emotions (3) in dramatherapy, were found; dramatherapy’s person-centredness (4) and the use of structure (5) were also found. The creation of safety, in the therapeutic relationship (6) and space (7) and, the ability to develop meaningful social connections (8) via dramatherapy, were also identified as active ingredients, as were, dramatherapists’ use of theory (9), the importance of a systemic approach (10) and that therapeutic experiences are integrated into life beyond dramatherapy (11). This study is the first to explore the active ingredients of school-based dramatherapy for CYPs with emotional distress. The findings presented may inform further research, measuring mediators of change, and practice, which enhances symptom reduction

The experience of school-based dramatherapists: Understanding the barriers and facilitators of UK school-based dramatherapy to inform better implementation

Approximately 50% of UK dramatherapists deliver their work in schools. Despite this, little is currently known about the way in which school settings affect the dramatherapy that is delivered within them. This qualitative investigation utilised semi-structured interviews (N = 12) and reflexive thematic analysis to identify the facilitators and barriers of providing dramatherapy in school settings. In addition, the unique experiences of working as a dramatherapist in a school setting were also investigated. Amongst others, the facilitators identified included school as an accessible and safe place for therapy to occur. In addition, the structure provided by the school's daily and annual timetable, and the support of other school-based professionals and organisations were also identified. The barriers identified related to funding challenges, inappropriate referrals, schools seeking quick results and a lack of access to suitable spaces for therapy to occur. Regarding their experiences of employment, many dramatherapists spoke of working in multiple schools and, whilst some enjoyed the flexibility this offered, many found it challenging to become part of the school community and experienced a sense of isolation whilst working. Feeling like they are lower paid than clinical counterparts, such as colleagues in Child and Adolescent Mental Health Services (CAMHS), was also raised by those interviewed. These findings suggest that resource investment and investment into teachers’ and other school-based professionals’ knowledge of dramatherapy is warranted. In addition, dramatherapists who work in schools may benefit from community building. Future research, which explores the experience of dramatherapists in other settings is also encouraged

The number of offspring weaned from ewe lambs is affected differently by liveweight and age at breeding

In this paper, we tested the hypothesis that ewe lambs that are heavier and older at breeding will wean more offspring, due to increased reproductive rate and offspring survival and lower maternal mortality. To test this hypothesis, we analyzed data from more than 11,500 maternal composite ewe lambs collected over eight years. The ewe lambs had full pedigree records including birth type, age and liveweight at breeding plus records of the birthweight and survival of their offspring and the dam. The average liveweight and age at breeding was 40.2 kg and 228 days. The reproductive rate and weaning rate responses to liveweight at breeding were curvilinear (p < 0.001), and if ewe lambs achieved 45 kg by the start of breeding, their reproductive rate and weaning rate were within 5% of their maximum. By contrast, the effects of age at breeding on weaning rate was linear and increased by 0.4% per day, despite a quadratic (p < 0.01) effect of age at breeding on reproductive rate which increased only marginally when ewe lambs were older than 8 months at breeding. Increasing liveweight (p < 0.05) or age (p < 0.001) at breeding increased survival of their offspring, however an extra 10 kg of liveweight or 30 days of age at breeding increased offspring survival by less than 5%. Both liveweight (p < 0.001) and age (p < 0.01) at breeding also influenced survival of the ewe lamb dam but survival rates exceeded 95% across the range in liveweights from 30 to 55 kg and ages from 6 to 9 months. This understanding of the trade-off between age and liveweight at breeding will assist farmers to optimize the management of their ewe lambs, given the earlier they can be bred successfully the easier they can be integrated with the breeding of the adult ewe flock the following year

Understanding lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London: a qualitative study protocol.

INTRODUCTION: It is important to promote resilience in preadolescence; however, there is limited research on children's understandings and experiences of resilience. Quantitative approaches may not capture dynamic and context-specific aspects of resilience. Resilience research has historically focused on white, middle-class Western adults and adolescents, creating an evidence gap regarding diverse experiences of resilience in middle childhood which could inform interventions. East London's Muslim community represents a diverse, growing population. Despite being disproportionately affected by deprivation and racial and cultural discrimination, this population is under-represented in resilience research. Using participatory and arts-based methods, this study aims to explore lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London. METHODS AND ANALYSIS: We propose a qualitative study, grounded in embodied inquiry, consisting of a participatory workshop with 6-12 children and their parents/carers to explore lived experiences and perceptions of resilience. Participants will be identified and recruited from community settings in East London. Eligible participants will be English-speaking Muslims who identify as being black or South Asian, have a child aged 8-12 years and live in East London. The workshop (approx. 3.5 hours) will take place at an Islamic community centre and will include body mapping with children and a focus group discussion with parents/carers to explore resilience perspectives and meanings. Participants will also complete a demographic survey. Workshop audio recordings will be transcribed verbatim and body maps and other paper-based activities will be photographed. Data will be analysed using systematic visuo-textual analysis which affords equal importance to visual and textual data. ETHICS AND DISSEMINATION: The Queen Mary Ethics of Research Committee at Queen Mary University of London has approved this study (approval date: 9 October 2023; ref: QME23.0042). The researchers plan to publish the results in peer-reviewed journals and present findings at academic conferences

Film as architectural theory

Publications on architectural theory have predominantly taken on the form of text-based books, monographs, and articles. With the rise of transdisciplinary and practice-based research in architecture, new opportunities are opening up for other forms of architectural theory, such as film-based mediums, which promise to expand and alter the convention of the written practice of theory. Two possible types of filmic theory are presented here. One follows the method of ethnographic documentary filmmaking inspired by Sarah Pinkfilm-based mediums, which promise to expand and alter thellows the line of art house filmmaking inspired by Kathryn Rameyyn Rameyg inspired by Sarah Pinkfilm-based mediums, which promise to expand ae to expand ad mediums, which promise to expand a convention of the written practice of theory. or constructing knowledge, new discourses on filmic theory can be opened up. It is argued here that film as architectural theory is part of this new discourse, broadening the audience’u engagement with architecture through not only “readership” but also “viewership.

Understanding lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London: a qualitative study protocol

Supplementary materials: Supplementary Data are available online at: https://bmjopen.bmj.com/content/14/4/e082346.info .ProtocolIntroduction: It is important to promote resilience in preadolescence; however, there is limited research on children’s understandings and experiences of resilience. Quantitative approaches may not capture dynamic and context-specific aspects of resilience. Resilience research has historically focused on white, middle-class Western adults and adolescents, creating an evidence gap regarding diverse experiences of resilience in middle childhood which could inform interventions. East London’s Muslim community represents a diverse, growing population. Despite being disproportionately affected by deprivation and racial and cultural discrimination, this population is under-represented in resilience research. Using participatory and arts-based methods, this study aims to explore lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London. Methods and analysis: We propose a qualitative study, grounded in embodied inquiry, consisting of a participatory workshop with 6–12 children and their parents/carers to explore lived experiences and perceptions of resilience. Participants will be identified and recruited from community settings in East London. Eligible participants will be English-speaking Muslims who identify as being black or South Asian, have a child aged 8–12 years and live in East London. The workshop (approx. 3.5 hours) will take place at an Islamic community centre and will include body mapping with children and a focus group discussion with parents/carers to explore resilience perspectives and meanings. Participants will also complete a demographic survey. Workshop audio recordings will be transcribed verbatim and body maps and other paper-based activities will be photographed. Data will be analysed using systematic visuo-textual analysis which affords equal importance to visual and textual data.Barts Charity, UK (charity number: 212563, project code: MRC&U0042)

Intensive community care services for children and young people in psychiatric crisis: an expert opinion.

BACKGROUND: Children and young people's (CYP) mental health is worsening, and an increasing number are seeking psychiatric and mental health care. Whilst many CYPs with low-to-medium levels of psychiatric distress can be treated in outpatient services, CYPs in crisis often require inpatient hospital treatment. Although necessary in many cases, inpatient care can be distressing for CYPs and their families. Amongst other things, inpatient stays often isolate CYPs from their support networks and disrupt their education. In response to such limitations, and in order to effectively support CYPs with complex mental health needs, intensive community-based treatment models, which are known in this paper as intensive community care services (ICCS), have been developed. Although ICCS have been developed in a number of settings, there is, at present, little to no consensus of what ICCS entails. METHODS: A group of child and adolescent mental health clinicians, researchers and academics convened in London in January 2023. They met to discuss and agree upon the minimum requirements of ICCS. The discussion was semi-structured and used the Dartmouth Assertive Community Treatment Fidelity Scale as a framework. Following the meeting, the agreed features of ICCS, as described in this paper, were written up. RESULTS: ICCS was defined as a service which provides treatment primarily outside of hospital in community settings such as the school or home. Alongside this, ICCS should provide at least some out-of-hours support, and a minimum of 90% of CYPs should be supported at least twice per week. The maximum caseload should be approximately 5 clients per full time equivalent (FTE), and the minimum number of staff for an ICCS team should be 4 FTE. The group also confirmed the importance of supporting CYPs engagement with their communities and the need to remain flexible in treatment provision. Finally, the importance of robust evaluation utilising tools including the Children's Global Assessment Scale were agreed. CONCLUSIONS: This paper presents the agreed minimum requirements of intensive community-based psychiatric care. Using the parameters laid out herein, clinicians, academics, and related colleagues working in ICCS should seek to further develop the evidence base for this treatment model