Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs ('Resilience Hubs') using normalisation process theory

Objectives Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic. Design Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach. Setting Three Resilience Hubs in the North of England. Participants Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63). Results Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs. Conclusions Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context

A service mapping exercise of four health and social care staff mental health and wellbeing services, Resilience Hubs, to describe health service provision and interventions

Background: NHS England funded 40 Mental Health and Wellbeing Hubs to support health and social care staff affected by the COVID-19 pandemic. We aimed to document variations in how national guidance was adapted to the local contexts of four Hubs in the North of England.Methods: We used a modified version of Price’s (2019) service mapping methodology. Service level data were used to inform the analysis. A mapping template was adapted from a range of tools, including the European Service Mapping Schedule, and reviewed by Hub leads. Key data included service model; staffing; and interventions. Data were collected between March 2021 – March 2022 by site research assistants. Findings were accuracy-checked by Hub leads, and a logic model developed to theorise how the Hubs may effect change.Results: Hub goals and service models closely reflected guidance; offering: proactive outreach; team-based support; clinical assessment; onward referral, and rapid access to mental health support (in-house and external). Implementation reflected a service context of a client group with high mental health need, and high waiting times at external mental health services. Hubs were predominantly staffed by experienced clinicians, to manage these mental health presentations and organisational working. Formulation-based psychological assessment and the provision of direct therapy were not core functions of the NHS England model, however all Hubs incorporated these adaptations into their service models in response to local contexts, such as extensive waiting lists within external services, and/or client presentations falling between gaps in existing service provision. Finally, a standalone clinical records system was seen as important to reassure Hub users of confidentiality. Other more nuanced variation depended on localised contexts.Conclusion: This study provides a map for setting up services, emphasising early understandings of how new services will integrate within existing systems. Local and regional contexts led to variation in service configuration. Whilst additional Hub functions are supported by available literature, further research is needed to determine whether these functions should comprise essential components of staff wellbeing services moving forward. Future research should also determine the comparative effectiveness of service components, and the limits of permissible variation.Study registration: researchregistry6303.</p

A service mapping exercise of four health and social care staff mental health and wellbeing services, Resilience Hubs, to describe health service provision and interventions

Background: NHS England funded 40 Mental Health and Wellbeing Hubs to support health and social care staff affected by the COVID-19 pandemic. We aimed to document variations in how national guidance was adapted to the local contexts of four Hubs in the North of England. Methods: We used a modified version of Price’s (2019) service mapping methodology. Service level data were used to inform the analysis. A mapping template was adapted from a range of tools, including the European Service Mapping Schedule, and reviewed by Hub leads. Key data included service model; staffing; and interventions. Data were collected between March 2021 – March 2022 by site research assistants. Findings were accuracy-checked by Hub leads, and a logic model developed to theorise how the Hubs may effect change. Results: Hub goals and service models closely reflected guidance; offering: proactive outreach; team-based support; clinical assessment; onward referral, and rapid access to mental health support (in-house and external). Implementation reflected a service context of a client group with high mental health need, and high waiting times at external mental health services. Hubs were predominantly staffed by experienced clinicians, to manage these mental health presentations and organisational working. Formulation-based psychological assessment and the provision of direct therapy were not core functions of the NHS England model, however all Hubs incorporated these adaptations into their service models in response to local contexts, such as extensive waiting lists within external services, and/or client presentations falling between gaps in existing service provision. Finally, a standalone clinical records system was seen as important to reassure Hub users of confidentiality. Other more nuanced variation depended on localised contexts. Conclusion: This study provides a map for setting up services, emphasising early understandings of how new services will integrate within existing systems. Local and regional contexts led to variation in service configuration. Whilst additional Hub functions are supported by available literature, further research is needed to determine whether these functions should comprise essential components of staff wellbeing services moving forward. Future research should also determine the comparative effectiveness of service components, and the limits of permissible variation. Study registration: researchregistry6303

Eye movement desensitization and reprocessing (EMDR) facilitating rational emotive behaviour therapy (REBT) in the treatment of test anxiety

Thesis (MA)--Stellenbosch University, 1998.ENGLISH ABSTRACT: Recent research in psychotherapy reflects the development of a pragmatic eclecticism. This new eclecticism also fits into the growing perception that relevant aspects of different schools of thought can be brought together to develop more balanced, holistic scientific models of psychoth~rapy. The purpose of this study was to determine whether an eclectic psychotherapeutic approach, combining Rational Emotive Behaviour Therapy (REST) and Eye Movement Desensitization and Reprocessing (EMDR), would lead to a more effective therapy for the treatment of test anxiety than Rational Emotive Behaviour Therapy (REBT) alone. A group of six undergraduate university students receiving only REST, was compared to a similar group of students that received a combination of REST and EMDR, as well as to a control group of six students. Five group sessions of REST as well as one individual session of REST or EMDR were presented over a period of three weeks. The level of test anxiety, the dependant variable of this study, was measured before and after the respective psychotherapeutic interventions, as well as at follow-up. As an outcome measure of the in vivo levels of test anxiety of the participants in the two treatment groups, a theoretical test of the REST rationale was also administered. The REST treatment and the combination of REST and EMDR treatment both succeeded in significantly reducing test anxiety. The results of the combined treatment however, were not significantly better than that of the REST group. There was a statistical tendency to a greater reduction in test anxiety with the REST treatment alone, than with the REST and EMDR combined.AFRIKAANSE OPSOMMING: Onlangse navorsing in psigoterapie reflekteer die ontwikkeling van 'n pragmatiese eklektisisme. Die nuwe eklektisisme pas in die groeiende persepsie dat relevante aspekte van verskillende denkskole saamgevat moet word om meer gebalanseerde, holistiese wetenskaplike modelle van psigoterapie daar te stel. Die doelstelling van hierdie studie was om vas te stel of 'n eklektiese psigoterapeutiese benadering, wat Rasioneel Emotiewe Gedrags Terapie (REST) en Oogbeweging Desensitisasie en Herprosessering (EMDR) kombineer, meer effektief is in die behandeling van toetsangs as wanneer Rasioneel Emotiewe Gedrags Terapie (REST) alleen aangebied word. 'n Groep van ses voorgraadse universiteitstudente wat slegs REST ontvang het, is vergelyk met 'n soortgelyke groep wat beide REST en EMDR ontvang het, sowel as met 'n kontrole groep van ses studente. Vyf groepsessies van REST, sowel as een individuele sessie van REST of EMDR is oor 'n tydperk van drie weke aangebied. Die mate van toetsangs, die afhanklike veranderlike van die studie, is voor en na die psigoterapeutiese intervensies, sowel as met 'n opvolgmeting bepaal. As 'n uitkomsmeting van die mate van toetsangs wat in vivo voorkom, is 'n kennistoets van die REST rasionaal ook afgeneem. Die REST behandeling alleen en die kombinasie van REST en EMDR het beide aanleiding gegee tot 'n betekenisvolle afname in die toetsangs. Die resultate van die gekombineerde behandeling was egter nie betekenisvol beter as die resultate wat verkry is waar die REST alleen aangebied is nie. Daar was wel statistiese aanduidings dat die REST benadering alleen tot grater vermindering in die vlak van toetsangs aanleiding gegee het as die kombinasie van REST en EMDR

A National Process to Enhance the Validity of Entrustment Decisions for Dutch Pediatric Residents

Background: Postgraduate medical education (PGME) has become increasingly individualized, and entrustable professional activities (EPAs) have been adopted to operationalize this. At the same time, the process and content to determine residents' progress using high-stakes summative entrustment decisions by clinical competency committees (CCCs) is not yet well established. Objective: We evaluated the experiences with a structured process for assessment of EPAs to attain uniform summative entrustment decisions for a national sample of pediatric residents. Methods: An EPA-based national PGME program for pediatric residents was introduced in the Netherlands, including a process of uniform summative entrustment decisions, termed the Evaluation and Assessment of Residents by Supervisors (EARS) procedure. To evaluate the program, we assessed survey data and information from invitational conferences. Results: Beginning in January 2017, 125 pediatric residents in all 8 Dutch residency regions started training in the EARS program. The program enabled robust summative entrustment decisions. Preliminary data suggested that faculty, despite increased preparation time, appreciated the comprehensive appraisal of resident qualifications. The EPA-based program was well accepted by residents. Fifty-one percent (57 of 112) had at least 2 EARS procedures per year, and for 75% (84 of 112) the level of supervision was often or always adjusted to their level of training. Conclusions: A national EPA-based program provided a structured process for summative entrustment decisions by CCCs and enabled individualized stepwise progression of residents toward unsupervised practice. Broader application of these concepts may require adaptations to accommodate different health care systems and specialties

Mortality risk in atrial fibrillation : the role of aspirin, vitamin K and non-vitamin K antagonists

Background As an alternative to vitamin K antagonist and low-dose aspirin ( 2). Conclusion Non vitamin K oral anticoagulants are associated with a higher risk on all-cause mortality, particularly in men and in patients with higher stroke risk

Mortality risk in atrial fibrillation: the role of aspirin, vitamin K and non-vitamin K antagonists

Background As an alternative to vitamin K antagonist and low-dose aspirin ( 2). Conclusion Non vitamin K oral anticoagulants are associated with a higher risk on all-cause mortality, particularly in men and in patients with higher stroke risk.ISSN:2210-7703ISSN:0928-1231ISSN:2210-771

An analysis of the costs and treatment success of etanercept in juvenile idiopathic arthritis: results from the Dutch Arthritis and Biologicals in Children register

Objective. To analyse and report the costs and effects of etanercept therapy in patients with JIA. Methods. Forty-nine JIA patients were evaluated by means of the JIA core set at the start of etanercept and after 3, 15 and 27 months of therapy. At the same time-points, parents of the patients were asked to complete the Health Utility Index Mark 3 (HUI3). Direct medical costs were collected for 1 year before and 27 months after the start of etanercept and compared with gain in utility. Results. Mean total direct medical costs after the start of etanercept were on average 12 478 euros per patient-year compared with 3720 euros before start. The cost analysis showed that three-quarters of total direct medical costs were from etanercept itself. Other direct medical costs, such as costs concerning hospitalization and concomitant medication, decreased compared with the costs in the period before start of etanercept. Especially a great reduction of consultations at the outpatient clinic was seen. Utility was 0.53 before start of etanercept, according to the multi-attribute utility function of the HUI3 on a scale from 0 (dead) to 1 (perfect health). After 27 months, utility was 0.78. In accordance, also all JIA core set response variables improved significantly over 27 months of etanercept treatment. Conclusions. Although costs of etanercept therapy are substantial, the gain in utility is even more impressive. Considering that these JIA patients were previously refractory to conventional treatment including MTX, and were at risk of long-time disability and pain, costs are justifiable

Mortality risk in atrial fibrillation: the role of aspirin, vitamin K and non-vitamin K antagonists

Background As an alternative to vitamin K antagonist and low-dose aspirin ( 2). Conclusion Non vitamin K oral anticoagulants are associated with a higher risk on all-cause mortality, particularly in men and in patients with higher stroke risk