By Amber Bhardwaj, Catherine Byng & Zoë Morrice
Editorial Note from Julia Howe, Course Tutor
This is a slightly different blog post from those that we normally publish. It is a piece of work commission by Dudley Educational Psychology Service (EPS) from the Year 1 trainees on the initial training course for educational psychologists at the University of Birmingham. The trainees were asked to complete a Rapid Review of literature from previous epidemics in order to provide evidence based guidance for the EPS on how to support school staff during and after the current pandemic. As mentioned in the review this guidance has been extrapolated from research mainly conducted with health care workers and in this respect it needs to be treated with caution. It has not been peer reviewed but we hope that it is still useful in supporting the work of local authorities and other services. For the practical reason of length I have taken out the table that provides an overview of the research studies and their methodologies but I can provide this if you contact me.
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In light of Covid-19, this rapid literature review aims to examine what psychological support may be helpful for school staff during and after the pandemic. As there is very little evidence in relation to school staff this review will also examine the literature into what support is helpful for frontline healthcare workers during and following epidemics in order to consider how this can be applied to workers in other areas.
Summary of findings
Within the literature on how best to support staff during and after an epidemic, the key overarching principles were strengthening resiliency and empowerment by building on and mobilising existing resources. The literature identifies that within any support or intervention it is crucial to consider culture. This means that a ‘one size fits all’ approach would not be beneficial. Furthermore, the importance of a stepped approach was evident as the literature highlighted most individuals are highly resilient and do not require psychological intervention. Ensuring normal reactions to the situation, such as responses to grief and high stress, are not pathologized is therefore important. Key factors highlighted within these stepped approaches were first ensuring basic practical support needs were meet before considering emotional support.
The empowerment of individuals through the identification and development of coping/self-help strategies and psychoeducation about stress and anxiety, were evident within many papers. Furthermore, the importance of looking at the wider community systems in order to strengthen connectedness, belonging, and identify resources was highlighted. Social support was identified to be a key protective factor and measures implemented during epidemics such as social distancing were found to reduce social connectedness and support. Consideration of how to rebuild connectedness between families, friends, employers and colleagues is therefore important.
The most common programmes used within the literature to support frontline workers were Psychological First Aid and the Mental Health Gap Action Program (WHO, 2010). However, there is a distinct lack of evidence into the long-term outcomes of interventions in this area. So, some caution is necessary as there is not a clear understanding of how to intervene effectively.
In terms of how best to support workers during or following an epidemic from an organisational perspective the literature identifies key factors to be visible leadership, clear communication and open discussions, and building team cohesion. Furthermore, allowing individuals time to reflect and utilise peer support or supervision has been suggested as being helpful.
A needs assessment identifying what support individuals found helpful and what ongoing support staff would like may also be useful. Additionally, identification of individuals who may be ‘at risk’ of greater psychological difficulties to allow for monitoring and extra support if needed should be considered.
The literature indicates risk factors for greater psychological distress during or following an epidemic to be previous mental or physical health difficulties, personal impact of the epidemic (e.g. bereavement, loss of housing/income), low socio-economic status, and poor self-perceived social support. Finally, continual support for staff members development and learning, such as acknowledging reflective conversations as useful learning opportunities, is suggested to enhance resilience. Training staff on how to support others (e.g. peer support groups) has also been shown to not only support those receiving the help but also to be beneficial to the helpers’ wellbeing, however ensuring staff have an awareness of when to seek further help or supervision is key.
Based on the findings of this rapid literature review, the following recommendations for supporting frontline workers in the education sector have been provided:
Culture and context
- EPs will need to gain knowledge of the existing systems of support that are already in place in settings. This can be achieved through multi-agency working and collaboration with key stakeholders.
- Strong systems of support within the workplace during/after the pandemic may mitigate some of the potential adverse psychological outcomes for staff.
- It is important to understand the individual characteristics of the staff who do require support, whilst also taking into consideration the complex dynamics of the organisation’s culture.
- EPs should encourage visible leadership, clear communication and open discussions within settings, to enhance team cohesion.
Organisation and individual factors
Peer support/supervision and rebuilding connectedness
- EPs should support leadership to provide staff with the time to reflect on experiences, offer opportunities for ongoing peer support, and praise staff for their response to the situation.
- If appropriate to the setting, EPs should consider setting up weekly peer support groups to create a safe space for staff to discuss emerging issues in the wake of the COVID-19 pandemic.
- Peer support groups may also incorporate discussions and exercises with staff that focus on the development of coping strategies and enhancing resilience, to minimise the risk of burnout.
- It may be necessary for EPs to facilitate open discussions between staff and senior leaders to encourage reciprocity of decision-making within organisations and encourage sensitivity to ethical and cultural considerations.
- EPs should make use of the technology available to stay connected with schools, social workers and families throughout the period of social distancing and look to strengthen social connectedness within and between settings.
Assessment of individual needs
- Individual and psychological support should be offered to members of staff who are considered to be ‘at-risk’ of greater psychological difficulty, and who may be displaying maladaptive responses/ coping strategies.
- Factors that may place an individual at greater risk are; bereavement or illness of a relative or close friend, exposure to the COVID-19 outbreak at work, perceived level of risk at work, being quarantined, loss of housing/income, lower socio-economic status, and poor self-perceived social support.
- For individuals requiring psychological support, action plans will need to be holistic, informed by evidence and make use of implementation strategies that are focused on sustainable, long term outcomes.
- EPs will need to ensure they are only delivering mental health care that is within the boundaries of their competence. It may prove worthwhile for the whole service to engage in Psychological First Aid training.
Resiliency and empowerment
- It will be important to consider how staff resilience can be continually promoted to develop protective factors that will facilitate personal empowerment and the ability to cope with both the personal and professional challenges of living and working through a time of crisis.
- EPs can support leadership teams to encourage help-seeking amongst their staff and promote continual learning and development to enhance staff resilience.
- It may be useful for EPs to determine suitable interventions to enhance staff resilience e.g. Psychological First Aid, and tailor these approaches to school staff.
- EPs should consider both the personal and professional burdens of school staff to establish the area of greatest need (e.g. practical vs personal) before planning an intervention.
- Consultation, review and responsiveness should be embedded into the decision- making process before any intervention is carried out/continued, and ongoing evaluations conducted to ensure best practice is being achieved.
- Formal psychological intervention should take a stepped approach. This includes ensuring basic practical needs are met before considering emotional support. This type of approach is addressed through the Psychological First Aid program.
Psychological First Aid (PFA)
- PFA provides a programme of interventions that can be utilised by EPs to support staff and pupils during and after the pandemic e.g. building social support, normalising grief.
- It may be appropriate for experienced EPs to train school staff and to deliver PFA within their own settings, incorporating interventions that focus on self-help/ coping strategies that can be used in their work to support one another.
- Using a ‘train the trainer’ approach (EPs training school staff) may help staff by empowering them, as well as benefiting pupils.
- EPs could offer supervision and/or facilitate the set-up of peer support networks within settings, e.g. buddy systems, to ensure staff who are implementing PFA have connection with social supports.
- Important aspects of PFA may include supporting with/ teaching self-help strategies (e.g. relaxation techniques), practical support, psychoeducation about COVID-19, looking at community systems, normalisation of an anxiety response and knowing when to seek further help.
We searched the literature using a range of databases including PubMed, Google Scholar & FindIt@Bham. We used the key words keywords “Ebola” OR “SARS” OR “MERS” OR “Covid-19”AND “Mental health” OR “Intervention” OR “Mental health intervention” OR “Psychological intervention” OR “Psychosocial intervention” OR “Social intervention” OR “Mental health program” AND “Frontline worker” OR “Frontline staff” OR “Education” OR “Teachers”.
Studies were included if they addressed the mental health of frontline staff. Studies focused on children or patient groups were excluded. We included any type of study design, report or review and included guidance from major organisations involved in responses to epidemics and pandemics such as the World Health Organisation.
The findings and guidance in this review needs to be viewed with caution because of the short timeframe and the less systematic approach to searching the literature. The synthetisation of evidence in this rapid review is not as rigorous as a systematic review would be. This may mean that evidence has been missed as our search is not as comprehensive as a systematic review. Our findings also need to be interpreted cautiously as we have extrapolated the data from frontline workers, usually healthcare workers during and after previous epidemics and used the findings to offer guidance to support school staff and social workers during the current pandemic. It may not be appropriate to extrapolate the data from one population to another. Some of the literature included was guidance from major organisations based on psychological principles but was not rigorous evidence based on experimental studies which may limit some of our findings.
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