A multi-levelled evidence-based creative psychological intervention to support NHS clinical staff affected by the COVID-19 pandemic: a feasibility study

The aim of this study is to evaluate a multi-levelled evidence-based creative psychological intervention developed for the recovery of NHS clinical staff affected by Covid-19. Its feasibility will be established at the Royal Liverpool Hospital i.e. Liverpool University Hospitals NHS Foundation Trust in the first instance, before seeking NIHR funding (Health Services and Delivery Research) for cascading useful outcomes to four more NHS Trust in the North West.

The study responds to the reported psychological risks of NHS staff during the pandemic and the call for action highlighted in the Lancet Psychiatry positioning paper (Holmes et al 2020). The Health and Wellbeing NHS National Framework (HEE 2018) suggests that multi-levelled, evidence-based psychological interventions are needed to address the needs of the workforce. It is expected that creative methods will support engagement, enable non-verbal opportunities for recovery and contribute towards the attractiveness, acceptability, and value of the intervention.

The intervention was originally developed as part of the Arts for the Blues project within IAPT services for patients with depression. In collaboration with colleagues responsible for the wellbeing of staff and service improvement in the NHS, this intervention was diversified to meet the current needs of staff affected by the pandemic.

This new intervention will be evaluated as follows:

Stage A: The psychological needs of NHS clinical staff in the selected trust will be identified through semi-structured interviews with 2 key informants (N=2).

Stage B: The intervention will be adapted to meet the workforce needs identified in Stage A, informed by existing research in the use of creative methods in psychotherapy (Arts for the Blues project) and PPI input. Both prevention and treatment will be targeted, developing options for both in-person and remote delivery. The intervention will have three levels:
1. creative tasks/sessions for the whole organisation;
2. creative psychoeducational workshops with teams (and;
3. creative psychotherapy sessions with individuals in a group.

Stage C: The feasibility of the study in the selected NHS trust will be explored over a period of 3 months. The perceived value of the intervention and acceptability in terms of recruitment, research methods, and numbers of participants will be explored. A minimum of 30 staff at level 1 (n=30), 15 staff at level 2 (n=15) and 8 staff at level 3 (n=8) will be recruited. Process evaluation will include diaries, reflective notes and attendance records. Outcome evaluation will include a brief evaluation form and the Moral Distress Thermometer for all participants. Brief standardised questionnaires will also be used before and after the intervention (level 2: BRCS, WHO-5; level 3: IES-R, PHQ-9, GAD-7) along with focus groups (level 2) and one-to one interviews (level 3). A 3-month follow up collection of quantitative data will take place to assess any long-standing impact of the intervention for the participants.