An iterative approach to promoting departmental wellbeing during COVID-19.

RATIONALE, AIMS, AND OBJECTIVES: Addressing wellbeing among learners, faculty, and staff during the COVID-19 pandemic is a challenge for many clinical departments. Continued and systemic supports are needed to combat the pandemic's impact on mental health and wellbeing. This article describes an iterative approach to conducting a needs assessment and implementing a COVID-19-related wellness initiative in a psychiatry department. METHODS: Development of the initiative followed the Plan-Do-Study-Act (PDSA) quality improvement cycle and was informed by Shanafelt and colleagues' framework for supporting healthcare workers during the COVID-19 pandemic. Key features included the establishment of a Wellness Working Group, the curation of relevant resources on the Department's website, and the deployment of regular, monthly surveys that informed the creation of further supports, such as a weekly online drop-in support group. RESULTS: Survey response rates ranged from 22% to 32% (n = 90-127) throughout our initiative. Across multiple surveys, approximately 80% of respondents reported feeling supported or very supported by the Department, and 90% were satisfied or very satisfied with the quantity and quality of information provided. Our support group and resources page were accessed by nearly one-quarter and one-third of respondents, respectively, with satisfaction rates of 81% or higher. Consistent with the Department's mandate, ensuring equity was a key focus of the Working Group throughout its operations. CONCLUSIONS: There is potential for this model to be scaled to create a faculty-wide, institution-wide, or regional approach to addressing wellbeing. Other departments may also wish to adopt similar approaches to supporting their members during this challenging time.

A Qualitative Investigation of Burnout and Well-being Among Faculty and Residents in a Canadian Psychiatry Department.

OBJECTIVE: This study used semi-structured interviews with faculty and residents in psychiatry to inform a qualitative, process-based understanding of well-being and related concepts, as well as to identify and critically explore strategies for maintaining well-being in psychiatry. METHODS: Using interpretive description as a qualitative research methodology, semi-structured phone interviews were conducted with 12 faculty (nine clinical and three non-clinical) and five residents in a Canadian psychiatry department between September and December 2019, prior to the onset of the COVID-19 pandemic. Interviews were transcribed, coded, and subsequently analyzed for themes by the research team. RESULTS: Fourteen women and three men completed the study, consisting of nine faculty members, five psychiatry residents, and three non-clinical PhD scientists. Four themes were developed from the interview data: (1) The nature of working in academic psychiatry, (2) professional identity as a double-edged sword, (3) feelings of isolation and powerlessness in the system, and (4) strategies to support well-being. CONCLUSION: In the absence of many qualitative perspectives on well-being in academic psychiatry, the findings of this study can be used as a first step to inform future interventions and meaningful institutional change around well-being in psychiatry. The findings may help to enable conversations about well-being that embrace humanity and vulnerability as essential components of professional identity in psychiatry and provide opportunities for open discussion and support.

A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response.

Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents' understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.

LIVES for families psychological first aid training programme to address COVID-19 psychological distress: a mixed methods acceptability and feasibility protocol.

INTRODUCTION: Best practice approaches for addressing COVID-19-related psychological distress among young people (<25 years) and their families remain unclear. Psychological first aid (PFA) is promoted by public health authorities to provide psychological support in the context of extreme events; however, there is limited evidence for its effectiveness. As a prerequisite to conducting a randomised controlled trial to examine programme effectiveness, this project is evaluating the acceptability and feasibility of implementing and evaluating a PFA training programme ('LIVES for Families') for mental health (MH) practitioners to improve their ability to recognise and respond to COVID-19-related psychological distress among their clients. METHODS AND ANALYSIS: We are using a triangulation mixed methods research design; complementary strands of quantitative and qualitative data are being collected in parallel and will be merged at the interpretation phase of the project. The quantitative strand uses a repeated measures design; a consecutive sample of MH practitioners (n=80) providing MH support to young people or their families are being recruited to participate in the LIVES for Families PFA training programme and complete quantitative measures at baseline (pretraining), 2-week and 6-month follow-up time points. The qualitative strand uses fundamental description and semistructured interviews with a subset of practitioners (n=30), as well as managers of MH agencies (n=20). A mixed methods joint display and associated narrative will generate a comprehensive understanding regarding acceptability and feasibility. ETHICS AND DISSEMINATION: The Hamilton Integrated Research Ethics Board approved the study (project number: 11295). Results will be shared broadly with the policy and practice community through publications, presentations and public webinars. As a brief, evidence-informed intervention, the LIVES for Families PFA training programme is suitable in its mode of delivery across care settings. The outcomes of this study could have international implications for mitigating the MH impacts of viral pandemics.