An investigation of radiation therapy peer group supervision in a metropolitan cancer centre

Objectives: To investigate radiation therapists' perceptions of participating in peer group supervision (PGS) and the effects of the COVID-19 pandemic on PGS. Method(s): Radiation therapists were introduced to PGS at an in-service facilitated by an employee assistance program representative. Nine volunteers were then placed into one of two PGS groups of similar experience levels. Groups met monthly for PGS sessions;and after six and 12 meetings each participant was sent a link to the 14-item Clinical Supervision Evaluation Questionnaire (CSEQ),1 three open-ended and three demographic questions. The study used both quantitative and qualitative methods. Result(s): Survey completion rates were 8/9 (88.9%) pre- and 6/7 (85.7%) post-COVID-19. Analysis of the CSEQ revealed that pre-COVID-19 seven participants (87.5%) and post-COVID-19 five participants (71.4%) had a positive experience with PGS. One (12.5%) and two (28.6%) participants pre- and post-COVID-19, respectively, stated that their experience was neither positive nor negative. The thematic data showed that the participants perceived PGS to assist with (i) feeling supported at work, (ii) developing an element of trust between group members, (iii) encouraging self-reflection, (iv) fostering an awareness of others, and (v) increasing problem-solving skills. Restrictions due to the COVID-19 pandemic led to fewer regular meetings, which had a negative impact on participants. Conclusion(s): Involvement in PGS within a radiation therapist setting has reportedly positively affected those involved. Regular access to a supportive, trusting team has enabled the participants to self-reflect and better troubleshoot work-related experiences.

Impact of COVID-19 on clinical supervision in radiography

When the World Health Organization formally declared COVID-19 a global pandemic, health care and education institutions around the world changed forever. COVID-19 had a significant impact on the clinical supervision of radiographers through severe restrictions to their clinical placement and the necessary conversion to online education delivery.1 The past impacts of COVID-19 have led to current problems in radiography practice including a wide gap in students' theory to practice. In order to address these past impacts and champion future change to prevent similar events from occurring, an analysis of the literature was performed to assess how COVID-19 has adversely impacted the three domains of clinical supervision in radiography. Formative supervision was negatively impacted by COVID-19 as studies reported reduced skill acquisition and preparedness for workforce from not only reduced clinical hours, but also the competing demands on supervisors.2 The 'restorative' domain of supervision was adversely impacted by reports of increased mental health issues among radiography students due to stress, isolation and the financial burden of COVID-19.3 The last domain impacted was 'normative supervision' from the lack of mental and financial support for students reported in multiple comprehensive studies. These highlighted the gap in communication between students, supervisors and universities.4 This unresolved organisation systemic issue requires higher education institutions and tertiary hospitals to better collaborate on structured pathways to support students through future pandemics. To champion change, we must honour the past impacts of COVID-19 on supervision to encourage further research towards improved supervision practice and better prepare for similar future pandemics.

Restorative clinical supervision: a chance for change but are we ready?

In the wake of the COVID-19 pandemic, nurses are experiencing increasing stress, burnout and mental health problems. The Advocating and Educating for Quality ImProvement (A-EQUIP) model of clinical supervision aims to support staff wellbeing, promote positive work cultures and improve patient care. Although a growing body of empirical evidence supports the positive impact of clinical supervision, several individual and organisational barriers may impede the implementation of A-EQUIP in practice. Organisational culture, staffing and workforce pressures all affect employees' ability to engage with supervision, and organisations and clinical leaders must consciously work to sustain lasting change.

Using a Delphi Technique to Define Primary Care Behavioral Health Clinical Supervision Competencies.

There is an increasing need for Primary Care Behavioral Health (PCBH) workforce development (i.e., increase in well-trained PCBH providers) given the growth of behavioral health (BH) integration into primary care, specifically at a time when behavioral health needs are increasing because of the COVID-19 pandemic (Kanzler and Ogbeide in Psychol Trauma 12(S1):S177-S179, https://doi.org/10.1037/tra0000761 , 2020). Therefore, it is imperative to provide current and future behavioral health clinical supervisors in primary care settings specific competencies, given there are no current competencies specific to clinical supervision within the PCBH Model. Using a Delphi process, the authors identified and reached expert consensus on competencies for BH clinical supervisors in primary care. A purposive sample (in: Patton, Qualitative evaluation and research methods, Sage, Newbury Park, 1990) of fifteen experts (n = 15) in PCBH clinical training and education evaluated quantitative and qualitative domains and specific competencies associated with PCBH supervision gathered during an initial in-depth qualitative interview. This was followed by two subsequent rounds of quantitative Delphi surveys to reach consensus. The response rates from our panel of experts were 100% (15/15) for all stages (interviews, round one and round two surveys). Three domains (Primary Care Knowledge, Clinical Supervisor Development, and Clinical Supervision Skills) were rated as essential for providing clinical supervision with PCBH for pre-licensure level learners. The development of competencies will further support BH clinical supervisor needs, professional development, and provide a concrete way to evaluate progress towards teaching and training excellence. This will also have a great impact on the development of the future BH workforce within primary care.

Girft in Action: Advanced Practice Physiotherapist and Advanced Practice Nurse Expertise Provides Valuable Triage and Assessment Clinics for Non-Urgent Rheumatology Referrals

Background/Aims Rheumatology referrals classified as non-urgent/routine are commonly non-inflammatory conditions or medically non-urgent and can have significant waiting times for appointments. These waits were further escalated by the COVID-19 pandemic. Early intervention for noninflammatory conditions can be crucial to good outcomes and long wait-times can have significant adverse impacts while appropriate care pathways are determined. Recent UK GIRFT recommendations include using non-medical health professional expertise in assessment and management pathways to support right place, right time, right care. This study evaluated effectiveness, impacts and patient experiences of Advanced Practice Physiotherapist (APP) and Advanced Practice Nurse (APN) Triage and Assessment Clinics for routine new referrals. Methods The non-urgent/routine referral waiting list was e-triaged by a Rheumatology APP and APN supported by clinical record searches. Patients were contacted by telephone to update on clinical status and appointment requirements determined. Triage criteria were applied to determine new referrals suitable for APP and APN Rheumatology clinics, which included low likelihood of inflammatory disease or new referrals for known diagnosis/stable conditions. Clinics were undertaken with collocated Consultant clinical supervision. Assessment findings were discussed and management agreed, or seen if needed. With waiting list attrition, clinics were expanded to include Consultantdetermined stable condition reviews and follow-up reviews for nonsuspected inflammatory disease. Results At 01 July 2021, 214 new routine referrals were waiting a Consultant appointment (n=103 over 2yrs). Since service initiation, clinic outcomes to date include: 69% (n=243/358) new routine referrals discharged to GP or directed to right pathway with information, advice and self-management resources;8% (n=29) escalated to urgent;3% (11/358) with medical complexity remained on Consultant waitlist. Most common presentations seen included: Osteoarthritis (general or hand);Back and other spinal pain;Fibromyalgia;Persistent Fatigue and Widespread Pain;JHS/hEDS;Positive ANA without clinical features;Musculoskeletal conditions- other. To date, no patients have been re-referred and 329 new patient and 89 follow-up Consultant direct consultations have been spared. There is currently no wait-time for non-urgent/routine appointments. Patient experience feedback on the service has offered a 100% recommendation to continue and expressed highly positive experiences with the MDT approach. Patients value the breadth of expertise and care support, and the timely, thorough and professional service provided. Conclusion Rheumatology non-urgent/routine new referrals with low probability of underlying autoimmune conditions may be effectively and efficiently managed in a collaborative model using an advanced practice physiotherapist and nurse. This innovation has expanded a traditionally medical pathway to an MDT model utilising value-adding nonmedical expertise in service delivery. It has enhanced interdisciplinary learning and is a valued, collaborative approach to patient care. The initiative provides support to GIRFT recommendations of using an MDT skill-set to support improved patient access, service efficiencies and earlier intervention.

Cultivating support during COVID-19 through clinical supervision: A discussion article.

AIM: This article aims to discuss how clinical supervision is an important approach in supporting frontline nurses and students during and post COVID-19 through the lens of the nursing metaparadigms. DESIGN: Discussion article. METHODS: Discourse of the literature considering the importance of working collaboratively with healthcare and educational organisations in operationalising clinical supervision. RESULTS: The evidence base supporting clinical supervision as an effective support strategy for nurses exists, however, its implementation and practice has become sporadic. A resurgence is required to support student's and nurse's during this pandemic. It is timely for nurse educators to creatively engage with clinical partners in supporting clinical supervision to enhance both nurses and students pandemic practice experiences. Clinical supervision is proposed as one strategy to support and guide both nurses and students to develop, strengthen and challenge the effectiveness of their care during COVID-19.

Examining the impact of COVID-19 on supervisees' experiences of clinical supervision

The global pandemic, COVID-19, changed the clinical supervision landscape in professional psychology. Supervisees transitioned from in-person supervision, to virtual, or telesupervision, in some cases, with limited preparation. We used a mixed methods approach to evaluate supervisee experiences during the transition to telesupervision precipitated by the global pandemic and to provide a historical record of the impact of the pandemic on clinical training. We also assessed the relationship between the supervisory working alliance and attitudes toward telesupervision. Authors used consensual qualitative research-modified to analyze qualitative data from 324 participants. Data revealed categories of technology, organization and productivity, and communication and connection, as the top three challenges experienced by clinical supervisees. Supervisees reported flexibility and convenience and saving time and money, as the top two benefits of engaging in telesupervision during the pandemic. Quantitative data from 310 participants suggested a moderate, positive, relationship between supervisee perception of the working alliance and attitudes toward telesupervision. Implications for research, practice, and theory are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The global pandemic of COVID-19 shifted the clinical training of professional psychology students from in-person, to virtual, or telesupervision. Studying this particular historical event provides us with insights about the challenges and benefits of conducting telesupervision (a) on a wide scale, (b) for the first time for many professional psychology trainees, and (c) within the context of a global crisis that disrupted everyday protocols. By investigating the experiences of professional psychology trainees during this rare crisis, we are provided not only a starting point for developing best telesupervision practices overall but also best practices for clinical supervision during crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Design And Development Of an Individualised Training Program For Metastatic Breast Cancer (MBC) Nursing Incorporating Remote And Onsite Learning Experiences During A Pandemic

Problem statement: Those diagnosed with metastatic breast cancer (MBC) have complex supportive care needs and the Australian Government funded 30 new dedicated MBC nurse roles across Australia in 2019 to better meet these needs. A pilot training program was designed to meet the individual learning needs of these nurses to increase their level of expertise in MBC nursing. Initially this program was designed to be delivered in-person, however recurrent COVID-19 restrictions required a change of approach to enable remote participation. Method(s): An expert working group created a curriculum of 20 learning modules addressing key elements of MBC nursing. From these modules a bespoke training program was designed for each participant to address their identified learning needs based on the validated Cancer Nurse Self-Assessment Tool for Metastatic Breast Cancer (CaN-SAT-MBC) and baseline interviews. During the pilot program, four intakes of two nurses (n=8) participated from August 2021 to June 2022. Participants completed a suite of online learning modules, 'attended' a 3-day clinical practicum, and commenced 12 months of bi-monthly clinical supervision for ongoing support. Participants attended the clinical practicum component either in-person or via a telepresence robot. Knowledge, skills and confidence in relation to MBC nursing are being measured by the CaN-SAT-MBC, and learner goals, expectations and experiences are being explored via qualitative interviews at three-time intervals: pre-training;post-practicum;and 12 months post-clinical supervision. Result(s): The final results of the evaluation will be available in 2023. It is hypothesised that nurses will report increased knowledge, skills and confidence in the areas of MBC nursing relevant to their identified learning needs following completion of the training program. Furthermore, it is also hypothesised that remote participation using robot technology will offer an equivalent learning experience to in-person training in this current pandemic environment. Conclusion(s): This study will test an individualised and innovative approach to breast cancer nurse education that may be utilised across Australia to upskill nurses in the provision of supportive care to those with MBC. There is potential for wide-spread adoption of robot technology for cancer education across Australia and beyond. Disclosure of interest: This project is partially funded by Astra ZenecaCopyright © 2022

Perceptions of clinical supervision held by early-career social workers during times of extreme stress: A thematic analysis

This qualitative research study explores perceptions of post-masters, early-career social workers regarding their clinical supervisory relationships during the Covid-19 global pandemic. Twenty-one pre-licensed social workers were interviewed regarding experiences of how their supervisory relationships affected continued professional and personal development during the rapid transition to virtual social work and subsequent stressors of the pandemic. Relational, trauma, and intersectionality theories informed the study. Thematic analysis of the data suggested the presence of stress-related responses associated with the pandemic and shared communal traumas, such as police violence against Black people, anti-Asian hate and violence, and national political unrest. The ability of new social workers to talk openly about intersectionality and other social justice issues with their clinical supervisors created mutual trust, influenced their professional and personal identity development, and contributed to feelings of connection and support within the relationship during times of extreme stress created by the pandemic era. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Improving Patient Safety with Staff Wellbeing

Introduction: The wellbeing of hospital staff can influence the quality of patient care & safety. Following the recent COVID-19 pandemic, the longstanding issues of an overstretched & overstressed workforce within the UK National Health Service has been again highlighted. This has resulted in a renewed organisational drive to provide resources for staff health & wellbeing. Many of these are self-directed & targeted at helping the individual improve their management of external stress independently, but it has been acknowledged in the literature that local primary interventions to modify or eliminate stress to staff wellbeing must also be considered. Method(s): Staff feedback was obtained via informal interviews on the wellbeing interventions established in the local haemophilia service. Interventions evaluated included: The development of practice supporting Standard Operation Procedures (SOPs). DailyMDTwellbeing check during safety huddles. Clinical supervision time. Social interventions such as nutrition focuses, staff feedback methods & physical activity focuses. Result(s): Feedback demonstrates that social interventions implemented such as team building participation in the Haemophilia Society's Race Around the World, the HeamTeam Shoutout Board to recognise a colleague's accomplishment & offer the opportunity to show appreciation for their work, & the formation of weekly Soup & Scoop Clubs to encourage healthier eating in the department were all beneficial for staff's overall wellbeing. There was a greater sense of belonging within the team & improved interpersonal relations. The introduction of interventions such as the SOP & clinical supervision ensured staff were clear of roles & responsibilities, preventing missed opportunities to support patients and develop staff. The daily wellbeing check-in provided recognition and value of an individual's wellbeing. Discussion/Conclusion: The interventions instigated by the Sheffield Haemophilia and Thrombosis team required minimal resources & were not time commitment heavy, focusing on creating a wellness culture with regular, sustainable opportunities to engage in wellbeing conversation. However, a more comprehensive review is required to determine the long-term effects on patient care and safety outcomes.

Online Telesupervision: Competence Forged in a Pandemic

Online telesupervision (OTS) is synchronous (real-time) audio and video interactions between a supervisor and a clinician who are not in the same physical location. The COVID-19 pandemic created an abrupt pivot to OTS, requiring systemic supervisors and clinicians to adopt and utilize technologies which were unfamiliar to many. To facilitate the effective adoption and implementation of OTS we draw attention to three distinct competencies critical to the effective use of OTS: technological, contextual, and relational. These competencies are in no way exhaustive but lay the ground work for systemic supervisors to engage and connect with supervisees using video conferencing technology. In addition to the competencies, specific techniques and strategies are suggested to assist supervisors hone their skills in OTS and subsequently improve the quality and effectiveness of supervision in a virtual environment.

Examining the impact of COVID-19 on supervisees' experiences of clinical supervision

The global pandemic, COVID-19, changed the clinical supervision landscape in professional psychology. Supervisees transitioned from in-person supervision, to virtual, or telesupervision, in some cases, with limited preparation. We used a mixed methods approach to evaluate supervisee experiences during the transition to telesupervision precipitated by the global pandemic and to provide a historical record of the impact of the pandemic on clinical training. We also assessed the relationship between the supervisory working alliance and attitudes toward telesupervision. Authors used consensual qualitative research-modified to analyze qualitative data from 324 participants. Data revealed categories of technology, organization and productivity, and communication and connection, as the top three challenges experienced by clinical supervisees. Supervisees reported flexibility and convenience and saving time and money, as the top two benefits of engaging in telesupervision during the pandemic. Quantitative data from 310 participants suggested a moderate, positive, relationship between supervisee perception of the working alliance and attitudes toward telesupervision. Implications for research, practice, and theory are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The global pandemic of COVID-19 shifted the clinical training of professional psychology students from in-person, to virtual, or telesupervision. Studying this particular historical event provides us with insights about the challenges and benefits of conducting telesupervision (a) on a wide scale, (b) for the first time for many professional psychology trainees, and (c) within the context of a global crisis that disrupted everyday protocols. By investigating the experiences of professional psychology trainees during this rare crisis, we are provided not only a starting point for developing best telesupervision practices overall but also best practices for clinical supervision during crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Examining face-to-face and online supervisee disclosure within the supervisory alliance

The purpose of this research was to examine face-to-face and online supervisee disclosure within the supervisory alliance. Just as client care pivoted to online platforms, as a result of the COVID-19 pandemic, so did clinical supervision, which was uncharted territory for many, including those familiar with online counseling. The methodology used was consensual qualitative research (CSR). Eight participants were recruited as a sample of convenience, and semistructured interviews were conducted via Zoom. Results indicated domains such as important characteristics of the supervisory relationship, importance of communication, supervisor characteristics related to self-disclosure, positive aspects and negative aspects of online supervision, and positive and negative aspects of face-to-face supervision. In addition, relevant categories were identified. This study is relevant for counselors in training, counselor educators, and supervisors who are engaged in and considering online and face-to-face supervision. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu). (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Impact of the COVID-19 pandemic on student supervision and education in health care settings: A state-wide survey of health care workers.

OBJECTIVE: To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID-19 pandemic. BACKGROUND: Studies on the impact of COVID-19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks. METHODS: The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi-square tests. Free-text comments were analysed using content analysis. RESULTS: Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well-being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted. CONCLUSIONS: This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future-proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic.

Supervision in neuropsychology: Practical, ethical, and theoretical considerations

Clinical supervision is one of the primary means by which health service psychologists learn to provide clinical care to patients or clients. Clinical supervision has been conceptualized as an intervention that consists of a collaborative and evaluative relationship in which the supervisor monitors the professional services offered and serves as a gate keeper of those who are entering the profession. In the general fields of clinical and counseling psychology, supervision is one of the top five activities performed by psychologists. During the last three decades, the importance of clinical supervision has been recognized in clinical psychology in various ways. This book provides a detailed discussion of topics relevant to the provision of supervision in clinical neuropsychology for supervisors, training programs, and trainees who are learning how to supervise. Each chapter has been written by authors with extensive experience teaching and supervising trainees at all levels of training (i.e., practicum, internship, and postdoctoral residency). The specialty of neuropsychology has grappled with changes in clinical practice as a result of the COVID-19 pandemic. Social distancing and stay-at-home orders drastically altered the provision of services and escalated the conversation around tele-neuropsychology. The effects of the pandemic have also extended to supervision. Trainees have been faced with suspension of in-person patient care and a rapid shift to virtual supervision and didactics. Supervisors have needed to navigate the ethical and legal waters of providing supervision at a distance while ensuring that trainees are being appropriately supervised. On a more positive note, trainees are learning first-hand that their supervisors do not always have the answers and that learning is an ongoing aspect of being a neuropsychologist. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Could clinical supervision help us to support increasingly complex needs in the community?

This paper presents qualitative research exploring the benefits of clinical supervision for workers supporting people experiencing multiple disadvantages. The clinical supervision supported worker wellbeing, lessened compassion fatigue and created space for workers to think creatively, manage risk and develop trauma-informed and reflective practice. Clinical supervision may be one solution to the growing demand, more complex needs and higher stress, burnout and fatigue among workers faced by the voluntary sector following the COVID-19 pandemic.

Advanced practice and clinical supervision: An exploration of perceived facilitators and barriers in practice.

AIM AND OBJECTIVES: The aim of this study was to investigate current advanced practice Masters students' experience of clinical supervision, to explore how clinical supervision works in practice and to identify students' perceptions of the facilitators and barriers to clinical supervision in their workplace. BACKGROUND: Advanced practitioners, and in particular nurses, play a pivotal role in delivering health care across acute and primary care settings. These non-medical professionals fulfil a rapidly expanding proportion of roles traditionally undertaken by medically qualified staff within the National Health Service in the United Kingdom and often lead specialist clinics and services. To prepare for the advanced practice role, individuals are required to undertake a Master's in advanced practice to develop the required skills and knowledge and work in clinical practice with a clinical assessor/supervisor to demonstrate competence and performance. DESIGN: A mixed method study using an online descriptive cross-sectional survey and qualitative data were collected via focus groups and has been reported using the Good Reporting of a Mixed Methods Study checklist. RESULTS: A total of 79 students completed the online survey (from 145 AP students), a response rate of 55%. Most respondents were nurses (n = 73) with 49 (62%) in a formal advanced practice trainee role, and the majority believed their clinical supervisor had a good understanding of advanced practice and the advanced practice role. Two focus groups were held with 16 participants in total. Thematic analysis revealed five themes: (a) perceived level and amount of support from clinical supervisors, (b) skill level of clinical supervisors, (c) physicians and their perceptions on supervising, Advanced practitioners (d) clinical supervisors' preparation for the role and (e) transition from trainee to qualified advanced practitioner. CONCLUSION: The survey revealed that advanced practitioner students perceived that clinical supervisors and workplace colleagues had a good understanding of the advanced practice role with good levels of support in practice. A more coherent approach is required for clinical supervision and an implementation framework that can be formally evaluated. RELEVANCE TO CLINICAL PRACTICE: Several significant barriers to clinical supervision for advanced practitioner students were identified, and there are currently more barriers (including COVID-19) than facilitators.

Understanding Challenges to Wellbeing among Medical and Nursing Staff Working in Paediatric Critical Care: An Enhanced Critical Incident Technique Study

BACKGROUND AND AIM: Staff working in paediatric critical care (PCC) experience high levels of burnout, compassion fatigue and symptoms of post-traumatic stress. We aimed to identify critical incidents inside or outside work which challenged staff's wellbeing, what hindered and helped;to identify successful strategies for maintaining workplace wellbeing. METHOD(S): Using the Enhanced Critical Incident Technique, individuals were asked to reflect on situations which challenged their wellbeing and to provide wish list items that would improve their workplace wellbeing RESULTS: Seven themes were identified (n=53): Covid-19 represented a significant challenge to wellbeing, yet it stimulated positive conversations about vulnerability. Shiftwork was experienced as challenging, especially with an Ageing workforce. Being older though brought self-awareness of one's limits and successful wellbeing strategies. Clinical investigations were distressing, sometimes worsened by opaque procedures. Yet support from seniors was available and highly valued. Frustration with Leadership was expressed, but PCC were described as quick to innovate and act. Patient outcomes sometimes led to moral distress, but news about patients' successes post discharge was rewarding. Facilities were described as unsatisfactory, except for some well-maintained quiet spaces. Finally, personal circumstances (e.g. bereavement, relationship breakdown) impacted staff's ability to work productively, but friends and family provided much-needed respite. Wishlist items included: self-rostering, recognising the impact of ageing and menopause, transparent investigation protocols, psychological support, communication training, comfortable spaces. CONCLUSION(S): Threats to wellbeing are multifaceted, but largely predictable. Knowing this, we need to develop protocols, support packages, and training to better equip staff to manage wellbeing prior to crisis.