The iHV Emotional Wellbeing at Work Champions Programme: Building capacity to protect and enhance the emotional wellbeing of the health visiting workforce in the UK.

The Institute of Health Visiting (iHV) Emotional Wellbeing at Work Programme was developed during the COVID-19 pandemic to support the health visiting services to deal with the increased demands placed on them. This paper discusses the development of the iHV Emotional Wellbeing at Work (EWW) Champions Programme, which has built on the original model to enable the creation of EWW Champions. The iHV has a good track record of building leadership and capacity for rolling out training and development on a wider scale using the iHV Champions model of training. The portfolio currently includes a range of Perinatal and Infant Mental Health Champions (Baldwin and Kelly, 2016; Baldwin et al., 2018) [1,2], Research Champions (Mugweni et al., 2019) [3], Delivering Different News Champions, Healthy Weight and Healthy Nutrition Champions, Changing Conversations: Autism Ambassadors, and Neonatal Families Ambassadors. This paper discusses how the EWW programme was further developed to create this Champions' model to enable other experienced and skilled health visitors to become EWW facilitators. Through this model, trained health visitors can support their colleagues in the workplace, protecting and enhancing their emotional wellbeing at work and broadening access to support services and resources.

Background

Following the first COVID-19 wave, health visitors across the country reported increased levels of stress, resulting from higher workload demands, increased levels of vulnerability within families, redeployment of team members, and concerns about the lack of personal protective equipment (PPE) and their own safety [4,5]. Conti and Dow [6] reported the negative impacts to the physical health of the workforce including poor sleep as well as unhealthy behaviours for managing stress, such as drinking more alcohol and comfort eating. The health visiting service was already depleted prior to the COVID-19 pandemic following year-on-year cuts to the public health grant and a 31% reduction in health visitors since 2015 [5] resulting now in an estimated national shortage of 5000 health visitors [7,8]. The wellbeing needs of this professional group needs to be adequately supported especially as this is a workforce that was already experiencing high levels of stress prior to the pandemic.

In recognition of the importance of supporting the wellbeing of healthcare staff being paramount to the delivery of high-quality care [9], the iHV developed a virtual group programme to support the emotional wellbeing of health visiting team members. The ‘Emotional Wellbeing at Work Programme’ was funded by the RCN Foundation and based on the key principle of ‘Every Mind Matters’ [10]. It uses a number of reflective, restorative, solution-focused and strengths-based approaches that mirror the work of health visiting teams in providing a space for compassion, safety, being heard without judgement, validation, processing and reflection. The programme model incorporates evidence-based strategies, and the development of the programme has previously been reported [11].

The EWW programme was implemented in two phases between October 2020–January 2021. The programme consisted of six interactive sessions facilitated by two experienced and skilled facilitators, with the first half of each session conducted as a ‘whole group’ session, followed by ‘break out’ sessions into two smaller groups. Full evaluation of this programme was undertaken involving 59 health visiting team members (health visitors, team leads, community nurses, student health visitors and nursery nurses) from England, Scotland, Wales and the Channel Islands. Evaluation data showed that the programme was valued by those who attended, with improvements to the average scores across three validated scales measuring mental wellbeing, perceived stress and professional quality of life [12]. Qualitative data suggested positive outcomes relating to having a ‘safe space’ to discuss and reflect on own difficulties; learning techniques to improve mental health and wellbeing; improved resilience and coping mechanisms; and feeling supported by colleagues.

Following the evaluation of both phases of the programme, a logic model was developed (Fig. 1) to explain how the activities undertaken by the programme contributed to the intended outcomes outlined in the previously reported ‘theory of change’ (ToC) [11]. A ToC provides a comprehensive description and illustration of how and why a desired change is expected to happen in a particular context [11], which was developed during the planning stages of the initial EWW programme and informed the key questions for evaluation reported in a previous paper [12].

Fig. 1

Logic model for the Emotional Wellbeing at Work virtual programme.

A logic model is “a graphic description of a system and is designed to identify important elements and relationships within that system”. [13], p−34 In other words, the logic model is a diagrammatic representation of the causal pathways of the programme which includes the intervention, programme activities, outputs, outcomes and impacts. The process of developing a logic model helped to understand the factors affecting behaviour and the multiple levels of influence (such as individual, interpersonal, organisational, community and public policy). While the ToC [11] provides an overview and summarises the intervention at a strategic level, the logic model illustrates understanding of the change process at implementation level, focusing on specific pathways within the theory of change.

Development and implementation of the EWW Champions Programme

The EWW programme was further developed to create a Champions’ model. This model presents a sustainable approach, offering participants the opportunity to experience the iHV EWW programme themselves and develop skills to go on to cascade the Emotional Wellbeing at Work sessions to their colleagues in group formats using the resources provided.

The content of this programme includes the original six sessions, all delivered using a virtual meeting platform (1. Introduction, stigma and mental health, strengths and threats to wellbeing; 2. Relationships at work and finding support; 3. Mindfulness and self-compassion; 4. Giving, gratitude and tolerating emotions; 5. Racial/cultural identity and inclusivity; 6. Growth mindsets and goal setting), plus additional sessions focused on preparing Champions to plan, deliver and evaluate the EWW programme that they deliver to their colleagues in their organisation. These additional sessions incorporate facilitation skills and group processes (including safeguarding in the context of a professional group). There is also particular focus on person-centred facilitation using solution-focused coaching questions, modelling and enabling reflective function in groups and recognising/exploring our own drive to fix and rescue others.

Participants receive individual supervision sessions to support them to establish and deliver their first EWW group which they will co-facilitate with another EWW Champion from their organisation. In addition, there are further three group supervision sessions where participants come together again to share their experiences of delivering the groups and engage in further reflection to explore any issues arising. Following these facilitated sessions, EWW Champions will be encouraged to continue with peer supervision with their set group and continue to access individual supervision through their employing organisation.

Participants of this programme have access to a range of resources to support the delivery of the sessions. The materials are accessible via a password-protected area of the iHV website and include an EWW Champions Training Manual covering key aspects of managing groups safely, as well as standardised PowerPoint slide sets and templates to utilise to initiate groups, recruit participants, deliver the sessions and evaluate their own groups.

This programme has been funded by the COVID-19 Health Care Support Appeal (CHSA) and is being rolled out to 24 health visitors from various trusts (two health visitors from each organisation) across England and Scotland between June 2021 - April 2022. A robust evaluation plan is in place to evaluate the EWW Champions programme at the end of its implementation, using validated outcome measures and qualitative feedback from participants. Further evaluation is being planned to capture long-term impacts of the EWW programme, which will include feedback from the EWW Champions as well as the participants within their groups.

Previous evaluation shows that the EWW programme improved staff wellbeing by reducing their levels of stress and anxiety, helping them gain and/or maintain a sense of control and professional self-worth, and providing support to build capacity to cope better with work demands [12]. Through the increased reach afforded by the EWW Champions cascade delivery model, the programme has the potential to be rolled out to 576 health visiting members per year if 12 participants are supported by each Champion pair quarterly. This will increase the number of health visiting staff benefitting from this programme, creating greater capacity to enhance the emotional wellbeing of the health visiting workforce where this is delivered by the Champions via a rolling programme.

Since the start of the COVID-19 pandemic, there has been increased recognition of the need to support the wellbeing of the healthcare workforce both nationally [6,9,14] and internationally [[15], [16], [17]]. This message was recently emphasised by the chief nursing officer for England, prioritising the mental health and wellbeing of the nursing workforce for the coming year [18]. As a result there is a plethora of wellbeing support available at organisational and national level for healthcare staff (such as Mental health toolkit for nurses [19], RCN Wellbeing resources [20], NHS England Support [21], etc). It is acknowledged that supporting staff wellbeing alone is not the answer and a major boost in workforce growth is required to meet growing demand for care and existing workforce deficits [7,22]. This will require significant long-term investment and commitment from the government.

The iHV EWW programme is a bespoke programme designed specifically for the health visiting workforce, to support them through the unique professional challenges they may face, while complementing and utilising the existing resources on offer. This paper has discussed the development of the iHV EWW Champions’ programme. The well documented link between the wellbeing of healthcare staff and quality of care suggests that the positive outcomes from this programme has the potential to contribute to the delivery of high standards of care to children and families which is compassionate, professional and effective [9]. The authors plan to publish a further paper following completion and evaluation of the programme to share findings and learning from the programme.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

This programme has been funded by the COVID-19 Health Care Support Appeal (CHSA).

Ethical approval

Not required as this paper is reporting the development of an intervention.