Front-line workers are always at risk. It’s in the name. The COVID-19 pandemic has made this reality more salient for everyone. Risks of sickness from COVID-19 include death and morbidity. Front-line workers may also have lost more friends and co-workers than the average person. Healthcare workers have also been subject to violence and see the devastation from COVID-19 on a daily basis. While this post will mostly cover resiliency training for front-line workers, there are many ways to support them.
Supporting Workers
As I’ve mentioned before, the best way to support and protect workers is to control the hazards they face at the highest possible level–removing the hazard if possible. Praise can be great, of course–who wasn’t moved by the 7pm clapping at the start of the pandemic? Calling healthcare workers heroes can make us and them feel great, but the media focus can also be problematic. Paying workers fairly, protecting their health and well-being, and ensuring adequate access to services are more important. Positively changing someone’s day-to-day work could benefit them, their employer, and their community.
Resiliency
As noted by the Mayo Clinic, “[r]esilience means being able to adapt to life’s misfortunes and setbacks.” Resiliency has been touted as a way to explain why some people succeed despite enormous adversity or adapt well to life-changing situations over time, while others do not. Resiliency, as a multi-layered construct, can also be used to describe groups, such as families, communities, and societies.
It is not simply the foil of vulnerability though. It can be described as a trait, process, or outcome and likely exists along a continuum. Though initially stemming from natural disaster-related research, resilience is now used in many contexts. Each permutation of resiliency lends itself to slightly different definitions and measurements.
Community Resiliency Model
The Community Resiliency Model (CRM) is a noncognitive variant of mindfulness, emphasizing attunement to interoceptive and exteroceptive signaling cues for regulation of autonomic responses to stress.
– Grabbe, Higgins, Baird, and Pfeiffer
This model of training was originally developed as the Trauma Resiliency Model for use with survivors of natural disasters and is a licensed product of the nonprofit Trauma Resource Institute. While the training is mostly delivered to individuals, the goal is to give them skills that they can teach to other community members. One randomized trial compared nurses who took a 3 hour CRM training (n=40 completed) to others who took a nutrition class (n=37 completed) with some significant differences between the two groups in outcomes, such as resilience.
Brief Intervention of CRM in Front-line Workers
In a recent Medical Care article, authors Grabbe, Higgins, Baird, and Pfeiffer report the results of a quasi-experimental design (pretest-posttest) to test the effectiveness of CRM. They delivered a 3-hour training to a convenience sample of front-line workers (not all in healthcare). In all, 104 participants completed the training. The authors conducted follow-up surveys at 1 week, 3 months, and 1 year. A total of 55 participants completed the 3-month follow-up after the training. At 1 week, there were clinically and statistically significant improvements in the Secondary Traumatic Stress Scale and the Somatic Symptom Scale-8. There weren’t large or statistically significant changes in either the WHO-5 or the Connor-Davidson Resilience Scale-10. Qualitative data suggested that many of the participants were very enthusiastic about the training and derived great value from it.
Where to go from here?
Changing individual-level resilience through interventions can be difficult. A Cochrane review of psychological interventions to foster resilience in healthcare workers (current through June 2019) found low-certainty evidence of positive effects. We need additional research that measures medium- and long-term outcomes with a high degree of rigor. More resources for organizational resilience are emerging, such as the AMA’s care provider resource.
Is resiliency training a magic wand to make difficult and traumatic life events more meaningful or lessen their impact? Certainly not. However, while we can try to change systems and structures to reduce the amount of trauma and adversity people experience, we cannot eliminate it. Figuring out the best ways to help people cope is a worthwhile objective.
Jess Williams
MISSED THE POINT!
Thank you for bringing this important loss of our medical workforce to the forefront.
The second paragraph is well stated but the subsequent emphasis on resilience belies the more important “cause” of the problem. This is actually alluded to at the beginning: namely, provider health and well-being. Well-being icludes the ability do what a medical provider knows is right. This country needs a “health care system” providing just that: caring for everyone and good health rather than creating the most wealth. This would thereby in keeping with the provider’s training, values, purpose and mental health. Less “resiliency” would be needed if the systematic disillusionment, burnout and moral injury were prevented in the first place.