Peer-Support Coaching Boosts Mental Health in Front-Line Workers

Resilience coaching can help bolster mental wellness among front-line hospital workers in times of stress, researchers reported.

According to a project launched at a single center in Toronto, peer-support resilience coaching delivered by healthcare workers to their colleagues during the COVID-19 pandemic yielded a slew of beneficial mental health outcomes, reported Benjamin Rosen, MD, of the University of Toronto, at the American Psychiatric Association (APA) virtual meeting.

Healthcare providers who took part in this resilience coaching said some of the benefits they experienced included improved inter-colleague relationships, decreased feelings of loneliness, and a heightened sense of being supported by their organization.

In a sense, these coaching sessions provide “psychological PPE,” Rosen said during a press conference.

“This pandemic has been an enormous threat to the resilience of healthcare workers,” he added. “Working at a hospital this year, you’re not only worried about battling COVID, but you’re also enduring uncertainty, fear, and moral distress, which has just contributed to unprecedented levels of burnout.”

He explained that the project stemmed from what they learned from previous pandemic times: “Based on some of the lessons we learned about the impact of chronic stress on healthcare workers from the SARS outbreak, which people might remember in 2003 where Toronto was a hotspot, we tried to be as proactive as possible to ensure that we were prepared to provide support.”

Last March, 15 coaches were deployed by the psychiatry department throughout 17 units and clinical teams at Sinai Health, which included Mount Sinai Hospital and Bridgepoint Active Healthcare in Toronto.

The vast majority of healthcare providers who participated in the coaching sessions were physicians (44%), followed by nurses (23%), allied health workers (23%), other types of hospital staff (7%), and research staff (3%).

These coaching sessions typically consisted of small groups — often under 15 people — and were held either in person, like in a huddle in the emergency department or ICU, or virtually over Zoom.

Coaches leading these pandemic-resilience sessions, which included Rosen himself, drew upon psychotherapeutic tools often used in practice, including supportive psychotherapy, group therapy, cognitive behavioral therapy, mindfulness-based stress reduction, interpersonal therapy, and dialectical behavioral therapy, as well as motivational interviewing tools.

Harnessing these therapeutic tools, the coaches would lead discussions on topics like the personal and professional impacts of the COVID-19 pandemic, as well as access to vaccines and personal protective equipment. The coaches would then engage in active listening to provide collegial support, and utilize other tools such as psychoeducation, validation, and sometimes referring to additional clinical help.

The researchers explained that this type of small-huddle coaching session gave healthcare workers a platform for emotional expression — which they said was almost always pandemic-related anger or fear — as well as an opportunity for emotional decompression, collaborative advocacy, and an educational opportunity to teach stress-reduction skills.

“Coaching is distinct from clinical care, so it is support of our colleagues in other disciplines and in other specialties, but isn’t a traditional care relationship,” said co-author Mary Preisman, MD, also of the University of Toronto, during the press conference. She also pointed out that when participants requested additional clinical support, the coaches then facilitated a connection with outside psychiatrists not involved in the coaching sessions.

However, this type of resilience coaching didn’t come without challenges. Not surprisingly, time was one major constraint that cut into coaching time. Some other challenges that the coaches faced with this intervention included certain workers feeling uncomfortable in a group setting, therefore leading to only more dominant voices being heard, Rosen noted. Another challenge that arose involved coaches maintaining a boundary to separate collegial support from clinical mental health support.

The group said they plan to release hard documentation, including an online course and handbook, so that other clinical sites and hospitals can employ this coaching model for their healthcare workers.

“I think this is an excellent model for helping people who are on the front lines,” commented press conference moderator Jeffrey Borenstein, MD, president and CEO of the Brain & Behavior Research Foundation in New York City. “I think the model and the work that they’ve done around this model can certainly be used around the world.”