A Co-produced Long-Covid Support Pathway Humber &
Description: A Co-produced Long-Covid Support Pathway Humber North Yorkshire Resilience Hub Dr Jo Jordan, Consultant Clinical Applied Psychologist Professional Clinical Lead of the HNY Resilience Hub The Humber, Coast and Vale Resilience Hub (HCV)
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slide1. A Co-produced Long-Covid Support Pathway
Humber & North Yorkshire Resilience Hub
Dr Jo Jordan, Consultant Clinical Applied Psychologist & Professional Clinical Lead of the HNY Resilience Hub<br>
slide2. The Humber, Coast and Vale Resilience Hub (HCV) has been created to support frontline staff in response to the COVI
The Humber & North Yorkshire (HNY) Resilience Hub has been created to provide a psychological led staff well-being service to support health and care staff, emergency service workers, voluntary and community sector organisations, in response to the COVID-19 pandemic.
Within the HNY Resilience hub, a high number of service users were presenting with symptoms associated with Long-COVID. Definition: signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis (NICE, 2022).
Symptoms: Fatigue, breathlessness, cough, palpitations, headache, joint pain, myalgia and weakness, insomnia, neurocognitive issues including memory and concentration problems and worsened quality of life (Raveendran et al, 2021). Brief Background<br>
slide3. Brief Background Higher rates of COVID-19 infections were found in healthcare staff and subsequently a high prevalence of post COVID-19 symptoms (Gaber et al, 2021). Reports suggest they are 7 times more likely to experience severe Covid symptoms (Mutambudzi et al 2022).
45% reported a persistence in symptoms including moderate to severe fatigue, anxiety, sleep disturbance and mild to moderate shortness of breath (Gaber et al, 2021).
Recent research indicated that COVID-19 survivors may display higher levels of psychological distress due to the stigma and social isolation unique to their experiences (Devlin et al, 2020).
According to research, the design of long COVID services should take account of patient experience (Macpherson et al., 2022).<br>
slide4. LONG-COVID ROADMAP HUMBER & NORTH YORKSHIRE RESILIENCE HUB 1
APRIL 2021 2
May 2021 3 4 5
July 2021 Focus Groups with initial 15 clients self-referred into hub with long-covid. 2 Pilot groups n = 8
Weekly sessions (6) sessions. Weekly review & feedback. Collate course feedback, examine themes, identified topics. Focus group to co-produce group and on-going plans for provision. Shaped 8 week programme, alternate psycho-ed and shared space and create wellness action plan. Social Isolation, seeking validation Lack of understanding around symptoms & management Concerns around work Developing coping strategies<br>
slide5. LONG-COVID ROADMAP HUMBER, COAST & VALE RESILIENCE HUB 6 7 8
NOV 21 9
MAY 2022 10
JUNE 2022 Weekly groups run and adaption through co-production and feedback. SWEMBS, Brief coping, PHQ9 & GAD7 utilised. Publish initial feedback from groups (DCP) and cohorts run every 10 weeks. Cohort 6 & Neuro Psych onboard as cognitive issues predominate, explore evidence and provision. Cohort 12,
n = 120+ clients, review and audit administrative
and evaluative procedures. Comprehensive neuro-pathway seen first n=30 clients post group.<br>
slide6. LONG-COVID ROADMAP HUMBER & NORTH YORKSHIRE RESILIENCE HUB 11
Aug 22 12
Aug 22 13
Aug 22 14
Sep/Oct
22 15
Sep/Oct
22 TO DATE TO DATE Cognitive Rehabilitation Group co-created & first cohort completed Mind & Body Group formed after feedback from group requesting access to more psychological frameworks Peer Mentoring (L2) offered to all cohorts of LC group to co-create future support On-going re-evaluation & development of Wellness Plan through focus groups & questionnaire feedback Quantitative evaluation of cognitive pathway (Hull Uni) & Qualitative evaluation of LC Pathway (Teeside Uni)<br>
slide7. Self-Refer into
Resilience Hub Comprehensive
Clinical Assessment Long COVID Wellness
Plan introduction Long COVID
Group Long COVID
Group Long COVID
Group A B Session
2 Session
3 Session
4 LONG COVID PEER SUPPORT GROUP MODEL HUMBER & NORTH YORKSHIRE RESILIENCE HUB Individuals self refer or are supported by their organisation to self refer to HCV website portal & complete screening questionnaires
(20 mins).
Referral triaged by clinical team and admin organise virtual appointment with clinical member of long covid team. Initial comprehensive holistic psychological assessment to understand current situation, worries, & difficulties.
Neuropsychological Assessment if required to establish cognitive baseline and profile of strengths & needs Introduce the group to the wellness plan
To further develop a comprehensive understanding of current needs physically, occupationally and crucially develop an understanding off interaction with medical/long covid clinics & medical testing/intervention
Liaison with GP, long covid clinic & Occupational Health where required & consented. Introductions/
sharing experiences, outline psychological safety & confidentiality.
Session review & evaluation questionnaire Fatigue, Pacing, baselines & Sleep Hygiene session.
Psycho-education & Interaction
Session review & evaluation questionnaire Sharing experiences
Clinically supported discussion & reflection on experience
Session review & evaluation questionnaire Session
1 Recent addition This document is for the use of the Humber & North Yorkshire Resilience Hub & is not to be shared externally. © 2022 Tees, Esk & Wear Valleys NHS Foundation Trust, © NAViGO Health & Social Care CIC..
All rights reserved. Please seek permission from the Humber & North Yorkshire Resilience Hub to reproduce for personal & educational use. Commercial copying, hiring, lending is prohibited.<br>
slide8. Long COVID
Group Long COVID
Group Long COVID
Group Long COVID
Group Long COVID
Group Long COVID
Wellness Plan
Review Session
5 Session
6 Session
7 Session
8 Session
9 3 & 6
month
Review LONG COVID PEER SUPPORT GROUP MODEL HUMBER & NORTH YORKSHIRE RESILIENCE HUB Sharing experiences
Clinically supported discussion & reflection on experience
Session review & evaluation questionnaire Final session: sharing experiences and Reflections
Clinically supported discussion & reflection on experience
Session review & evaluation questionnaire Mindfulness practice theory & experiential exercises.
Psycho-education & Interaction
Respiratory & physical Symptoms -
Session review & evaluation questionnaire Return to work.
Occupational Health advice & Support
Psycho-education & Interaction
Session review & evaluation questionnaire Drop in sessions every 2 weeks
General review, update long covid wellness plan & identify on-going needs within a holistic framework
Identify any additional psychological support or signposting
Session review & evaluation questionnaire Illness Representation (Leventhal) -developing an understanding of long term health conditions from a psychological perspective.
Psycho-education & Interaction
Session review & evaluation questionnaire September 22
n = 180
14 cohorts This document is for the use of the Humber & North Yorkshire Resilience Hub & is not to be shared externally. © 2022 Tees, Esk & Wear Valleys NHS Foundation Trust, © NAViGO Health & Social Care CIC..
All rights reserved. Please seek permission from the Humber & North Yorkshire Resilience Hub to reproduce for personal & educational use. Commercial copying, hiring, lending is prohibited.<br>
slide9. During the initial cohorts of the group, Long Covid neurocognitive symptoms highly evident.
Common themes of symptoms identified within our cohorts were brain fog, memory problems and word finding difficulties. Individuals were commonly sharing these symptoms and the associated impact on their activities of daily living, within their support sessions. These findings are concurrent with the current research literature, which reports memory and concentration problems are amongst the most common Long Covid symptoms (Raveendran et al, 2021)
Through collaborative learning and listening, we heard that staff requested and required neurorehabilitative support. In response to clinical need, we expanded to offer group based neurorehabiltation for fatigue, attention, memory and executive difficulties; based on The Brain Injury Rehabilitation Workbook (Winson, Wilson, and Bateman, 2016) and to maximise inclusivity, 1:1 neurocognitive support also became available. Long-Covid Cognitive Support<br>
slide10. LONG COVID NEURO PATHWAY HUMBER & NORTH YORKSHIRE RESILIENCE HUB Long Covid
Neuro Pathway Outcomes Green marketing is a practice Cognitive Rehab Group Cognitive Screen
1hr 30min 4 sessions weekly 6 sessions weekly This document is for the use of the Humber & North Yorkshire Resilience Hub & is not to be shared externally. © 2022 Tees, Esk & Wear Valleys NHS Foundation Trust, © NAViGO Health & Social Care CIC.. All rights reserved. Please seek permission from the Humber & North Yorkshire Resilience Hub to reproduce for personal & educational use. Commercial copying, hiring, lending is prohibited.<br>
slide11. Extensive consent sort at initial point of referral and PHQ9, GAD7, ITQ, WSAS and IRQA completed pre and post intervention.
Peer support group: Brief-COPE and SWEMWBS
Service satisfaction outcomes, clinical outcomes and service outcomes
Neuro Screening Pathway: cognitive screen, fatigue screen, wellbeing screen
Body and Mind group: illness perception questionnaire, Acceptance and Action Questionnaire Recognising our clients as assets
Building & creating service based on client need
Developing two-way, reciprocal relationships
Encouraging peer support
Facilitating rather than delivering
Cyclical process of feedback & change KEY ELEMENTS OF OUR LC CO-PRODUCTION OUTCOME MEASURES<br>
slide12. The Resilience Hub has been my lifeline since having nearly lost my life to Covid in 2021. Through one to one counselling and joining the Long Covid Group, I have gained strength each day both physically and mentally.’ The Long Covid Group provides a safe and secure on-line place to meet likeminded people and where we can share our Covid experiences and support each other in managing our day to day battle with Long Covid symptoms. I couldn't imagine my life without the Resilience Hub and its dedicated staff, because of them and their support I continue to go from strength to strength’ ‘The group members and facilitators have become such an important part of my Covid recovery’ ‘…. this group has increased my quality of life tremendously’<br>
slide13. CSM Illness representation (Leventhal, et al, 1980) popular – developed further psychological understanding & extended therapeutic group offer, inc ACT, CFT.
Peer support training for long-covid cohorts (L2 peer mentoring).
On-going re-evaluation & development of Wellness Plan
Quantitative evaluation of cognitive pathway (Trainee Clinical Psychologist, Megan Heaver, Hull University)
Qualitative evaluation of cognitive pathway (Trainee Clinical Psychologist, Hester Bowers, Teeside University) New Initiatives<br>
slide14. A Big Thank you! All our Resilience Hub Staff
Our Long-Covid Team
NHSE – Long covid SIG (Hollie Shearer)
LC Centre’s in HNY
Our HNY ICB & Partners
BPS/DCP
Clinical Leads & Teams in the Resilience Hubs across UK Contact details:
joanne.jordan12@nhs.net
laura-jaynecarter@nhs.net
amy.somerton2@nhs.net
tewv.hcv-resiliencehub@nhs.net<br>
slide15. References Gaber, T. A., Ashish, A., & Unsworth, A. (2021). Persistent post-covid symptoms in healthcare workers. Occupational Medicine.
NICE (2022) https://www.guidelines.co.uk/infection/nice-long-covid-guideline/455728.article
Raveendran, A.m.,Anoop, M (2021). Post COVID-19 Symptoms & diabetes: challenges in diagnosis & management. Diabetes 7 metabolic Syndrome: Clinical Research & Reviews 15 (5), 102235
Resnick, S.L.,Fridley, M.S., Heffernan, K.S., (2022). The effect habitual exercise on older adults mental health during the CoVID-19pandemic. International Journal of Exercise Science: Coneference Proceedings 9 (10), 25. Devlin, M.J., et al. (2020). Supporting the well-being of health care providers during the cOVID-19 pandemic. General Hospital Psychiatry, 67, 62-69.
The Brain Injury Rehabilitation Workbook. Edited by Rachel Winson, Barbara Wilson & Andrew Bateman (2016). Guildford Publications.
Macpherson, K., Cooper, K., Harbour, J., Mahal, D., (2022). Experiences of living with long-ovid & accessing healthcare services: a qualitative systematic review. BMJ open 12 (1).<br>
Humber & North Yorkshire Resilience Hub
Dr Jo Jordan, Consultant Clinical Applied Psychologist & Professional Clinical Lead of the HNY Resilience Hub<br>
slide2. The Humber, Coast and Vale Resilience Hub (HCV) has been created to support frontline staff in response to the COVI
The Humber & North Yorkshire (HNY) Resilience Hub has been created to provide a psychological led staff well-being service to support health and care staff, emergency service workers, voluntary and community sector organisations, in response to the COVID-19 pandemic.
Within the HNY Resilience hub, a high number of service users were presenting with symptoms associated with Long-COVID. Definition: signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis (NICE, 2022).
Symptoms: Fatigue, breathlessness, cough, palpitations, headache, joint pain, myalgia and weakness, insomnia, neurocognitive issues including memory and concentration problems and worsened quality of life (Raveendran et al, 2021). Brief Background<br>
slide3. Brief Background Higher rates of COVID-19 infections were found in healthcare staff and subsequently a high prevalence of post COVID-19 symptoms (Gaber et al, 2021). Reports suggest they are 7 times more likely to experience severe Covid symptoms (Mutambudzi et al 2022).
45% reported a persistence in symptoms including moderate to severe fatigue, anxiety, sleep disturbance and mild to moderate shortness of breath (Gaber et al, 2021).
Recent research indicated that COVID-19 survivors may display higher levels of psychological distress due to the stigma and social isolation unique to their experiences (Devlin et al, 2020).
According to research, the design of long COVID services should take account of patient experience (Macpherson et al., 2022).<br>
slide4. LONG-COVID ROADMAP HUMBER & NORTH YORKSHIRE RESILIENCE HUB 1
APRIL 2021 2
May 2021 3 4 5
July 2021 Focus Groups with initial 15 clients self-referred into hub with long-covid. 2 Pilot groups n = 8
Weekly sessions (6) sessions. Weekly review & feedback. Collate course feedback, examine themes, identified topics. Focus group to co-produce group and on-going plans for provision. Shaped 8 week programme, alternate psycho-ed and shared space and create wellness action plan. Social Isolation, seeking validation Lack of understanding around symptoms & management Concerns around work Developing coping strategies<br>
slide5. LONG-COVID ROADMAP HUMBER, COAST & VALE RESILIENCE HUB 6 7 8
NOV 21 9
MAY 2022 10
JUNE 2022 Weekly groups run and adaption through co-production and feedback. SWEMBS, Brief coping, PHQ9 & GAD7 utilised. Publish initial feedback from groups (DCP) and cohorts run every 10 weeks. Cohort 6 & Neuro Psych onboard as cognitive issues predominate, explore evidence and provision. Cohort 12,
n = 120+ clients, review and audit administrative
and evaluative procedures. Comprehensive neuro-pathway seen first n=30 clients post group.<br>
slide6. LONG-COVID ROADMAP HUMBER & NORTH YORKSHIRE RESILIENCE HUB 11
Aug 22 12
Aug 22 13
Aug 22 14
Sep/Oct
22 15
Sep/Oct
22 TO DATE TO DATE Cognitive Rehabilitation Group co-created & first cohort completed Mind & Body Group formed after feedback from group requesting access to more psychological frameworks Peer Mentoring (L2) offered to all cohorts of LC group to co-create future support On-going re-evaluation & development of Wellness Plan through focus groups & questionnaire feedback Quantitative evaluation of cognitive pathway (Hull Uni) & Qualitative evaluation of LC Pathway (Teeside Uni)<br>
slide7. Self-Refer into
Resilience Hub Comprehensive
Clinical Assessment Long COVID Wellness
Plan introduction Long COVID
Group Long COVID
Group Long COVID
Group A B Session
2 Session
3 Session
4 LONG COVID PEER SUPPORT GROUP MODEL HUMBER & NORTH YORKSHIRE RESILIENCE HUB Individuals self refer or are supported by their organisation to self refer to HCV website portal & complete screening questionnaires
(20 mins).
Referral triaged by clinical team and admin organise virtual appointment with clinical member of long covid team. Initial comprehensive holistic psychological assessment to understand current situation, worries, & difficulties.
Neuropsychological Assessment if required to establish cognitive baseline and profile of strengths & needs Introduce the group to the wellness plan
To further develop a comprehensive understanding of current needs physically, occupationally and crucially develop an understanding off interaction with medical/long covid clinics & medical testing/intervention
Liaison with GP, long covid clinic & Occupational Health where required & consented. Introductions/
sharing experiences, outline psychological safety & confidentiality.
Session review & evaluation questionnaire Fatigue, Pacing, baselines & Sleep Hygiene session.
Psycho-education & Interaction
Session review & evaluation questionnaire Sharing experiences
Clinically supported discussion & reflection on experience
Session review & evaluation questionnaire Session
1 Recent addition This document is for the use of the Humber & North Yorkshire Resilience Hub & is not to be shared externally. © 2022 Tees, Esk & Wear Valleys NHS Foundation Trust, © NAViGO Health & Social Care CIC..
All rights reserved. Please seek permission from the Humber & North Yorkshire Resilience Hub to reproduce for personal & educational use. Commercial copying, hiring, lending is prohibited.<br>
slide8. Long COVID
Group Long COVID
Group Long COVID
Group Long COVID
Group Long COVID
Group Long COVID
Wellness Plan
Review Session
5 Session
6 Session
7 Session
8 Session
9 3 & 6
month
Review LONG COVID PEER SUPPORT GROUP MODEL HUMBER & NORTH YORKSHIRE RESILIENCE HUB Sharing experiences
Clinically supported discussion & reflection on experience
Session review & evaluation questionnaire Final session: sharing experiences and Reflections
Clinically supported discussion & reflection on experience
Session review & evaluation questionnaire Mindfulness practice theory & experiential exercises.
Psycho-education & Interaction
Respiratory & physical Symptoms -
Session review & evaluation questionnaire Return to work.
Occupational Health advice & Support
Psycho-education & Interaction
Session review & evaluation questionnaire Drop in sessions every 2 weeks
General review, update long covid wellness plan & identify on-going needs within a holistic framework
Identify any additional psychological support or signposting
Session review & evaluation questionnaire Illness Representation (Leventhal) -developing an understanding of long term health conditions from a psychological perspective.
Psycho-education & Interaction
Session review & evaluation questionnaire September 22
n = 180
14 cohorts This document is for the use of the Humber & North Yorkshire Resilience Hub & is not to be shared externally. © 2022 Tees, Esk & Wear Valleys NHS Foundation Trust, © NAViGO Health & Social Care CIC..
All rights reserved. Please seek permission from the Humber & North Yorkshire Resilience Hub to reproduce for personal & educational use. Commercial copying, hiring, lending is prohibited.<br>
slide9. During the initial cohorts of the group, Long Covid neurocognitive symptoms highly evident.
Common themes of symptoms identified within our cohorts were brain fog, memory problems and word finding difficulties. Individuals were commonly sharing these symptoms and the associated impact on their activities of daily living, within their support sessions. These findings are concurrent with the current research literature, which reports memory and concentration problems are amongst the most common Long Covid symptoms (Raveendran et al, 2021)
Through collaborative learning and listening, we heard that staff requested and required neurorehabilitative support. In response to clinical need, we expanded to offer group based neurorehabiltation for fatigue, attention, memory and executive difficulties; based on The Brain Injury Rehabilitation Workbook (Winson, Wilson, and Bateman, 2016) and to maximise inclusivity, 1:1 neurocognitive support also became available. Long-Covid Cognitive Support<br>
slide10. LONG COVID NEURO PATHWAY HUMBER & NORTH YORKSHIRE RESILIENCE HUB Long Covid
Neuro Pathway Outcomes Green marketing is a practice Cognitive Rehab Group Cognitive Screen
1hr 30min 4 sessions weekly 6 sessions weekly This document is for the use of the Humber & North Yorkshire Resilience Hub & is not to be shared externally. © 2022 Tees, Esk & Wear Valleys NHS Foundation Trust, © NAViGO Health & Social Care CIC.. All rights reserved. Please seek permission from the Humber & North Yorkshire Resilience Hub to reproduce for personal & educational use. Commercial copying, hiring, lending is prohibited.<br>
slide11. Extensive consent sort at initial point of referral and PHQ9, GAD7, ITQ, WSAS and IRQA completed pre and post intervention.
Peer support group: Brief-COPE and SWEMWBS
Service satisfaction outcomes, clinical outcomes and service outcomes
Neuro Screening Pathway: cognitive screen, fatigue screen, wellbeing screen
Body and Mind group: illness perception questionnaire, Acceptance and Action Questionnaire Recognising our clients as assets
Building & creating service based on client need
Developing two-way, reciprocal relationships
Encouraging peer support
Facilitating rather than delivering
Cyclical process of feedback & change KEY ELEMENTS OF OUR LC CO-PRODUCTION OUTCOME MEASURES<br>
slide12. The Resilience Hub has been my lifeline since having nearly lost my life to Covid in 2021. Through one to one counselling and joining the Long Covid Group, I have gained strength each day both physically and mentally.’ The Long Covid Group provides a safe and secure on-line place to meet likeminded people and where we can share our Covid experiences and support each other in managing our day to day battle with Long Covid symptoms. I couldn't imagine my life without the Resilience Hub and its dedicated staff, because of them and their support I continue to go from strength to strength’ ‘The group members and facilitators have become such an important part of my Covid recovery’ ‘…. this group has increased my quality of life tremendously’<br>
slide13. CSM Illness representation (Leventhal, et al, 1980) popular – developed further psychological understanding & extended therapeutic group offer, inc ACT, CFT.
Peer support training for long-covid cohorts (L2 peer mentoring).
On-going re-evaluation & development of Wellness Plan
Quantitative evaluation of cognitive pathway (Trainee Clinical Psychologist, Megan Heaver, Hull University)
Qualitative evaluation of cognitive pathway (Trainee Clinical Psychologist, Hester Bowers, Teeside University) New Initiatives<br>
slide14. A Big Thank you! All our Resilience Hub Staff
Our Long-Covid Team
NHSE – Long covid SIG (Hollie Shearer)
LC Centre’s in HNY
Our HNY ICB & Partners
BPS/DCP
Clinical Leads & Teams in the Resilience Hubs across UK Contact details:
joanne.jordan12@nhs.net
laura-jaynecarter@nhs.net
amy.somerton2@nhs.net
tewv.hcv-resiliencehub@nhs.net<br>
slide15. References Gaber, T. A., Ashish, A., & Unsworth, A. (2021). Persistent post-covid symptoms in healthcare workers. Occupational Medicine.
NICE (2022) https://www.guidelines.co.uk/infection/nice-long-covid-guideline/455728.article
Raveendran, A.m.,Anoop, M (2021). Post COVID-19 Symptoms & diabetes: challenges in diagnosis & management. Diabetes 7 metabolic Syndrome: Clinical Research & Reviews 15 (5), 102235
Resnick, S.L.,Fridley, M.S., Heffernan, K.S., (2022). The effect habitual exercise on older adults mental health during the CoVID-19pandemic. International Journal of Exercise Science: Coneference Proceedings 9 (10), 25. Devlin, M.J., et al. (2020). Supporting the well-being of health care providers during the cOVID-19 pandemic. General Hospital Psychiatry, 67, 62-69.
The Brain Injury Rehabilitation Workbook. Edited by Rachel Winson, Barbara Wilson & Andrew Bateman (2016). Guildford Publications.
Macpherson, K., Cooper, K., Harbour, J., Mahal, D., (2022). Experiences of living with long-ovid & accessing healthcare services: a qualitative systematic review. BMJ open 12 (1).<br>