MSU – Mount Sinai Hospital – University Health Network Academic Medical Organization
Pandemic Acceptance & Commitment to Empowerment Response Intervention for Frontline Healthcare Providers (PACER-HCP)
The Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training program is an innovative virtual blended skills-building program designed to increase the resilience and well-being of participants and their capacity to promote social justice. The 6-week program consists of a weekly online self-guided learning module, accompanied by weekly 1.5-hour facilitator led videoconference to consolidate learning. Our target population includes all healthcare staff and providers at hospitals, healthcare, and social services settings. Through a CIHR grant, our intervention is also translated into Chinese Cantonese and Mandarin, targeting the Chinese population, which has been identified as particularly vulnerable; participants from the Chinese community are recruited if they have had COVID or have been impacted by social effects of the pandemic such as racism.
The design of the program is novel and unique in that:
1. The underlying model, Acceptance and Commitment to Empowerment (ACE), integrates training to increase psychological flexibility and mindfulness based on Acceptance and Commitment Therapy (ACT) and awareness of social justice issues based on Group Empowerment Psychoeducation (GEP), thereby, increasing both individual and collective empowerment
2. Each module consists of an unfolding series of guided self-reflective questions, gamified interactive exercises, and guided meditation; the interactive exercises are all newly developed and tailored to promote deep reflection and evocative experiential learning; each module builds on learning of previous modules
3. The train-the-trainer program builds capacity of interested participants to lead PACER groups; the program includes 2-session virtual group training, an online MCQ exam, and a role-play exam to ensure facilitators are able to guide participants, with a training manual to help maintain fidelity
Participants complete self-report questionnaires at pre, post, and 3-mth post. This includes demographics and standardized measures on psychological flexibility (AAQ-II), mental distress (GHQ), resilience (MSMR), and empowerment (ES). Qualitative data are gathered from participant response to module questions and focus groups.
Our initial pilot group showed very high satisfaction feedback. Participants valued the design of the modules and the supportive nature of the group sessions. To date, 328 participants have enrolled in the program, including 191 healthcare providers (HCP) and 137 non-HCP. Our HCP includes frontline nurses, social workers, psychologists, counsellors, physicians as well as managerial, administrative and housing support staff. The language used for the participants included: English 69.2%, Cantonese (21%), and Mandarin (9.8%). The sample includes 271 (82.6%) female, 53 (16.2%) male, and 1 transgender (0.3%). Pre- and post-intervention preliminary results are available for 214 participants. For HCP, there was significant improvement across all measures, including psychological flexibility, mental distress, resilience, and empowerment (p <0.001), with significant moderate effect sizes. For non-HCP, there was significant improvement in all (p <0.001) except empowerment. Closer examination reveals that the non-HCP sample improved in the personal and interpersonal subscales, but not the social-political subscale, which may reflect the limited political power experienced by non-HCP in the sample, especially with a higher percentage of participants from the Chinese community.
Equally revealing are the qualitative data that are emerging from the participant entries, shedding light on the nature of HCP distress and resilience. Further, based on a specific social justice related ACE exercise, many participants expressed realization of hidden biases as well as identifying actions to promote social justice and equity, including helping out specific marginalized groups, initiating conversations with friends and family about social issues, practicing self-awareness and education, and modifying behaviours towards others.
The PACER program based on preliminary data demonstrates a promising innovative approach to promote individual wellbeing while promoting social justice.
Sustainability and Knowledge Dissemination:
As of December 2021, our train-the-trainer program has trained over 15 facilitators. We have published the protocol paper for the PACER program, and have drafted a feasibility and acceptability manuscript being reviewed by co-authors. We have conducted 5 presentations and workshops on the project at professional national and international conferences and meetings, with very positive feedback and interest.
Mental Health and Well-Being
Primary Project Lead for Contact
Dr. Kenneth Fung