Promoting Resilience for Pediatric Health Care Workers in the Era of COVID-19: The PRISM at Work Program

Dear Editor:

Our research group has systematically sought to equip people with psychosocial resources and bolster resilience as they navigate some of the most challenging times of their lives. ¹ The work began in pediatric serious illness—namely among children with cancer or type 1 diabetes and their parents. These diagnoses represent two paradigms: an acute life-threatening condition and a chronic potentially life-limiting disease. Both contribute to high levels of stress and distress. We created the Promoting Resilience in Stress Management (PRISM) program to help these patients and families build four evidence-based resilience skills: (1) stress management, (2) goal setting, (3) catching and reframing negative self-talk, and (4) benefit finding. For the past decade, PRISM has been developed, iteratively refined, extended to different medical communities, and found to be feasible, acceptable, and efficacious.^2–4

In the wake of the COVID-19 pandemic, we wondered if there was an opportunity to translate our successful patient-centered PRISM program to one that supported health care staff. Our overall goal was to help health care providers manage stress and build resilience skills. To create “PRISM at Work,” we adapted the curriculum language to that of professional staff and structured content for small group (Zoom) sessions; for example, adding modules to didactically introduce and conclude the program and building in small group exercises. Each of the six modules were delivered with two to four established PRISM coaches and included a consistent three-part structure: (1) icebreakers/group dialogue and discussion of group rules to cultivate psychological safety, (2) didactic teaching and group practice of the resilience skills (Table 1), and (3) a plan for participants' practice. Each session lasted 1–1.25 hours and workshop participants received access to the already-existing PRISM smartphone app with which they could practice and log their resilience skills and mood.

To date, we have delivered the program to three groups (total N = 39 PRISM-at-Work students). Feasibility and acceptability have been exceptional: all 39 (100%) of participants completed the six-week program in its entirety. Of the 27 who provided written feedback, all reported they were satisfied/highly satisfied with the program, and all but one reported they were likely/very likely to recommend the program to their peers. All six sessions were deemed effective/highly effective by participants and none were suggested to be cut. Based on this initial success, we now plan to conduct a formal feasibility and acceptability pilot for 240 members of our workforce within Seattle Children's Hospital.

The full impact of the COVID-19 pandemic on the health care workforce remains uncertain. Emerging data suggest that health care workers are at high risk for substantial and ongoing stress, anxiety, and burnout, ⁵ and the World Health Organization has designated that access to mental health resources is a critical response to the COVID-19 pandemic. For our part, we aimed to utilize our accumulated knowledge on stress and resilience to provide an opportunity for health care workers to build up resources, draw from strengths, manage stress, and promote communities of resilience. We look forward to learning if and how this program can be scaled more broadly for our community.