Development & evaluation of a training programme to address complex post-COVID psychological needs

Materials & Methods

This study was conducted by the departments of Clinical Psychology and Mental Health Education, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru between June 2023 and February 2024. This study was carried out in accordance with the guidelines of the Institute Ethics Committee (Behaviour Sciences Division). The participants were not required to pay for the training. Participants, who requested further training/supervision beyond the programme, were offered appropriate options and resources. All participants were provided contact resources in the event of personal psychological distress. The study employed a sequential exploratory mixed research design: Phase I included identification of training needs and programme development based on the Steps for Quality Intervention Development (6SQuID)²⁶-defining and understanding training needs, clarifying how training will be delivered, testing the programme, and rigorous evaluation. Phase II comprised programme delivery and evaluation of participation, satisfaction, learning and competence²⁷.

Phase I: Programme development:

Defining and understanding training needs

Training needs were identified through three gateways: literature review of existing training programmes and identification of training gaps in India; consultation with subject experts and content designers; and needs-assessment survey of psychologists.

The needs assessment survey sent via online forms to 121 psychologists meeting criteria (described in Phase II and Fig. 1) sought information on knowledge about COVID, previous training, client practice and personal experiences in the post-COVID period. The responses of the survey have been mentioned in the results section.

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Fig.1.

Prisma flow chart explaining steps of allocation of participants to the training programme. ^*LMS, learning management system.

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Results

As evidenced from table I, participants were between 22 to 51 yr age (mean=28.2; SD=6.2). A majority were female, more than half specialised in clinical psychology, and were employed in private organisations. Most participants provided offline sessions, and a majority had client contact up to two years.

On the needs assessment survey, of the 48 responses received, 26 individuals (54.16%) rated their knowledge on post-COVID mental health issues as average or below average (indicated by a score ≤ 3 out of 5). Participants reported that stressors most frequently encountered with clients in the post-COVID era include loneliness and death of a loved one (n=46; 95.8%), financial loss (n=41; 85.4%), employment loss (n=40; 83.3%) and post-COVID health complications (n=35; 72.91%) with concerns like anxiety (n=48; 100%), depression (n=47; 97.9%) and loneliness (n=41; 85.4%) intensified in the post-COVID period. Addiction to technology (n=25; 52.1%), family conflicts (n=25; 52.1%), grief (n=24; 50%), depression (n=19; 39.6%) and loneliness (n=19; 39.6%) were reported as the most challenging to address. Participants rated their training as average or below average (indicated by a score ≤ 3) in the area of problematic technology use (n=41; 85.4%), trauma and grief (n=40;83.33%) and suicidality (n=36; 75%). Additionally, a majority (n=37; 77.1%) reported lack of access to sufficient resources to help clients and aid their practice. All participants reported themselves experiencing one or more stressors during the pandemic, namely, challenges while handling clients (n=27, 56.3%), risk of becoming infected (n=24, 50%), finances (n=21, 43.8%), switching to online consultation (n=19, 37.6%), risk of passing the infection on to others (n=17, 35.4%), increased workload (n=13, 27.1%), loss of a loved one (n=11, 22.9%), employment loss (n=5, 10.4%) and reduced self-esteem (n=1, 2.1%). Techniques like self-care (n=40, 83.3%) and peer discussions (n=36, 75%) were reported as helpful to assist their clinical practice. Hence the training program was tailor-made to address the needs identified by participants themselves.

The gaps in literature and the needs identified in the survey were discussed with subject experts, i.e., authors and resource persons who identified the important themes to be addressed in the training, and sub-themes of the same, to be developed into a course curriculum.

Figure 2 shows the key data extracted to understand training needs and clarify training development and delivery.

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Fig. 2.

Process of identification of training needs and development of training programme.

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Developing training content and structure

Content of the modules

The programme content (Table II) was curated by the authors, based on the needs identified from the survey, starting with post-COVID mental health issues and stressors (Module 2). The physical health module addressed long COVID, while the mental health module included long-term impacts of psychological stressors (changes in academic, work and social functioning), quarantine, coping with loss, and cognitive issues, particularly for vulnerable populations. This knowledge was crucial for interventions and psychoeducation (Module 5). Modules 4 and 8 covered intake, assessments and negative effects, which although part of basic training, were addressed for COVID concerns. Shortfalls identified in the needs assessment survey in areas such as technology addiction, grief, trauma, suicidality, and were included (Modules 3, 7 and 9), along with practice issues such as ethics, tele psychotherapy and self-care for psychologists (Module 10).

Table II. Modules, structure and format of the training programme

Module 1: Introduction to the programme
Overview and context of the programme, introduction to the project team and a guide to use LMS
Module 2: Impact of COVID-19
	EO	PT	RP	RM	OLS
Long-term physical health implications	ü			ü
Mental health and socio-occupational implications	ü			ü
Concerns in vulnerable populations in India				ü
Psychiatric and psychological conditions in the pandemic and post-pandemic period	ü			ü
Cognitive concerns associated with Long COVID-19	ü			ü
Module 3: COVID-19 and technology
	EO	PT	RP	RM	OLS
Technology use related to COVID-19	ü			ü
Internet, gaming, and social networking sites: addiction and overuse		ü		ü
Infodemic during the pandemic	ü
Module 4: Initial interview
	EO	PT	RP	RM	OLS
Case history taking			ü
Micro skills				ü
Brief assessments				ü
Module 5: Psychoeducation
	EO	PT	RP	RM	OLS
Psychoeducation for COVID-related mental health concerns		ü		ü
Module 6: Supportive intervention
	EO	PT	RP	RM	OLS
Purpose, strategies, and techniques	ü			ü
Module 7: Loss and grief
	EO	PT	RP	RM	OLS
Understanding loss and grief		ü
Addressing grief during the pandemic		ü
Grief and loss: An overview	ü
Coping with grief			ü	ü
Module 8: Negative affect
	EO	PT	RP	RM	OLS
Negative affect: An overview	ü
Brief interventions for depression and related concerns			ü	ü
Brief interventions anxiety and related concerns			ü	ü
Module 9: Crisis and trauma intervention
	EO	PT	RP	RM	OLS
Crisis and trauma intervention	ü			ü
Crisis intervention and suicidality		ü	ü	ü
Trauma informed care		ü	ü
Module 10: Practice issues in psychological care
	EO	PT	RP	RM	OLS
Tele psychotherapy	ü			ü
Ethics in psychotherapy	ü			ü	ü
Challenges and self-care for psychologists				ü	ü

Note: The table represents the modules and sub-modules of the training programme along with the mode of delivery. EO, expert overview; PT, presentations; RP, role play; RM, reading material; OLS, online live session

Structure and format

The training material comprised knowledge, skills training and practice/application in each of the ten modules. Knowledge component included 10–15 min video presentations, reading materials (comprising of research articles and information sheets, categorised as recommended and additional resources), and quizzes (Table II). Skills training involved role-play recordings of practical skills for interviews and interventions, highlighting key takeaways and post-hoc session discussions. The practice/application section featured expert overviews and weekly interactive sessions with experts (clinical psychologists with over 15 yr of experience).

Subject experts structured the programme to progress from basic skills (interviewing, assessment) to advanced skills (brief interventions), catering to participants with varying clinical experience. Each module included reading materials, expert overviews, presentations, interviews, role plays, and module quizzes for evaluation. Participants could progress to the next module after completing the quiz of the subsequent module.

Ethics, practice issues and supervision

Optional group supervision was offered for four weekly sessions, with participants each presenting one case. Offered by the second author (clinical psychologist with over 15 yr of experience), the supervision aimed at risk assessment, intervention optimization, and identification of referral needs. The objective was to support participants in maintaining ethical and evidence-based practice. Ethical considerations and practice issues were identified by subject experts as needing elaboration in the training content.

Culture-sensitivity

Culture-sensitivity was maintained throughout with a focus on the Indian context (e.g., impact of COVID, ethical considerations, and tele-psychotherapy). Reading materials incorporated Indian research while pre-recorded expert overviews and role plays addressed cultural nuances unique to the Indian context such as large-scale losses without mourning rituals; socio-cultural factors in technology addiction like reduced social support, long periods of isolation and the infodemic; and systemic issues like overwhelmed mental health services and reduced sustainability of services for crises responses.

Digitization of the programme

The course was hosted on the institute’s LMS and offered free of charge for easy access, especially for remote participants. A landing page and user manual guided navigation, while an intro session addressed platform concerns and boosted engagement. Videos and reading materials were embedded on the LMS. The programme spanned one month (25 h total), with approximately one hour of learning per weekday.

Figure 3 shows the effectiveness of the training programme as assessed on the evaluation framework for continuing medical education²⁷.

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Fig. 3.

The figure shows the evaluation of the training programme based on the levels of Moore’s evaluation framework (2015) as follows: (A) Participation, (B) satisfaction (1-very dissatisfied, 2-dissatisfied, 3-neutral, 4-satisfied, 5-very satisfied), (C) learning scores on each module (Module 2-impact of COVID, Module 3 - COVID and technology, Module 4 – initial interview, Module 5 and 6 – psychoeducation and supportive intervention, Module 7 – loss and grief, Module 8 – negative affect, Module 9 – crisis and trauma intervention, Module 10 – practice issues in psychological care), and (D) self-rated competence (1-very poor, 2-poor, 3-fair, 4-good, 5-very good).

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Discussion

The study aimed to develop, implement and evaluate a training and supervision programme for psychologists with a special focus on the complex nature of post-COVID issues in India. Significant gaps have been identified in existing training programmes relating to complexity of psychological concerns, culture-sensitive interventions, and supervision²³. The current study attempted to bridge these gaps, by training psychologists to identify and address psychological needs that have intensified post-COVID. This was done by defining and understanding training needs from the literature and various stakeholders, developing engaging and skill-focused training content to be hosted, delivered and evaluated through the online learning management system.

Triangulation of data from literature review, consultation with experts and needs assessment survey formed the phase I results and informed the content of the modules. Training content ranged from basic interviewing, identification of referral needs, and interventions for concerns like trauma, suicidality and grief, in a culture sensitive manner and self-care for professionals which were identified in existing literature^7,8,18,23,25 and the needs assessment survey of phase I. The focus of training and difficulty level were also maintained through careful selection of a homogenous group of participants with basic training in psychology, and experience with client contact, managed through login-based access to eligible participants.

In phase II, the programme was well-received as evidenced by participation, satisfaction, competence ratings and learning scores²⁷. Participants provided positive feedback about the relevance and easy applicability of the content, and progressive difficulty levels. Online mode of training has been highlighted in the literature as a convenient and a time-saving method which increases accessibility, availability and affordability among participants^18,29. Some challenges were highlighted in online training programmes of the recent past, such as adoption of a completely asynchronous model of teaching, use of complex language, time constraints and lack of video-based interactive sessions²⁹. As highlighted in other studies²¹ this programme attempted to overcome these challenges by balancing synchronous (interactive live sessions and case-based supervision) and asynchronous (recorded audio-visual content and reading materials in simple language) aspects of learning. This balance ensured that participants could complete the asynchronous content at their own pace and attend scheduled synchronous sessions.Interactive sessions were highlighted by our participants as a space for practical learning and greater connectivity with one another.

Satisfaction was reported on fulfilment of expectations. High satisfaction scores in our study could be attributed to curation of the training programme based on the needs-assessment from participants themselves²⁹. Relatedly, there was an increase from pre-to post training ratings of competence, since the programme targeted areas where training was lacking. On feedback, participants suggested training in more intensive psychotherapeutic interventions. Learning was demonstrated in the form of average to above-average scores in all modules. Over 95 per cent of our participants reported applying skills learnt from the programme into their practice – this reflects the utility of the knowledge-skills-practice components of the programme.

The structure and format of the programme was intended to ensure maximum trainee engagement in several ways: Firstly, the videos were limited to a duration of around ten min. This duration has been recommended to reduce extraneous cognitive load and aid in schema building, contributing to greater student engagement and learning as compared to longer videos^30-32. Practice quizzes are known to function as an incentive for active learning and preparatory reading and are recommended to improve student activity and persistence in online training programmes³³. This feature of the programme bridges a gap identified in recent studies^18,23. Role plays and case-based supervision emphasised practical learning and application, which are integral to training and a quality assurance tool in treatment delivery³⁴.

Participant motivation was managed through regular email contact, availability for troubleshooting, restrictions on content downloading to minimise procrastination, module quizzes, interactive sessions, and certificates for programme completion. Recommendations from a recent systematic review²³ indicated a need for specialised training and supportive supervision to help professionals deliver intervention in the context of the pandemic and beyond. In adherence to this, the training programme content spanned across various mental health concerns covering topics like grief, crisis and trauma which had received little attention in existing programmes. This programme also aimed to offer broad basic training in interviewing, micro-skills and low-intensity interventions, unlike the selective focus of some other programmes²⁰. Additionally, the case-based supervision in this programme was reported by participants as helpful, and has been highlighted as an important component²³. Only a few existing programmes had peer supervision or mentoring based on trainee needs²⁹.

A key strength of the programme was its wide reach, with participants from across India, enabled by the digitization of content for sustainability. This was among the few programmes developed specifically for the post-pandemic context. Unlike other shorter programmes for training frontline volunteers in providing telephonic support regarding concerns in the acute phase of COVID-19¹⁸, this programme was developed for persisting, complex pandemic-related concerns, for longer-term therapies conducted online, offline or hybrid.