A redesigned training and staff support programme to enhance job retention in employees with moderate-severe depression

Abstract

Purpose Closing the treatment gap in depression is vital to prevent people from losing their jobs. Delivering group-based interventions at work could reach more employees than delivering 1:1 interventions in a clinical setting. This study aims to redesign a Treatment Programme to make it more acceptable and accessible for employees with depression. Design/methodology/approach A mixed-methods exploratory sequential design with a high level of stakeholder consultation was used to redesign an interdisciplinary Work-focussed Relational Group CBT Treatment Programme for moderate-severe depression. Qualitative data from focus groups and quantitative data from a small feasibility study were integrated to develop the new Training (and Staff Support) Programme (TSSP), which was fully specified and manualised in line with the Template for Intervention Description and Replication (TIDieR) for future delivery. Findings Focus groups identified a need for improved acceptability and accessibility of the tertiary preventative Work-focussed Relational Group CBT Treatment Programme. This programme was, therefore, simplified for delivery by peer facilitators at the worksite as an intervention for all employees rather than an indicated/targeted intervention for only those with symptoms/risk of depression. The TSSP comprised a compulsory trauma-informed educational/experiential workshop over four days plus optional open-ended, peer-led base groups set up and run by volunteer peer facilitators. Research limitations/implications The focus groups comprised a convenience sample who knew the researchers as a colleague or therapist, so there is a risk of selection or relationship bias. They were not involved in the data analysis which undermines the element of co-production and increases the risk of analytic or confirmation bias. Practical implications Delivering the new intervention in a group format will require peer facilitators to acquire skills in co-facilitation using a structured-directive leadership style and an awareness of the potential side effects of group-based interventions. Social implications The worksite TSSP provides a democratic learning space and empowers employees to stay at work by self-managing their symptoms and by challenging the interpersonal dynamics and organisational structures that might precipitate and perpetuate depression. Originality/value This intervention is fully specified and manualised with an explicit programme theory, unlike most universal worksite-based CBT programmes.

The initial design and programme theory for a new work-focused psychotherapeutic intervention to treat moderate-severe recurrent depression and enhance job retention

“…The programme, which was piloted in the clinical setting, showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention (Walker et al , 2021). The programme underwent a second phase of development to improve its acceptability and accessibility by delivering it at work through peer facilitators (Walker and Dobbing, 2021). Here, we present the process used to develop the structure and theory of the programme to help other practitioners develop similar complex interventions.…”

“…Peer support interventions can reduce depressive symptoms more than care-as-usual and is comparable to group CBT (Bryan and Arkowitz, 2015; Pfeiffer et al , 2011). Indeed, our second iteration of the programme, the training (and staff support) programme (TSSP), further exploited the value of peers through simplification for delivery by peer facilitators at the worksite as an intervention for all employees rather than an indicated/targeted intervention for only those with symptoms/risk of depression (Walker and Dobbing, 2021). In this way, the worksite TSSP provides a democratic learning space and empowers employees to stay at work by self-managing their symptoms and by challenging the interpersonal dynamics and organisational structures that might precipitate and perpetuate depression (Walker and Dobbing, 2021).…”

“…The new programme showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention. Given the promising pilot, we redesigned this group-based psychotherapeutic intervention to be delivered in the workplace by peer facilitators, thereby improving acceptability and accessibility (Walker and Dobbing, 2021). Here, we report the initial intervention design and programme theory underpinning the original Relational Group CBT Treatment Programme.…”