Being an honorary assistant psychologist during a pandemic

The impact of Covid-19 has changed the NHS workplace, particularly in the context of non-qualified staff gaining valuable 'on the job' experience. Limited real-life interactions with service users, alongside hybrid or remote working, has meant that placements for undergraduate students in particular are very different from before. 

This article relates to the experiences of three Honorary Assistant Psychologists (HAPs) who were brave enough to undertake placements in the middle of a global pandemic. They reflect on their experiences and the specific challenges they faced when entering the working world at this time. 

Livewell Southwest is an independent social enterprise, thriving to provide health and social care services in and around Plymouth. Each year Livewell offer undergraduate psychology students the opportunity to undertake a placement year (we are aware that there are ethical considerations surrounding honorary positions… we will not address these here). We were all offered placements undertaking different roles within a Community Learning Disabilities Team; assisting with a prospective Down Syndrome Dementia Screening Programme, and working within a Positive Behaviour Support (PBS) team.

Relationships at work

Although unable to meet all of our 60 colleagues in person, we settled in extremely well to the team; everyone has been so friendly. The warm welcomes via video call (VC) made an incredible first impression and calmed down first day nerves almost immediately. Everyone continues to make us feel part of the team. As HAPs we try and come into the office on separate days to reduce risk, and therefore we see each other in person very little. But when in the office, people try and say hello to us from a distance and this little real-life interaction is something we all appreciate. 

Daily team meetings have helped us to stay connected and co-ordinated. A supervisor has arranged a remote peer support group to replicate the office setting. We share this virtual space with Assistant Psychologists and Trainee Clinical Psychologists. Although we can't build the office banter as we might through seeing each other every day, we have new opportunities to think together and lead CPD for each other. There are still some colleagues we haven't met in person, but we feel we have been able to form a connection virtually. A very strange experience for one of us was seeing a close colleague of the team at the covid vaccination centre, but not recognising each other! 

We firmly believe that every staff member wants to ensure we get the most out of our experience, and this is something we definitely feel we are getting. This virtual world has become our 'normal' as we did not experience how the team worked before the pandemic. However, for existing staff this seems to be a peculiar reality, as they are used to seeing the whole team face to face nearly every day and discussing everyone's ideas and opinions. For us this is not something we can even imagine. Maybe in the coming months, with the roll out of the new vaccine and gradual lifting of restrictions, real-life meetings could be something we get to experience.

Hybrid working

For most of us, working in an office setting is a completely new experience. Therefore, hybrid working felt easy to get used to as it's all we know. During staff discussions of hybrid working, as new members of the team, we all had the same thoughts – none of us could imagine working any other way. It seemed hard to imagine there ever being any big in-person meetings. The concept is entirely alien to us and we don't know how it would work. 

We are all able to work from home as we have been given equipment, and if we need any help, people are only a call or email away. As most of us live in student houses, our bedrooms have become our offices. This can often lead to difficulties separating work from personal time; this is a challenge we have had to overcome. We have done this by making timetables to ensure that all work is done by 5pm, helping us remain boundaried with our work and personal life. Having a work laptop also helped this process, as turning that off for the evening was a visual shutdown at the end of the working day. The nature of our work means we have to work in our bedrooms as communal spaces often have other people that not only provide a distraction but could also breach confidentiality. We have found that we have different feelings towards working from home – some of us are happy to work from home most of the time, and others will try and get into the office as much as possible. We all agree that working in the office makes us feel more professional and provides a 'more real' work experience.

What about Service User Contact? 

People with learning disabilities are 6.3 times more vulnerable to coronavirus than the general population Public Health England, 2020). In-person clinical work has been reduced to 'essential' contact only. This negates a lot of what some of us would typically be asked to do with service users (our client assessments would not be considered essential clinical care at present). 

Shadowing opportunities are rare, and there have been limited opportunities to observe assessments in order to learn how to do them ourselves. As we are in different teams our client interaction has varied. There has been more opportunity in the dementia service when people can come to the clinic setting. The PBS team work with individuals who present with behaviours of concern. Visits need to be in people's homes and organising PPE, risk assessment and Covid swabs for a HAP can be difficult. Also, with staff, the resident, the PBS clinician and the HAP, there are just too many people to be able to adhere to social distancing guidelines. Clinical interactions can happen online with successful outcomes, as demonstrated by qualified staff running some therapy sessions via VC. Unfortunately it is not possible to carry out our assessments online. Meetings however (risk management, staff workshops, best interest meetings) have all become more accessible and we have been able to join many of these, meaning we have gained helpful insight into other areas of the learning disability service. Although the minimal client interaction hasn't defined how valuable the experience is, it has had an effect.

A word about PPE

To ensure the safety of individuals, when we are lucky enough to have a face to face meeting with a Service User, we are head to toe in PPE. This includes face masks, visors, aprons and gloves, and if we are visiting a residential care home we must have a Covid swab before we can visit. Although the PPE is essential to ensure safety, it does produce some problems. For example, people with learning disabilities find facial expressions essential for interpreting and communicating with others.  Unfortunately, masks have made this very difficult. PPE can also produce problems for us, as it can be uncomfortable and glasses steam up with masks and visors. However, we understand how important it is for this to be adhered to. 

Risk

We all feel very safe in the office as risk assessments have been completed and there are a lot of protocols in place to ensure the office is 'Covid secure' and government guidelines are being adhered to. We wear masks around the building, check our temperature on arrival, wipe down surfaces, and follow general good hygiene practices. The building's new one way system and hybrid working means that we are not coming into contact with people often; when we do we are socially distanced. 

We are all very cautious to follow the government guidelines, and do not break any of the guidelines in our personal lives. We recognise that we work with vulnerable people and our colleagues may have older parents or young children who would potentially face more serious consequences of Covid.  However as students, we naturally have more potential to be exposed to Covid as we live in shared houses (with up to nine other people) and in an area of Plymouth with a higher population of students. Our housemates are currently allowed to attend university for in-person sessions and are therefore coming into contact with many other students. This adds a slight element of stress as we do not want to be responsible for passing Covid to someone vulnerable at the workplace, therefore we do all we can to ensure the safety of service users, colleagues and ourselves. Despite these efforts one of us did contract coronavirus. She shares her experience below. 

"I was lucky to have experienced only minor symptoms when I contracted Covid-19; losing my sense of smell and taste for three days. This meant that I was able to continue working from home, but had to self-isolate for 14 days. It was the isolation period that I found difficult. Going into the office provided structure to my week and without this I was more distracted and found it difficult to get work done. There were additional distractions as my six housemates were also self-isolating and were around a lot more. When the virus was particularly bad for some of my housemates (high fever, fatigue, aches and pains) I felt a duty of care as I was physically feeling fine and this would often take me away from my work. I found myself sitting at my laptop working, but felt as if I were getting nowhere. This really got me down as I take pride in my work and feeling unmotivated and unproductive really affected me. The addition of not being able to get fresh air or exercise was impacting on my mental health and by the end of the two weeks I was quite low. This feeling ended as soon as my isolation period was over and I was able to go outside. I missed out on some face to face training that the other HAP's really enjoyed. I will be able to receive the training at a later date but this felt disappointing as we don't get to spend a lot of time with each other. I was quite anxious about telling supervisors about the positive test as I didn't want to appear irresponsible despite doing everything I could to limit contact with others. Livewell had made it clear that everyone needed to follow government guidelines to keep ourselves and others safe. However, when I told my colleagues they were very concerned for my welfare and were supportive about the situation." 

An experience like no other

Does the pandemic compromise the placement experience? For us, we feel the learning experience has only improved. We are experiencing working during a global pandemic and within a service which is coping with rapid change and new ways of working; a learning process which we have very much been a part of. Knowing we are doing our part in helping vulnerable people through this difficult time is something that we feel is very rewarding. 

As honorary assistants we have been given the opportunity to see the working life of  clinical psychologists and the broader MDT, and to receive hands on experience with clients and carers. Within just a few months of the placement, the experience and learning has been endless and this opportunity is one that each of us feel is incredibly valuable for future career development. 

Recommendations for any placement students working at home are to stick to your working hours and plan your workload in the office hours. Use a diary or calendar to make these tasks visual. Dress comfortably but still relatively smart to try and remain in the work mind-set. Set boundaries with your other housemates and be clear that you shouldn't be distracted between certain hours. Give yourself a break and have that break for a set time away from your work space. 

Although we may have had different expectations for our placement year, we are all incredibly grateful to have the opportunity for this placement and we definitely believe we are getting an amazing and worthwhile experience. We would recommend a placement year to any undergraduates out there currently undecided, because it's an experience like no other!

Supervisor reflections

As a service we had to think very carefully about whether we could offer placements this year. Predominantly we did not know whether the placement would have value for the students and our own capacities were limited. We had interviewed in February, before things changed, so felt a responsibility to see if we could make it work. 

In preparation, we had several telephone calls with the students over the summer to explain the changes and to talk about the need for creativity from them in order to make it work. They were very enthusiastic about the ideas we shared, and thought carefully about whether they wished to begin the placement or complete their third year at university instead. Going into it with the view of co-creating the placement with the HAPs created a sense of excitement, which reduced the sense of overwhelm that has frequently accompanied working in the pandemic. The placements brought a sense of normality and routine which was somewhat restorative. 

The students have had some in-person experiences with people with Learning Disabilities and they have been able to do a lot of remote assessments with staff teams. Losing the limits of a physical meeting room has meant that they have been able to attend more clinical meetings than was previously possible. The wider MDT value the input of the students, which is supporting the service at a time when we are all finding our way through somewhat 'sticky' working days. There are challenges, for example rethinking the way in which the assessments are conducted and finding a place for HAP's in those changed processes (it always feels easier to do it oneself), supporting HAP's to understand 'now' vs 'then', and worrying that they are missing out. There is a sense of sadness within the PBS/Psychology team about the things the HAPs haven't experienced; meeting lots of people with Learning Disabilities, shadowing, informal chats with MDT, the camaraderie of the shared office space. However, we have also felt joy that we have been able to broaden the scope of the placements this year, and that we have the privilege of nurturing the HAP's innate creativity to get the most value out of their placement. We have felt gladdened observing what can be achieved through adversity, if the right support and encouragement is there. 

Jyothis Binoy, Honorary Assistant Psychologist Livewell Southwest Plymouth 

Callum Pritchard, Honorary Assistant Psychologist Livewell Southwest Plymouth

Joanna Broom, Honorary Assistant Psychologist Livewell Southwest Plymouth

Hayley Grantham, Assistant Psychologist, Livewell Southwest Plymouth

Dr Joanne Porter, Senior Clinical Psychologist, Livewell Southwest Plymouth