Developing online group art psychotherapy for children with long-term health conditions

Figures & data

Table 1. GAIN Complex Intervention Development Stages (based upon ‘Framework of actions for intervention development, Skivington et al., 2021, p. 41).

Action		Consideration
1.	Plan the development process	Identify the problem to be targeted Obtain sufficient resource/funding for intervention development Draw on a published intervention development approach Involve stakeholders during planning process (see next table row) Produce a protocol detailing processes to be undertaken
2.	Formation of a stakeholder group	Work closely with stakeholders during development Integrate patient and public involvement Identify best ways of working/co-production Use creative activities within team meetings to work with stakeholders to understand the problem and generate ideas for the intervention
3.	Formation of a decision-making team	Include individuals with relevant expertise, and include those with personal experience of the problem Agree a process for making decisions
4.	Identification of relevant literature and existing theories	Review published research evidence before starting to develop the intervention and throughout the development process Look for evidence that the proposed intervention may not work in the way intended
5.	Intervention refinement	Generate ideas about content, format and delivery with stakeholders Once an early version of the intervention is available, refine or optimise it using a series of iterations. Each iteration includes an assessment of how acceptable, feasible and engaging the intervention is, including potential harms and unintended consequences, resulting in refinement to the intervention.

Note: The original 'Framework of actions for intervention development' (Skivington et al., 2021 p.41) includes 11 items. The GAIN Complex Intervention Development Stages were based upon items 1–5 and item 10.

Figure 1. Flowchart of development process with PPI (patient and public involvement).

Figure 2. Example of GAIN visual material.

Table 2. GAIN session schedule.

	Group Sessions		Home Sessions
Session	Objectives	Session	Objectives
Getting to know each other	Introduce children to facilitators and peers. Familiarise children with the space/format. Explain group focus and format. Collaborate with children to set group rules/boundaries. Empower children to recognise their expertise in their bodies/conditions. Create supportive space for children to connect with peers and reduce isolation.	Celebrating me	Support and emphasise empowerment of children. Foster a positive self-image by recognising strengths and achievements. Promote a holistic view of identity beyond the condition. Acknowledge losses and gains. Encourage a focus on abilities rather than limitations. Empower parent/carer to facilitate discussion and prepare children to participate in next art therapy group.
(2) Celebrating me	Support and emphasise empowerment of children. Foster a positive self-image by recognising strengths and achievements. Promote a holistic view of identity beyond the condition. Acknowledge losses and gains. Encourage a focus on abilities rather than limitations. Create supportive space for children to connect with peers and reduce isolation.	(2) Understanding my needs	Encourage children to consider their physical and emotional health needs. Highlight that these needs extend beyond their condition. Help children to recognise their physical and emotional cues. Encourage self-care for both physical and emotional health. Assist children in communicating their health needs to others. Empower parent/carer to facilitate discussion and prepare children to participate in next art therapy group.
(3) Taking care of my health	Encourage children to consider their physical and emotional health needs. Highlight that these needs extend beyond their condition. Help children to recognise their physical and emotional cues. Encourage self-care for both physical and emotional health. Assist children in communicating their health needs to others. Create supportive space for children to connect with peers and reduce isolation.	(3) Communication and conversations	Encourage children to ask questions about their condition and its management. Reinforce their right to ask such questions. Promote independent and age-appropriate information-seeking. Encourage open and honest communication about their condition. Help children identify barriers to honesty when discussing condition. Empower parent/carer to facilitate discussion and prepare children to participate in next art therapy group.
(4) Honest conversations	Encourage children to ask questions about their condition and its management. Reinforce their right to ask such questions. Promote independent and age-appropriate information-seeking. Encourage open and honest communication about their condition. Help children identify barriers to honesty when discussing condition. Create supportive space for children to connect with peers and reduce isolation.	(4) Taking part in things	Support children to revisit the losses and gains associated with their condition. Promote honest conversation about what has changed, i.e. things they can no longer do. Explore and validate children’s feelings about any changes or losses that have occurred. Encourage children to think about new experiences they have gained since diagnosis. Support children to think about any new opportunities they can access. Empower parent/carer to facilitate discussion and prepare children to participate in next art therapy group.
(5) Taking care of my feelings	Encourage children to identify and express difficult feelings related to diagnosis. Reinforce their right to feel a range of emotions related to their condition. Help children to share their feelings, both positive and negative. Assist children in identifying and understanding their emotions and their physical manifestations. Encourage self-care for emotional well-being, and teach children how to ask for help with their emotions. Create supportive space for children to connect with peers and reduce isolation.	(5) Taking part in things/my future goals	Reinforce the things children can participate in. Explore with children what their future goals and ambitions are. Explore any worries children may have about achieving their goals and ambitions. Explore any potential barriers to children achieving their goals and how they may overcome this. Help children understand the age-appropriate steps they can take to stay well whilst achieving their goals. Empower parent/carer to facilitate discussion and prepare children to participate in next art therapy group.
(6) Stepping into my best future	Encourage children to consider their future goals. Emphasise that their diagnosis should not limit their aspirations. Assist children in planning for how they will manage their condition, medical appointments and medication in the future. Teach children how to seek help and support if their condition/health changes. Empower children to make decisions to achieve their future goals. Create supportive space for children to connect with peers and reduce isolation.	(6) My future goals in action	Celebrate children’s achievements and resilience, and their participation and learning in the art therapy and home sessions. Emphasise that their diagnosis should not limit their aspirations. Assist children in age-appropriate planning for how they will manage their condition, medical appointments and medication in the future. Teach children how to seek help and support if their condition/health changes. Empower children to make decisions to achieve their future goals. Reinforce the expertise that children and parents/carers have, and encourage the use of resources and learning from art therapy and home sessions to facilitate ongoing conversations.

Skivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., & Moore, L. (2021). Framework for the development and evaluation of complex interventions: Gap analysis, workshop and consultation-informed update. Health Technology Assessment (Winchester, England), 25(57), 1–132. https://doi.org/10.3310/hta25570

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