Improving Psychological Care after Stroke

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Improving Psychological Care after Stroke

• Introduction

2
Plan of the day

• Delegate packs
• Speakers
• Workshops
• Manuals
• Toolkit
• Poster presentations
• PowerPoint Presentations

3
The Backstory

• The North East Psychologists in Stroke group
  first conceived the idea of developing a training
  package/programme around psychological adjustment
  following stroke just over 2 years ago.
• After reviewing the training already on offer,
  there seemed to be a lack of training
  opportunities specific to psychological
  adjustment after stroke
• A core group interested in taking the project
  further formed. Along the way, more Psychologists
  and AHPs from the trusts within the NECVN
  network joined the group, ensuring all trusts had
  a regional representative.

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The Beginning

• The main question we had at the very beginning of
  the project was basically what shall we do?
• What did the patients want/need?
• To find out what staff wanted, we carried out a
  Training Needs Analysis, surveying almost 100
  members of staff across the region including
  nurses, speech and language therapists,
  physiotherapists, occupational therapists,
  healthcare assistants and doctors.
• We wanted to find out what skills and knowledge
  staff felt were important within their job role,
  and what skills and knowledge they lacked
  confidence in.

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Training Needs Analysis
Skill Importance Confidence Skill Importance Confidence
Knowledge of the brain and stroke Helping individuals to manage anger
Working with communication difficulties Working with challenging behaviour
Working with attention and concentration difficulties Working with motivation problems
Working with memory difficulties Understanding and supporting emotional/psychological difficulties
Working with executive dysfunction (e.g. problem solving, decision making) Understanding grief reactions (e.g. loss, adjustment)
Complications of insight and awareness Understanding sex and relationship difficulties
Understanding mental capacity Ability to set goals
Helping family and individuals manage personality change Working as part of a team
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Results

• The results from the Training Needs Analysis were
  very encouraging thankfully the vast majority
  of staff members felt that all of the skills
  listed were important.
• The skills that had the biggest discrepancy
  between importance and confidence (i.e. rated as
  very important, but low confidence in using the
  skill) were
• Understanding mental capacity
• Helping family and individuals manage personality
  change
• Helping individuals to manage anger
• Working with challenging behaviour
• Understanding sex and relationship difficulties

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Stepped Care Model for psychological
interventions after stroke(NHS Improvement 2011)
(Prof House Dr Knights

• Level 3 Severe and persistent disorders of mood
  and/or cognition requiring specialist
  intervention from clinical psychology / Mental
  Health
• Level 2 Mild/moderate symptoms of impaired mood
  and / or cognition that interfere with rehab
  requiring specialist stroke staff with psychol /
  MH expertise.
• Level 1 Sub-threshold problems requiring
  awareness and screening by stroke specialist
  staff

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Stroke Specific Skills and Competencies Best
Practice Tool(NECVN)
?These competencies are designed to support the
development of staff working with stroke patients
and their carers. They are aimed at all
disciplines of staff and while some of the
competencies are generic (all), others are
discipline specific (nursing, SW, physio, OT,
SALT, psychology).
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The Next Step

• After receiving feedback from staff working in
  stroke services, and from patients who had been
  through stroke services, it was time to decide on
  the main topics we wanted to cover in the
  training.
• At this point we got a little bit carried away
• Interpersonal skills
• Psychological care after stroke
• Cognitive changes after stroke
• Challenging behaviour
• Difficult issues

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How to Deliver

• We also needed to think about how we would
  deliver the training.
• Training Manual
• Toolkit of Resources
• PowerPoint Presentations
• Website

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The Training Manual

• The training manual is almost 250 pages long and
  aims to give people a good understanding of the
  psychological issues that an individual can face
  after stroke, and how they can offer support to
  that individual.
• Within the five sections mentioned earlier, the
  manual covers areas such as

• Self esteem
• Anxiety
• Anger
• Distress/depression
• Functional analysis
• Executive function

• Motivation
• Counselling skills
• Screening
• Sex and relationships
• Mental capacity
• Insight and awareness

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Toolkit

• Much of the feedback we received from staff told
  us that from training, they wanted to know what
  to do and they wanted the tools to be able to do
  it. They wanted interventions.
• Our toolkit contains various resources relevant
  to each section of the manual, that can be used
  with patients who are experiencing lower level
  difficulties.

• Distress scale
• Formulation sheets
• Relaxation scripts
• Aphasia friendly screening tools
• Goal setting worksheets
• ABC charts

• Worry diaries
• Activity schedules
• Challenging behaviour record sheets
• Problem solving
• Cognitive estimate tasks
• Planning tasks

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PowerPoint Slides

• Each section of the manual has been broken up
  further e.g. challenging behaviour
  introduction, challenging behaviour assessment
  and challenging behaviour intervention.
• There is a PowerPoint presentation for each of
  these topics (approx. 15 slides) which comes with
  an audio voiceover.
• Can be used by an individual or in groups for in
  service training.
• The content of the presentations is mostly based
  on the information which is provided in the
  manual they are another option depending on how
  you prefer to receive training, and how you learn
  best.
• Activities included within each presentation.

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Activity Example

• One way of exploring pros and cons, is to use a
  decisional balance worksheet with patients.
• This allows you to not only look at the pros and
  cons of changing, but also the pros and cons of
  not changing (in reality, there are positives to
  carrying out behaviours which are bad for us
  otherwise we wouldnt do them! It is important to
  acknowledge this as well as looking at the
  negatives of a given behaviour).
• Draw out your own decisional balance sheet, and
  either use a change which you would like to make,
  or make up an example (e.g. stop smoking, eat
  healthier diet, cut down alcohol).

Pros Cons


Change No Change
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Website

• Our website www.paast.co.uk brings all of the
  previously mentioned aspects of training
  together.
• Central hub where you can download sections of
  the manual, toolkit resources and PowerPoint
  presentations.
• The website is password protected you all have
  a card in your delegate pack with the username
  and password on.
• Allows us to update things when needed, and
  release information about any developments with
  the training, or in the wider field of
  psychological care after stroke.

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Today

• What is today all about?
• Launching our training resources
• We want people to learn things today, but the day
  isnt all about training.
• We want to spark peoples interest, get people
  feeling passionate about improving psychological
  care after stroke.
• Inspire people to want to learn more.
• Show the importance of dealing with the
  psychological impact of having a stroke, as well
  as the physical.
• Find champions push forward with the PAAST
  training.

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Finally

• Thank you to everyone who has helped us to
  develop these training materials, and to everyone
  helping us out today.
• We will be around all day so if you have any
  questions, please let us know!
• Please dont take the training manuals away with
  you today A PAAST representative will be coming
  out to each service in the following weeks to
  deliver the resources and provide any more
  information you need about how to use them.
• If you are interested in becoming a PAAST
  champion in your service, please leave your
  contact details on the sheet by the poster
  stands.
• ENJOY THE DAY!!!