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Improving Psychological Care after Stroke


Improving Psychological Care after Stroke Introduction After receiving feedback from staff working in stroke services, and from patients who had been through stroke ... – PowerPoint PPT presentation

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Title: Improving Psychological Care after Stroke

Improving Psychological Care after Stroke
  • Introduction

Plan of the day
  • Delegate packs
  • Speakers
  • Workshops
  • Manuals
  • Toolkit
  • Poster presentations
  • PowerPoint Presentations

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.

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
  • 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
  • Helping individuals to manage anger
  • Working with challenging behaviour
  • Understanding sex and relationship difficulties

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
  • 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

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
  • At this point we got a little bit carried away
  • Interpersonal skills
  • Psychological care after stroke
  • Cognitive changes after stroke
  • Challenging behaviour
  • Difficult issues

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

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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  • 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
  • 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
  • Activities included within each presentation.

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
  • Our website brings all of the
    previously mentioned aspects of training
  • Central hub where you can download sections of
    the manual, toolkit resources and PowerPoint
  • 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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  • 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

  • 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