Psychological Support After Stroke: A Role for ESD

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1 Psychological Support After Stroke: A Role for ESD Jack Smith Clinical Lead Psychology Cardiac and Stroke Network

2 Recovery after stroke A deeply personal experience and unique process of changing one s attitude, feelings, values, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by the illness. Recovery is the development of new meaning and purpose in one s life.

3 Information Hub and Guidance and click on Psychological care after stroke tab. Psychology Concise Guide for Stroke 2008 (Bowen and Knapp, BPS-RCP).

4 New Direction of the NHS Cultural shift Success defined by well-being rather than. Interdisciplinary care models to foster good mental health and wellbeing in addition to physical health in recovery.

5 Mental Health and Wellbeing Mental health and well-being is concerned with the feelings and functioning of all individuals: Feelings of hope and satisfaction. Confidence. Sense of purpose and control.

6 Timing is Right Promotion of better integrated care through the government reform agenda. 2 billion in Transforming Community Services programme getting evidence based practice into contracts for supporting LTC s. 400 million and new responsibilities for IAPT in Primary Care to support the psychological needs of people with a long-term condition.

7 Economic Case Invest 1 to save 4 Evidence : COPD Diabetes CHD Stroke coming soon!

8 Economic Modelling - Savings Psychological problems comorbid with a long-term condition increases individual patient health care costs from approx 3,910 to 5,670 a year (Kings Fund, 2012) Preliminary economic modelling indicates that if access to psychological support within the first 6 months after stroke were increased to 40% of patients, annual cost savings in the region of 64,000 per local economy could be made (NHS Stroke Improvement, 2012).

9 Where are the cost savings? Reduced A&E attendances and hospital admissions. Reduced avoidable outpatient/gp attendances. Reduced demand for social care support and long-term care placements. Reduced referrals to intensive clinical psychology services.

10 Network Audit of Psychological Support after Stroke in 2011/12. Access to clinical psychology is limited. Opportunities are often missed in community rehabilitation to detect distress and intervene. Lack of interdisciplinary staff integration, training and supervision in community setting. Outcome data meaningless without continuity.

11 Network priority work programme Deliverables during : Psychological Support Consensus Forum Guidance document for Commissioners (CCG) Outcomes research and data registry trial Meaningful training programmes for staff

12 Patient Centred Practice Recommended by the National Institute of Health and Clinical Excellence (NICE). Supported self-management of long-term condition. Shared decision making between practitioner, the patient and their family. Cultural shift - Establish patient s preferred hopes and identify patient s own resources during their recovery.

13 Network audit task Complete form in pack (5 mins). Return to helpers at end of the aisle. Results to form part of PhD research and inform future training programme needs for ESD staff.

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15 ESD Professionals: Key players Acceptable to patients and families during their recovery phase at home (Less stigma). Opportunities for identifying changes in mental health and wellbeing and referring on if severe/complex. Opportunities to foster wellbeing and good mental health where appropriate using patient centred approaches under supervision.

16 Potential role of ESD in Steps Refer to Clinical Psychology or Neuropsychology for further assessment and management. JS Psychology Ltd 2012 Level 3 Severe / Persistent mood and cognitive problems impeding recovery Offer brief intervention such as motivational interviewing or solution focused therapy (extended skills) under supervision of Clinical Psychologist /Clinical Specialist. Refer to IAPT in Primary Care via GP. Intensity of interventions and level of competence required. Level 2 Rehabilitation appears delayed due to changes in self-efficacy, selfesteem or identity. Screen Mood and Cognition. Offer self-efficacy training to include patient centred goal setting. Provide info on befriending and peer support groups if appropriate. Level 1 : All patients (and carers) Screening and Foster Wellbeing < 6 weeks.

17 Outcome Measures (Patient) Change in clinical scores on validated measures through the recovery phase. Self-reported well-being scores. Patient functional outcome eg start and after a period of intervention. Patient/Carer satisfaction.

18 Outcome Measures (Quality) Proportion of community rehabilitation professionals delivering care at Level 2 who receive monthly supervision. Qualitative satisfaction of community rehabilitation professionals. Improved Sentinel audit score for the local health economy.

19 Common Driver: RCP Sentinel Stroke National Audit from 2013 Not mandatory but a general duty to secure continuous improvement in quality standards. Proportion of stroke survivors screened for mood and cognition within 6 weeks of stroke diagnosis. Proportion receiving treatment for mood and/or cognitive impairment within 6 months.

20 Southport Example All disciplines agreed to focus on good mental health and wellbeing in recovery phase. Agreed pathway for routine screening and management of psychological distress. Collaborative commitment to staff training, supervision and meaningful outcome monitoring of wellbeing beyond the hospital stay.

21 Southport Example Yale & SADQ-H10 for Mood Screen. Solution Focused training and supervision. Outcome measurement using the Warwick- Edinburgh Mental Wellbeing Scale. Improved staff confidence in patient centred conversations during physical health care.

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23 Wirral example ESD and Neuropsychology Service piloting a triaging pathway. Validated measures for Mood and Wellbeing. Outcome collection using ipad technology. Direct e-link to Network outcome data registry.

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25 3 Key Messages 1. ESD Teams: Key players in the model. 2. Commissioners: Invest 1 to save Outcome focus: Mental Health & Wellbeing.

26 Network priority work programme For more information Contact me on: