North Staffs Mood Pathway Update. 20/09/2012

North Staffs Mood Pathway Update. 20/09/2012

North Staffs Mood Pathway Update. 20/09/2012 Stepped care approach In accordance with the stepped care model (Psychological Care after Stroke, DoH, 2011) 2 MDT Competencies L.1 & L.2 Mood Screening

L.1 & L.2 psychological care Steering group (encompassing key people within stroke pathway) Project Leads: J Morris OT-ASU / M OMara OT- ESD

Dr L Roberts Clinical Psychologist L Sillito Stroke Rehab OT B Lewis Neuro Rehab OT J Barnes / P Wells H&S Network J Rhodes ASU Nurse G Millward / M Edwards Stroke Association Objective: To design and implement robust / standardised mood pathway within stroke Reduce inappropriate referrals to Clinical Psychology Mood pathway 1 pathway with 3 separate components to suit ASU, Rehab Unit & ESD (Community)

YALE short screen completed within each stage of stroke pathway Repeated as aware of discharge as potential trigger point / allows for review Identified suitable screens for further assessment at each stage Embed MDT emphasis / focus on mood within stroke care Simple pathway / documentation Decrease staff wariness re: mood / suicide risk Commence mood pathway: Yale screen before discharge -Clinical presentation - Monitoring / Observation

Question: Does mood appear appropriate to diagnosis? Strand 1 (L1) Low or no risk / minimal potential for mood disturbance at time of assessment Level 1 Psychological support Strand 2 (L1/2) At risk / potential for mood disturbance at time of assessment Further

assessment appropriate to area Regular reviews Level 2 Psychological support Ongoing monitoring Clear management programme established Goal setting Referral to Clinical Psychology / IAPT / support agencies

: *Standard on discharge letter from all stroke services / checklist completed - Clear identification of mood status - Recommendations / ongoing management 6-8/52 Stroke Consultant GP review 6/12 month Screening tools used Completed at all stages: YALE Observation / clinical presentation Watchful waiting / monitoring

Further questions re: anxiety / mood if needed BASDEC risk / suicide question if needed & intent noted Further assessment: ASU: DISCS, SADQH-10 (Hospital version), ? Signs of Depression Scale (SDSS)

ESD: HADS, DISCS, SADQH-10 (Community version), BASDEC, Visual Analogue scale (VAS), Stroke Impact Scale REHAB UNITS: HADS, DISCS, SADQH-10 (Hospital version), BASDEC, Visual Analogue Scale (VAS), Distress Thermometer, Signs of Depression Scale (SDSS) Work in progress Mood

leaflet Audit Patient / carer perspective Staff perspective Level 1 /2 psychological training for all staff MDT engagement Community links / education Mood screen within 6/12 and annual reviews Engagement with IAPT / other agencies Cognitive pathway Positive outcomes Providing

structure to previously informal service Inclusion within ASU standardised 72 hour monitoring paperwork ASU exceeding ASI target 40% significantly ESD / rehab unit screening 100% of patients Improved handover re: mood issues / management between services / links with Clinical Psychology Established training package Increased MDT engagement / changes to MDT perception Increased patient / carer involvement & self management plans positive feedback!!!! No negative feedback!!!!! Increased management plans / goals & confidence of therapy staff with complex case management Developed links with H & S Network Improved links with support services Reduced inappropriate referrals to Clinical Psychology Lessons learnt

Clinical Psychology an asset! Evolving process / review ongoing Need to engage MDT as can fall on therapy staff Identify key champions!!!! Establish Training! Patients / carers welcome opportunity to discuss at ANY stage!!!! HYPERACUTE / ACUTE not too early!!!!!! Need to change MDT misconceptions re: mood screening Use targets as levers to stimulate / maintain momentum Utilise H & S Network Dont reinvent the wheel! Utilise SIP website Provide patients / carers with screens to complete independently Access voluntary agencies / support services Review at different stages

Training provides... Political and clinical context drawing on basic psychological theory Pros and cons of formal mood screens L.2 suicide screen Validating care

L.1 and L. 2 psychological Embedding psychological care L.1 training as mandatory for all staff involved in stroke care, e.g. Housekeepers, HCAs, domestics, nursing staff.... for OTs, physios, nursing staff, social workers, rehab practitioners, Drs, Stroke Association - group supervision offered to therapy staff on rehab ward and ESD

Thank you Any questions? Contact details: [email protected] [email protected] [email protected] [email protected] [email protected]

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