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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). MDT Competencies. L.1 & L.2 Mood Screening. L.1 & L.2 psychological care.

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North Staffs Mood Pathway Update. 20/09/2012

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  1. North Staffs Mood Pathway Update. 20/09/2012

  2. Stepped care approach In accordance with the stepped care model (Psychological Care after Stroke, DoH, 2011)

  3. MDT Competencies

  4. L.1 & L.2 Mood Screening

  5. L.1 & L.2 psychological care

  6. Steering group(encompassing key people within stroke pathway) • Project Leads: J Morris OT-ASU / M O’Mara 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

  7. 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

  8. Commence mood pathway: Yale screen before discharge -Clinical presentation - Monitoring / Observation Question: Does mood appear appropriate to diagnosis? Ongoing monitoring Strand 2 (L1/2) At risk / potential for mood disturbance at time of assessment Strand 1 (L1) Low or no risk / minimal potential for mood disturbance at time of assessment Referral to Clinical Psychology / IAPT / support agencies Clear management programme established Goal setting Further assessment appropriate to area Regular reviews Level 1 Psychological support Level 2 Psychological support • : • *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 & annual review

  9. 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)

  10. 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

  11. 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

  12. 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 • Don’t reinvent the wheel! Utilise SIP website • Provide patients / carers with screens to complete independently • Access voluntary agencies / support services • Review at different stages

  13. Training provides... • Political and clinical context drawing on basic psychological theory • Pro’s and con’s of formal mood screens • L.2 – suicide screen • Validating L.1 and L. 2 psychological care

  14. Embedding psychological care • L.1 training as mandatory for all staff involved in stroke care, e.g. Housekeepers, HCA’s, domestics, nursing staff.... • L.2.training for OT’s, physio’s, nursing staff, social workers, rehab practitioners, Dr’s, Stroke Association - group supervision offered to therapy staff on rehab ward and ESD

  15. Thank you • Any questions? Contact details: • Lorna.Roberts@northstaffs.nhs.uk • Margurita.OMara@uhns.nhs.uk • Josephine.Morris@uhns.nhs.uk • Laura.Silitto@uhns.nhs.uk • j.barnes@nhs.net

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