Dr Rachel Simkiss Consultant Clinical Neuropsychologist 6 th May 2016
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1 Dr Rachel Simkiss Consultant Clinical Neuropsychologist 6 th May 2016
2 Introduction & Context Why are we here today? Stepped Care Approach to Psychological Care within Stroke services (NHS Improvement Stroke 2011) RCP National Stroke Guidelines Can we now apply this to other conditions?
3 Psychological Care: Everybody s Business? Who looks after the stroke survivor s / family s emotional wellbeing in your work context?
4 Why Do We Need To Think About Emotions & Adjustment? Can influence how a person experiences their health and their attitude to recovery Important to understand what is normal and respond accordingly Thinking ahead: Helping people prepare, manage and cope Looking back: Helping people look back on what happened, take stock and re-appraise Implications for rehabilitation and recovery: Poor emotional adjustment is linked with poorer outcomes, mortality and quality of life
5 Psychological Care: Everybody s Business? I don t mind who asks me (what profession) or how they ask (using which assessment), but ask me from the start and keep asking me Stroke survivor from Dorset
6 A Framework for Everyone
7 Barts Health Framework Why we should be giving psychology away Miller (1969)
8 Barts Health Framework: What s different? Established & embedded within the stroke MDT: openaccess model Across the stroke pathway Significant role of psychology within a stroke MDT Clinical Reflective practice & professionals meetings Consultation / family meetings Teaching & training Part of the leadership team / list of supervisors / key worker
9 Barts Health Framework: Helping the MDT to think? An MDT approach: helping the team conceptualise distress by using accessible models for all e.g: WHO model Iceberg model Useful? MDT Feedback Questionnaire Having a psychologist in the team helps us to think I would recommend having a psychologist to a service that doesn t have it We need more of it (psychology)!
10 Barts Health Framework
11 Barts Health: Level 1 Psychological Care After Stroke Training To increase understanding and recognition of emotional and adjustment issues in complex health presentations To increase confidence and competence in providing compassionate care around the management of emotional and adjustment issues To know when and how to refer patients and their families for further psychological support
12 Barts Health: Level 1 Psychological Care After Stroke Training 1. Understanding Adjustment After Stroke 2. Having Difficult Conversations with Limited Time 3. Concerns to Look Out For 4. Self-Care and Supporting Others
13 Understanding Psychological Difficulties We re not just legs and arms and a mouth...we are human beings with a mixture of emotions. All these feelings...self esteem, self worth, confidence, identity...they re all under attack after a stroke...you can feel vulnerable, frightened and you can lose yourself Harry Clarke, Counsellor at Connect who has aphasia (From Psychological Care after Stroke, NHS Improvement, 2011)
14 Traditional Model?
15 Understanding Adjustment WHO Model of Disability Work Driving Using transport Friendship s Washing Dressing Housewor Leisure k Social contact Attitudes Making a hot drink Walking Standing Eating Toileting Weakness Coordination Balance Pain Altered sensation Epilepsy Swallowing Spasms Spasticity Sleep Nausea Vertigo Expressive speech Comprehension Memory Attention Vision Awareness Praying Making decisions Cooking Shopping Managing medicatio n Reading Writing Finances Holidays Religion Spiritualit y Emotional & Psychological difficulties Relationships Parenting Sexuality
16 Thoughts Social support Behaviour Health/rehab beliefs Life experiences Emotions Personal coping style Family beliefs Behaviour Thoughts Emotions Health/rehab beliefs Personal coping Life experiences style Family beliefs Cultural beliefs Cultural beliefs
17 Having Difficult Conversations in Limited Time Think of a time when you didn t feel heard or listened to - how did you know? What could be more helpful? Summarising Showing you ve heard What can I (staff member) do to help? What resources can you (patient) draw on?
18 Concerns To Look Out For Mood Screening Risk Referral Pathways
19 Taking Care
20 Sustaining Skills Follow-up Workshop Identify a case Utilise a technique learnt from this training and complete the reflection sheet Reflective Practice & Group Supervision Referral pathways is there a flow in the team and beyond? Use of MDMs, professionals meetings and family meetings to feedback work
21 Taking psychological care in stroke all neurological conditions forward. Making it the business of the whole team
22
23 Acknowledgements & Contact Details Camille Julien Maria Vidal Clinical Psychologist Clinical Psychologist
24 References & Resources George, M. (2013) Capturing the indirect contribution made by clinical neuropsychologists. Division of Neuropsychology Newsletter: British Psychological Society. Hall, E. T. (1997) Beyond Culture. Anchor Books. (Iceberg Model) Heinke, M. S., Julien, C., Blubert, L. Simkiss, R. (2013) Implementing a stepped approach to psychological care across the stroke pathway: a survey to identify existing staff attitudes, knowledge and skills, aiming to maximise existing resource use. Cerebrovascular diseases, 35, 213. Julien, C., Khatun-Ali, S., Blubert, L. & Simkiss, R. (2012) Psychological care after stroke: Implementing the distress thermometer in a community rehabilitation setting. International Journal of Stroke, 7, 66. Julien, C. & Simkiss, R. (2013) Stepping up psychological care after stroke: An evaluation of psychologist and serviceuser led level 1 training for MDT stroke professionals. International Journal of Stroke, 8, Miller, G A. (1969) Psychology as a means of promoting human welfare. American Psychologist, Vol 24(12), Vidal, M. & Simkiss, R. (2013) Implementing a stepped approach to psychological care across the stroke pathway: Introducing level 2 training. Organisation for Psychological Research into Stroke (OPSYRIS) conference presentation. Vidal, M. & Simkiss, R. (2014) Psychological care after stroke: Rolling out level 2 training. Conference Poster: UK Stroke Forum.
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