Stroke specific staff have received training to identify psychological distress and increase their confidence, to deliver low level psychological support. We also wanted to foster collaboration between stroke and psychology services (including acute, rehabilitation, community, voluntary stroke services and mental health services) by identifying champions in each of these services, who would act as a point of contact.
The patient pathway was successfully implemented in four sites across CLAHRC North West Coast. Staff liked the practical tips and suggestions of what to say and what not to say. They reported not being so worried about trying to address some of the issues around psychological distress and IAPT staff felt more able to adapt therapy materials to assist in communication with stroke survivors
Psychological problems after stroke, such as depression and anxiety, can negatively impact stroke survivors. However, the identification and management of psychological problems may be complicated by the effects of stroke such as aphasia, cognitive deficits, and stroke-related somatic symptoms. Furthermore, stroke healthcare staff report a lack of confidence in managing psychological distress. Although general psychological services exist (e.g. Improving Access to Psychological Therapies (IAPT)), there remains a lack of support for stroke survivors. This may be due to communication and cognitive problems experienced post-stroke which make it challenging for IAPT services to provide effective support. Additionally, stroke survivors may have difficulty accessing psychological support for themselves, leading to stroke survivors missing out on the care they need and a reduced quality of life.
So the aim of ADOPTS was to explore the feasibility of developing, implementing and evaluating site-specific collaborative psychological care pathways in four sites in CLAHRC North West Coast to facilitate access to, and increase provision of, psychological support for stroke survivors.
The study was carried out over three phases.
A paper to report the feasibility results is currently under preparation. As a result of staff being keen to be trained to provide higher-level support, a multi-centre randomised controlled trial of a talking therapy, motivational interviewing, is due to commence to determine its effectiveness as a potential higher-level therapy delivered by stroke specific staff for patients following a stroke (COMMITS).