IMPROVING
PSYCHOLOGICAL CARE
AFTER STROKE
Introduction
Plan of the day
• Delegate packs
• Speakers
• Workshops
• Manuals
• Toolkit
• Poster presentations
• PowerPoint Presentations
The Backstory
• The North East Psychologists in Stroke group first conceived
the idea of developing a training package/programme around
psychological adjustment following stroke just over 2 years
ago.
• After reviewing the training already on offer, there seemed to
be a lack of training opportunities specific to psychological
adjustment after stroke
• A core group interested in taking the project further formed.
Along the way, more Psychologists and AHP’s from the trusts
within the NECVN network joined the group, ensuring all
trusts had a regional representative.
The Beginning
• The main question we had at the very beginning of the project
was basically… what shall we do?
• What did the patients want/need?
• To find out what staff wanted, we carried out a Training Needs
Analysis, surveying almost 100 members of staff across the
region – including nurses, speech and language therapists,
physiotherapists, occupational therapists, healthcare
assistants and doctors.
• We wanted to find out what skills and knowledge staff felt
were important within their job role, and what skills and
knowledge they lacked confidence in.
Knowledge of the brain and stroke
Helping individuals to manage anger
Working with communication
difficulties
Working with challenging behaviour
Working with attention and
concentration difficulties
Working with motivation problems
Working with memory difficulties
Understanding and supporting
emotional/psychological difficulties
Working with executive dysfunction
(e.g. problem solving, decision making)
Understanding grief reactions (e.g. loss,
adjustment)
Complications of insight and awareness
Understanding sex and relationship
difficulties
Understanding mental capacity
Ability to set goals
Helping family and individuals manage
personality change
Working as part of a team
Confidence
Skill
Importance
Confidence
Skill
Importance
Training Needs Analysis
Results
• The results from the Training Needs Analysis were very
encouraging – thankfully the vast majority of staff members
felt that all of the skills listed were important.
• The skills that had the biggest discrepancy between
importance and confidence (i.e. rated as very important, but
low confidence in using the skill) were:
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Understanding mental capacity
Helping family and individuals manage personality change
Helping individuals to manage anger
Working with challenging behaviour
Understanding sex and relationship difficulties
Stepped Care Model for
psychological interventions after stroke
(NHS Improvement 2011) (Prof House & Dr Knights
• Level 3: Severe and persistent
disorders of mood and/or
cognition – requiring specialist
intervention from clinical
psychology / Mental Health
• Level 2: Mild/moderate
symptoms of impaired mood and
/ or cognition that interfere with
rehab – requiring specialist stroke
staff with psychol / MH expertise.
• Level 1: Sub-threshold problems
– requiring awareness and
screening by stroke specialist staff
Stroke Specific Skills and Competencies
Best Practice Tool
(NECVN)
These competencies are designed to support the development
of staff working with stroke patients and their carers. They are
aimed at all disciplines of staff and while some of the
competencies are generic (all), others are discipline specific
(nursing, SW, physio, OT, SALT, psychology).
The Next Step
• After receiving feedback from staff working in stroke services,
and from patients who had been through stroke services, it
was time to decide on the main topics we wanted to cover in
the training.
• At this point we got a little bit carried away…
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Interpersonal skills
Psychological care after stroke
Cognitive changes after stroke
Challenging behaviour
Difficult issues
How to Deliver
• We also needed to think about how we would deliver the
training.
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Training Manual
Toolkit of Resources
PowerPoint Presentations
Website
The Training Manual
• The training manual is almost 250 pages long and aims to give
people a good understanding of the psychological issues that
an individual can face after stroke, and how they can offer
support to that individual.
• Within the five sections mentioned earlier, the manual covers
areas such as:
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Self esteem
Anxiety
Anger
Distress/depression
Functional analysis
Executive function
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Motivation
Counselling skills
Screening
Sex and relationships
Mental capacity
Insight and awareness
Toolkit
• Much of the feedback we received from staff told us that from
training, they wanted to know what to do and they wanted
the tools to be able to do it. They wanted interventions.
• Our toolkit contains various resources relevant to each section
of the manual, that can be used with patients who are
experiencing lower level difficulties.
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Distress scale
Formulation sheets
Relaxation scripts
Aphasia friendly screening tools
Goal setting worksheets
ABC charts
• Worry diaries
• Activity schedules
• Challenging behaviour record
sheets
• Problem solving
• Cognitive estimate tasks
• Planning tasks
PowerPoint Slides
• Each section of the manual has been broken up further – e.g.
challenging behaviour introduction, challenging behaviour
assessment and challenging behaviour intervention.
• There is a PowerPoint presentation for each of these topics
(approx. 15 slides) which comes with an audio voiceover.
• Can be used by an individual or in groups for in service
training.
• The content of the presentations is mostly based on the
information which is provided in the manual – they are
another option depending on how you prefer to receive
training, and how you learn best.
• Activities included within each presentation.
Activity Example
Pros
Change
No Change
• One way of exploring pros and cons, is to
use a decisional balance worksheet with
patients.
• This allows you to not only look at the pros
and cons of changing, but also the pros
and cons of not changing (in reality, there
are positives to carrying out behaviours
which are “bad for us” – otherwise we
wouldn’t do them! It is important to
acknowledge this as well as looking at the
negatives of a given behaviour).
• Draw out your own decisional balance
sheet, and either use a change which you
would like to make, or make up an example
(e.g. stop smoking, eat healthier diet, cut
down alcohol).
Cons
Website
• Our website – www.paast.co.uk brings all of the previously
mentioned aspects of training together.
• Central hub where you can download sections of the manual,
toolkit resources and PowerPoint presentations.
• The website is password protected – you all have a card in
your delegate pack with the username and password on.
• Allows us to update things when needed, and release
information about any developments with the training, or in
the wider field of psychological care after stroke.
Today
• What is today all about?
• Launching our training resources…
• We want people to learn things today, but the day isn’t all
about training.
• We want to spark people’s interest, get people feeling
passionate about improving psychological care after stroke.
• Inspire people to want to learn more.
• Show the importance of dealing with the psychological impact
of having a stroke, as well as the physical.
• Find champions – push forward with the PAAST training.
Finally…
• Thank you to everyone who has helped us to develop these
training materials, and to everyone helping us out today….
• We will be around all day so if you have any questions, please
let us know!
• Please don’t take the training manuals away with you today…
A PAAST representative will be coming out to each service in
the following weeks to deliver the resources and provide any
more information you need about how to use them.
• If you are interested in becoming a “PAAST champion” in your
service, please leave your contact details on the sheet by the
poster stands.
• ENJOY THE DAY!!!