Transcript Stepped care aphasia lab copy SPA poster 2015

Introduction
Stepped care model
Across stroke care there is a divide
between the best available evidence
and what actually happens in clinical
practice.
To identify the evidence-practice gap in
care for depressive symptoms in poststroke aphasia from the perspectives of
people with aphasia and the stroke
multidisciplinary team.
This is known as an evidence-practice
gap: a complex phenomenon that exists
across health systems throughout the
world1.
This gap is relevant to the clinical care
of depressive symptoms post-stroke in
people with aphasia and their family
members.
Barriers widen the gap. For example,
the shortage of psychologists2 and the
evidence that health professionals lack
confidence to support emotions and
provide counselling3,4,5. Facilitators
narrow the gap. For example, training
in counselling skills3 and use of valid
tools to identify depressive symptoms5.
Assess, support & information
provision. Support by peers &
stroke staff
UK NICE guidelines for people with
depression and a chronic physical
health condition8
To describe the barriers and facilitators
in translating stepped psychological care
for depressive symptoms in post-stroke
aphasia from the perspectives of people
with aphasia and the stroke
multidisciplinary team.
Research method
The project will be comprised of 3
studies to investigate the aims:
Low intensity
therapy & monitoring
by stroke staff who are
supervised by psychologist
Translating stepped psychological
care may be useful in narrowing the
gap. It is a multidisciplinary and
hierarchical model evidenced in the
following clinical guidelines:
UK NHS Improvement Stroke:
Psychological care after stroke7
Research aims
High
intensity
therapy with
psychologist
&/or psychiatrist
Study 1 A systematic review of the
literature to investigate the best
available evidence for rehabilitation of
mood symptoms in post-stroke aphasia
Study 2 Qualitative research using semistructured interviews of people with
aphasia and their family members to
gather their perspective on experiences
and preferences of current and stepped
care
Study 3 Qualitative research using focus
groups with stroke multidisciplinary
teams to gather their perspective of
current practice and the viability of
stepped care
Clinical implications
The project will increase understanding
of mood and rehabilitation of depressive
symptoms in post-stroke aphasia. It will
contribute to explaining the evidencepractice gap with suggestions for care.
Further information
References
1. Buchan, H. (2004). Gaps between best evidence and
practice: causes for concern. Medical Journal of Australia,
180(6), 48-49.
2. Australian Psychological Society (2012). Psychology 2020.
The 2011-2012 presidential initiative on the future of
psychological science in Australia. Retrieved February 2, 2015
from:
http://www.psychology.org.au/Assets/Files/2012_APS_PIFOP
S_WEB.pdf
3. Avey, H., Matheny, K. B., Robbins, A., & Jacobson, T. A. (2003).
Health care providers’ training, perceptions, and practices
regarding stress and health
4. Sekhon, J., Rose, M., & Douglas, J. (2015). Current
Australian speech language pathology in addressing
psychological well-being in people with aphasia, IJSLP.
5. Wiley, E.J., Irwin, J.D., & Morrow, D. (2012). Health care
practitioners’ perceptions of motivational interviewing
training for facilitating behaviour in patients. Journal of Allied
Health, 41(3), 131-139.
6. Cobley, C., Thomas, S., Lincoln, N., & Walker, M. (2012). The
assessment of low mood in stroke patients with aphasia:
reliability and validity of the 10-item Hospital version of the
Stroke Aphasic Depression Questionnaire (SADQ-H10).
Clinical Rehabilitation, 26(4), 172-381.
7. National Health Service Improvement (2011).
Psychological care after stroke: Improving stroke services for
people with cognitive and mood disorders. U.K:Author.
8. NICE (2009) Depression in Adults with a Chronic Physical
Health Problem: Treatment and Management. NICE clinical
guideline 91. Retrieved February 7, 2015 from
www.nice.org.uk/CG91 [NICE guideline].
UK NHS Psychological care after
stroke (2011):
Connect on Twitter: @CarolineJM26
Stepped care model
These triangles will be attached with a
paper fastener to the top of the
corresponding triangles in the first poster
slide above to create a ‘swing the
triangle’ feature to describe the levels of
stepped care.
‘Sub-threshold problems’ at a
level common to many or most people
with stroke.
Mild/Moderate
symptoms of impaired mood
and /or cognition
Level 3: Severe
mood disorder