Accelerating delivery of psychological therapies after stroke

INTERVENTION: At the start of the study, stroke survivors are interviewed in order to find out about their experience and views of psychological services. In addition, staff at stroke services and psychological services staff are interviewed in order to inform the design of the implementation package (developed in earlier phases of the project). The Implementation Package itself will establish a care pathway for patients with psychological needs after stroke, based on a stepped care model. The pathway will focus on the collaborative work between the stroke teams and IAPT teams, allowing psychological needs after stroke to be identified, treated and where necessary, for more complex cases, referred on to appropriate services. The Implementation Package will be individualised for each site, taking into consideration the staff and service user views, current practices and pathways, and available resources at each site. While delivery will vary slightly across sites, the core aspects of the implementation strategies will be consistent across all sites and will include the care pathway, training, a manual and a model of supervision. The research team is experienced in developing intervention implementation packages and will use a co‐design approach where stroke patients and carers are involved in its conception and design. The rationale for such a partnership is to maximise the “potential fit” of the intervention with the local context in which the intervention will be implemented thus maximising buy‐in from clinical staff. The trial will include exploring the usual practice before the study begins, delivery plan for the main intervention, and capturing the experiences of participants after the study has finished. The trial comprises of the following three elements: casenote review,main trial and process evaluation. Casenote Review Retrospective review of patient hospital casenotes to explore feasibility of stepped‐wedge design. It is important to know whether the initial stages o CONDITION: Topic: Stroke; Subtopic: Rehabilitation; Disease: Therapy type ; Nervous System Diseases ; Stroke PRIMARY OUTCOME: Patient Health Questionnaire 9 item (PHQ‐9) at baseline, 6 weeks and 6 months. SECONDARY OUTCOME: 1. Behavioual Outcomes of Anxiety Scale (BOA) at baseline, 6 weeks and 6 months; 2. Generalised Anxiety Disorder 7 item (GAD‐7) at baseline, 6 weeks and 6 months; 3. Impact of Events Scale 6‐items at 6 weeks and 6 months; 4. Stroke Aphasia Depression Questionnaire 10 item (SADQ‐10) at baseline, 6 weeks and 6 months; 5. Work and Social Adjustment Scale 5‐items at 6 weeks and 6 months INCLUSION CRITERIA: Case note review All stroke patients on the acute stroke unit will be identified over one week during the usual care period (prior to process mapping and development of the implementation package), and one week during the period of rolling out the implementation package. Main Trial Consecutive stroke patients admitted to the acute stroke units will be identified who: 1. Survive to day 3 post‐stroke or being discharged prior to day 3 2. Lives within catchment area of trust 3. Aged 18 or over Process Evaluation Stroke patients and carers Stroke patients and carers will be purposely selected (12 per site) to recruit a balance in sex, age (younger and older), stroke severity (mild, moderate and severe), communication abilities and time since stroke. Staff Staff working within the stroke hospital settings within each of the sites. This may include nurses, doctors, OTs, physiotherapists, allied health professionals, reflectin