Screening for Psychological Distress

Objectives of Session To understand the principals of using the distress screening tool. To provide participants with an opportunity to practice using the distress screening tool.

Who should undertake the DS? The DS should only be administered by professionals at Level 2 and above competency Level 2 practitioners must possess problem– solving skills and have at least one of the following: Psychological Assessment Skills for UASC Have attended DS training sessions Those undertaking a DS should access consultation from Level 3 or 4 practitioners

When should DS be administered? Undertake as part of the Early Intervention Framework at all the key points in a UASC journey i.e.: At arrival At FTT and dispersal After significant change At key asylum process moments Other times when distress is apparent. A quick screening tool to assess psychological needs from which care can be planned during dispersal and in the new authority.

Principles of using DS Explanation Transparency Normal process Solution focused Use of UASC's own resources Assessment not therapy

The Distress Screening Please circle the number (0–10) that best describes how much distress you have been experiencing in the past week including today. Problem list: Indicate if any of the following have been a problem to you in the past week. Family: Bereavement Loss of contact with family Concern about family safety Emotional: Spiritual: Fear Loss of hope Anxiety Loss of spiritual Nightmares practices Hypervigilance Loss of spiritual community Physical: Unhappy with Fatigue how living life Constipation Loss of peace Sleep indigestion Why the DT: Work by Group identified several QOL tools – but many were one dimensional e.g. focussing on just depression, rather than global assessment. Was developed in USA specifically for Cancer and Palliative Care as a non-stigmatising bio-psycho-social- spiritual tool for distress. Well validated both in USA and current and ongoing validation in UK. User-friendly and familiar – asks patients to rate distress on thermometer from 0-10, then indicate which specific problems from a checklist are causing distress.

The Distress Screening Solution Focused Care Plan: 0 – 5: UASC does not require additional EM&WB support. Watch, wait and see protocol to be maintained. Level 2 clinician required from a competencies perspective. 6 – 7: UASC requires additional EH&WB support based on the Early Intervention Framework and a level 3 clinician is required from a competencies perspective. 8 – 10: UASC requires additional EH&WB support and review based on the Early Intervention Framework and input from a level 4 clinician required from a competencies perspective. Solution process: Is sleep work required and been undertaken? Yes No Is re-feeding work required and been undertaken? Yes No Is hope work required and been undertaken? Yes No Why the DT: Work by Group identified several QOL tools – but many were one dimensional e.g. focussing on just depression, rather than global assessment. Was developed in USA specifically for Cancer and Palliative Care as a non-stigmatising bio-psycho-social- spiritual tool for distress. Well validated both in USA and current and ongoing validation in UK. User-friendly and familiar – asks patients to rate distress on thermometer from 0-10, then indicate which specific problems from a checklist are causing distress.

Using the DS: Stage 1 Explain what you are doing and ask the UASC if they are willing to go ahead Show UASC DS & ask him/her to globally rate their distress over the past week Ask them to tick any items that have been of concern to them over the past week, adding any concerns not on the form ‘e.g. you are now at the end of your chemotherapy treatment and I’d like to talk with you to see how you are managing. We have a lot to cover so this assessment has been structured in a particular way. It is up to you to decide how much you wish to tell me but if you can tell me of any concerns then we will be able to think about how we can help you with these’.

Using the DT: Stage 1 Ask the UASC to think about what is the most important concern contributing to their overall distress Record this ranking (i.e. 1st) on the screening sheet Then ask for the next most highly ranked concern. Work through main concerns in this way ask the patient to use the thermometer again to rate the individual item as to the level of distress this has caused them over the past week. Record this below (or beside) the ranking.

Using the DS: Stage 2 Record the scoring on the screening From the problems list, see if any UASC Early Intervention work is required. Refer the UASC to a relevant clinician according to scoring or ensure that this goes in the health passport to the new authority so that they can action a care plan. 2. What does it involve? When did it start. What does the patient think it means? What may be maintaining the problem (i.e. preventing its solution)? What resources does the patient have to address these concerns (e.g. social support, coping skills etc).

Using the DS: Stage 3 Summarise what you’ve discussed & what steps you will take, if any, & those others have agreed to take. Ask UASC if they have any remaining questions/concerns. Thank UASC and tell them DS will be placed in their case notes and/or in their health passport. Take any actions you have agreed with UASC & inform other relevant parties

DS ratings <5 – UASC not exhibiting unusual signs of distress ACTION - continue to monitor as per watch, wait and see protocol >6 & <7 – UASC is exhibiting non-urgent distress ACTION - provide support within your skill-base, consult and/or refer to a Level 3/4 practitioners & continue to review progress >8 – UASC is exhibiting high levels of distress, pressing need for action ACTION – use caseload supervision seek consultation with Level 3/4 practitioner, bring case to UASC Network, liaise with other relevant professionals if necessary e.g. if needs are financial, physical etc If pt. score >7, clinicians must refer patient to level 3/4 practitioner. This score refers to global score. However, if a patient scores highly on a specific problem, but not globally, provide help within your skillbase, or refer on for that problem.

Now it’s your turn! Find a partner Partner A will take role of practitioner Partner B will take role of UASC Administer DS Then change roles 15 mins each.

Summary of administration This is part of a normal assessment Be Transparent Value the UASC's distress Use a problem solving approach Help UASC identify resources

Points to remember When - At all key points in UASC. pathway, & if UASC express emotional distress Who – min. Level 2 practitioners who have completed relevant training Supervision – should be accessed from Level 3/4 practitioners Support – score >4 & <6 provide support within your skill-base, consulting or ask for review with Level 3/4 Referral – score >6 – discuss UASC with Level 3/4 practitioners or request for this as part of their care plan, bring to UASC Network, liaise with other professionals if necessary

Final point We must remember: The importance of identifying and managing emotional distress for UASC. DS is a user-friendly tool that can simply and easily identify emotional distress It gets quicker & easier to administer the more it is used!