1. Bridges through the stroke pathway The Bridges Kingston Project Nicki Bailey Project Coordinator – Bridges Kingston Project

2. What is Bridges? A quick reminder… Workshops for practitioners Stroke workbook given to clients Individualised self- management programme

3. The Bridges Kingston Project South-West London Academic Health and Social Care System Pilot: First time social care practitioners included Training members of different teams in mixed workshops Objectives: Enable greater focus on promoting self-management throughout the stroke pathway Improve continuity of care for stroke survivors in Kingston Improve knowledge sharing and cross team working between teams on Kingston stroke pathway Conduct an evaluation of the project

4. Context Mapping & Preparations Project steering group Interviews with teams Role of service Current goal-setting practices Approaches to self-management Cross-team working within pathway Adaptations to training Kingston pathway specific ‘Pathway’ exercise Awareness raising of the project HASU St Georges (20 beds) STROKE UNIT Kingston Hospital (20 beds) Home with Community Rehab: ICT, Richmond CNRT Home with no support required In-patient Rehab eg Cedars Unit, QMH Community Resources RBK Social work input/ care package/ individual budget Input from RBK Stroke Co- coordinator Input from voluntary organisations and/ private organisations

5. The Kingston Stroke Pathway

6. Who participated? 54 participants completed intro & follow up Mix of teams and professions BUT social care restructure Executive session for GPs and managers

7. Results: Change in Practice Overall change in beliefs and attitude towards self-management 53% thought their practice had changed 28% used workbook “It’s like a refresher. It reminds us about giving people hope, listening to people’s goals” “I think it’s ended up this new thing, rather than just chatting to patients about goals, actually putting it down to make it a more visual tool” “It’s like a refresher. It reminds us about giving people hope, listening to people’s goals” “I think it’s ended up this new thing, rather than just chatting to patients about goals, actually putting it down to make it a more visual tool”

8. Results: Barriers to using Bridges 55% experienced barriers to using Bridges. The top 4 : Not enough timeDifficult when patient has communication difficultiesNot enough stroke patientsEnvironment wasn’t right (eg. Acute, short stay)

9. Results: Cross team training 99% said workshops enabled meeting people from other teams 19% felt team better connected (49% not sure) “I think it’s that connection having met them – oh yeah, you were on the training – on the telephone I just feel there is more of a connection there now” “It’s actually opened my eyes a bit to the pathway and how it all links together” HOWEVER “It was interesting to meet people from other teams. But I don’t think there’ll be a lasting link.”

10. Results: Bridges within the stroke pathway 78% thought could be used successfully throughout pathway Potential to improve continuity of care for patients in 3 ways: Shared ethos Provides practitioners in all teams with “some kind of shared ethos or philosophy to dip into” Continuity of goals “The patient isn’t going to have to start the whole goal setting process again, but has got a record, of ‘I’ve been working on this, I’ve achieved this.” Strengthened connections “It’s helped in liaising with the referrers...if they are referring from the Hospital we’ve mentioned oh what about the Bridges workbook... it’s a tool to help with that process of linking in.”

11. Results: Is Bridges relevant to social work? 1) Social workers already trained in ‘social model of disability’ “Responses were a lot more around empowerment and less risk averse” 2) Often stroke survivors have most difficulty once at home, outside of medical setting “He said ‘Actually things are more difficult than I’d hoped’... He’s using Bridges as a way of looking at how he can get back to activities he used to do before” 3) Bridges goal setting corresponds well with current social care practices (individual budgets, support plans) “ Bridges can be part of that support plan, as it is looking at what are their long-term goals and steps to work towards that” Bridges seen as “a good fit” with social work practice because:

12. What’s next? Investigating sustainability ‘Based on Bridges’ – not just stroke Study continuity of care from stroke survivor’s point of view

13. Any Questions? Visit: http://bridges-stroke.org.ukhttp://bridges-stroke.org.uk Email me: n.bailey@sgul.kingston.ac.ukn.bailey@sgul.kingston.ac.uk