Page 181 - Hospital Authority Convention 2017
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Masterclasses



                M15.3     Lesson Learnt from the Application of Stepped Care   14:30  Room 423 & Room 424
                          Model for Psychosocial Service in Palliative Care

               Stepped Care Model for Psychological Interventions in the Haematopoietic Stem Cell Transplantation Ward
               Yeung DKY                                                                                           HOSPITAL AUTHORITY CONVENTION 2017
               Clinical Psychology Department, Queen Mary Hospital, Hong Kong

               About 80% of patients undergoing haematopoietic stem cell transplantation (HSCT) suffered from emotional distress over
               their treatment (Siegel, 2008). Before 2013, the referral of HSCT patients for psychological care was mainly initiated by
               ward staff. Since November 2013, a stepped-care model was introduced in Queen Mary Hospital aiming to enhance the
               efficiency of clinical psychology service, and at the same time to ensure the matching of patients’ needs and the intensity
               of the intervention received. With the support from Psychology Assistant (PA) in providing low-intensity services, such as
               psycho-education, periodic screening and systematic mood monitoring at specific time from pre-HSCT to 12-month post-
               HSCT, Clinical Psychologist (CP) can focus on delivering high intensity services, such as addressing the anxiety on upcoming
               treatment and the psychological difficulties in adjusting to isolation ward.
               The stepped-care model has three major advantages. First, the programme provides 100% service coverage as all new
               inpatients are seen by CP in intake interview to assess their psychological functioning, the presence of psychosocial
               stressors or coping difficulties. Relevant information is passed to the treatment team for devising individualised treatment
               throughout the hospital stay. Second, the provision of services was proactive, thus even patients who do not have overt
               signs of emotional distress, difficulties may be identified through interviews or objective measures. Third, the step-up and
               step-down mechanism allows flexible and efficient use of resources better tailored to patients’ needs. Among those who
               received high-intensity CP intervention, a significant decrease in the scores of patients’ anxiety, depression and emotional
               distress was found. With these benefits, the stepped-care model was shown to be able to address different levels of patients’
               psychological needs, reduce the risks of psychological morbidities, while ensuring service quality along the journey of HSCT.






































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