Page 35 - Hospital Authority Convention 2017

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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