title: Stepped psychological care after stroke.
abstract: Emotional difficulties are common after stroke and have an impact on rehabilitation outcome. It is a challenge to manage these problems effectively, particularly in times of resource stringency. One proposal for how to do this has arisen out of an approach to general mental health management: a system of 'stepped care'. Such a system directs intervention by considering level of need, thereby making the most efficient use of available resources. It is the purpose of this article to articulate a stepped psychological care approach for emotional problems after stroke.
  
  
  
  Narrative review and elaboration of the model proposed by the Department of Health in England for the management of emotional problems after stroke.
  
  
  
  A stepped care model for the management of emotional problems after stroke is presented in detail, including descriptions of specific interventions and guidance to inform the level of management.
  
  
  
  The stepped psychological care proposal for emotional problems after stroke requires evaluation but is potentially of use within comparable healthcare systems. Implications for Rehabilitation Emotional problems are common after stroke and effect rehabilitation outcomes. A stepped care approach to these problems offers the ability to cater to all according to need. Greater specification of the services at each step can be outlined. While recommended, such an approach requires evaluation to prove its efficacy.
authors.affiliation: a Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney , Broadway , NSW , Australia.
authors.forename: Ian I
authors.initials: II
authors.lastname: Kneebone
mesh_terms: D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D011613:Psychotherapy / Q000379:methods*; D020521:Stroke / Q000150:complications* / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods; D016896:Treatment Outcome
keywords: Cerebrovascular disease; guidelines; mental disorders; psychological adjustment; stepped care; stroke