Frequently Asked Questions
- What is Stepping Out?
- Why is Stepping Out needed?
- How has Stepping Out been developed?
- Is Stepping Out relevant to all stroke survivors?
- What is there to support carers?
- Who are the Stepping Out training workshops for?
- What does the Stepping Out programme provide?
- Can the Stepping Out approach be used by anyone?
- How much does a Stepping Out workshop cost?
- How much does the Workbook cost?
- How do I book a Stepping Out workshop?
- How do I find out more about Stepping Out?
What is Stepping Out?
Stepping Out aims to provide stroke survivors with the opportunity to develop their self-management skills via an individualised programme delivered by trained practitioners based on self-efficacy research.
The Stepping Out programme has been designed in consultation with stroke survivors. It recognises that stroke is a unique and complex event, and that one size doesn’t fit all. It can be used alongside regular therapy or after discharge from rehabilitation
There are 3 main components to the Stepping Out programme:
- A workshop for stroke practitioners to enable them to learn effective skills, theory and research relevant to stroke self-management, and to be able to use the Stepping Out approach
- One-to-one self-management sessions with the stroke survivor
- The personalised, interactive, stroke workbook given to the stroke survivor to support their self-management. This becomes their own property and comprises of individual stories and strategies suggested by contributors, together with a diary section to record personal targets and successes.
Why is Stepping Out needed?
Stroke is the most complex and prevalent disability in the UK affecting over 130,000 people in England and Wales alone. In the UK, stoke costs £4.2 billion in terms of lost productivity, disability and informal care costs.
The National Stroke Strategy (2007) recommends that a range of programmes to support self-management skills after stroke are needed, to reduce long term care costs.
http://www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_083506
The DoH in the document ‘Supporting people with Long-term conditions to self-care: a guide to developing local strategies and good practice’ (2006), underlines the need for new approaches based on an increasing body of evidence, to enable people with long-term conditions to self-care , and live as normal life as possible.
Systematic reviews of the experiences of living with stroke reveal a complexity of problems faced by people in the longer term, including social isolation and mood disorders. It is often reported that many stroke survivors feel abandoned and ill prepared for coping with life after discharge from regular therapy.
How has Stepping Out been developed?
Stepping Out was originally conceived by Dr Fiona Jones (physiotherapist and academic in stroke) in 2005. Preliminary testing using a series of single-case studies (n=10), revealed a statistically significant change in self-efficacy, and improved activity, participation and mood in all participants following the intervention. The ongoing development has since been strongly influenced by policy context and research in stroke and self-management
Early in 2007, the Stepping Out programme was tested in three pilot sites (Inverness, London, and Christchurch). Over 45 nurses and allied health professionals attended an introductory workshop, and 150 stroke workbooks were distributed. Follow-up events to gain feedback about the workshops and stroke workbook were subsequently held in all pilot sites later in 2007. Feedback was positive and informed the development of the final training programme for practitioners and stroke workbook.
A multiprofessional expert Project Advisory Group, was established in January 2007, and has since guided the development of Stepping Out. The Group includes Stroke Survivors, Carers, Stroke Consultant, OT, Physiotherapist, Nurse Consultant Psychologist and advisors from Connect (UK Charity for people with Aphasia)
In February 2008 the stroke workbook was evaluated by communication advisors at Connect and considerable effort has been made to incorporate their suggestions into the final version of the stroke workbook, now completed. This has made the workbook more accessible for individuals with aphasia.
The first team workshop was held in Dundee in April 2008 and the first London based team workshop is set for July 2008 at Imperial Healthcare Trust. On 8th October 2008 the first Open Workshop will be held at St Georges University of London for individual practitioners who are unable to host their own workshop.
Stepping Out has been tested in a series of single-case studies, with participants between 12-72 weeks post stroke. The one-to-one sessions all took place after discharge from hospital. At the 3 pilot sites practitioners worked in both acute and community settings. Following focus groups with practitioners we learned that Stepping Out can be introduced in the acute setting or at any stage of the stroke pathway, but will depend for the most part on the readiness of the individual stroke survivor. We anticipate that Stepping Out can be used as early as 2-3 weeks post stroke, and there is no limit to how long post stroke. Many of the stories/cases in the workbook are from people who are many years post stroke. In April, 2008 a phase 1 pilot study will commence in Northern Ireland, with the results of this study providing more information about feasibility, acceptability and timing of Stepping Out. We recognise that successful self-management can also be contingent on the support and strategies used by carers. This was a strong theme expressed by practitioners from the pilot sites. We are aiming to develop an accompanying booklet for carers, and Stepping Out practitioners will be able to access this once it is available. Stepping Out workshops are aimed at all stroke professionals, including: nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists, doctors and any other health care practitioners working within the stroke pathway. We expect that the majority of our workshops will be team workshops, delivered to members of the same stroke team or pathway. However we do plan to hold open workshops based at St George’s University of London for individual practitioners who are unable to host their own workshop. Stepping Out delivers self-management training for practitioners working in stroke rehabilitation to encourage stroke survivors to take control of their daily lives. Workshops Session 1: Introduction to Stepping Out Session 2: Follow-up Team Workshop: we come to you Open Workshop: based at St George’s University of London Team Workshop: Costs include 5 copies of the Stroke Workbook and resource pack per participant, access to our web-based interactive discussion forum and email support. Open Workshop: Costs include 5 copies of the Stroke Workbook and resource pack per participant, access to our web-based interactive discussion forum and email support. Lunch and refreshments will be provided. Do I need to purchase ongoing supplies of the stroke workbook? And what would the costs be? The cost of the introductory Stepping Out workshop includes 5 copies of the Stepping Out workbook. We anticipate that additional copies will be needed by some stroke teams and extra copies can be purchased at: All costs are fixed until end of 2008. We suggest you do the following; Tel: +44(0)20 8725 0319 or email stepout@hscs.sgul.ac.uk A booking form should be completed and sent to the Stepping Out team: Click here to download a booking form or e-mail stepout@hscs.sgul.ac.uk and we will send you one via e-mail Please return the booking form to: Dr Fiona Jones We are currently accrediting a training course to meet the demand for practitioners to deliver the Stepping Out programme within their own organisation whilst ensuring that the quality and integrity of the Stepping Out approach is maintained. These courses will run according to demand at St. George’s University of London and will be delivered by academics from the Stepping Out Team. We are currently in the process of developing the course structure and participants will also have the opportunity to consider extending their accreditation to gain academic credits at postgraduate level, as part of a 15 credit module ‘Life after Stroke’ (subject to validation). Successful completion of the training course will allow the participant to deliver training to their own team members via the Stepping Out approach. Course materials and workbooks will be available to purchase from the Stepping Out team. To register your interest in Stepping Out, please click here You will be added onto our database and will receive via e-mail our quarterly newsletter ‘Stride’, details of Open Workshops and updates on Stepping Out. Download the latest and previous versions of ‘Stride ’ here. We welcome contact from individuals or trusts who would like to participate in Stepping Out training workshops. To discuss your training requirements, please contact the Director of Stepping Out, Dr Fiona Jones at: For any other enquiries, please contact the Stepping Out team on: E-mail: stepout@hscs.sgul.ac.uk
Can Stepping Out be used with all stroke survivors?
What is there to support carers?
Who are the Stepping Out training workshops for?
What does the Stepping Out training programme provide?
There are 3 main components:
Workshops are aimed at all stroke professionals, including nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists, doctors and any other health care practitioners working within the stroke pathway.
Each Workshop is a two-stage certification process of two separate sessions with an intervening period of 3-6 months.
The session enables participants to develop effective strategies to encourage self-management after stroke. Participants explore the Stepping Out model with examples from current research in stroke rehabilitation and chronic disease self-management. There is an opportunity to discuss person-centred rehabilitation in the context of National Stroke Guidelines and DOH policy.
Session 1 will enable participants to:
This session requires participants to report on and discuss at least one Stepping Out case study.
Session 2 will enable participants to:
In addition we provide:
Types of Workshop
Each workshop caters for up to 20 participants and is directed at that point of the stroke pathway at which practitioners are engaged (acute, early supported discharge, community). The Team Workshop includes both the Introduction and Follow-up sessions.
On 8th October 2008 we will hold our first Open Workshop for individual practitioners who are unable to host their own workshop. The Open Workshop includes both the Introduction and Follow-up sessions. Places are limited to 20 participants.
How much does a Stepping Out workshop cost?
Costs do not include travel and overnight accommodation for one Stepping Out trainer (if required), venue hire or catering costs, postage and packaging.
All costs are fixed until end of 2008.
How do I book a Stepping Out Workshop?
Principal Lecturer/Director
Faculty of Health and Social Care Sciences
Grosvenor Wing
St Georges University of London
Cranmer Terrace
London
SW17 0RE
Is the Stepping Out approach only to be used by practitioners who have attended workshops?
How do I find out more about Stepping Out?
Team Workshop enquiries
Tel: 020 8725 2445
