Clinical psychologists' experience of facilitating team case formulation in acute and crisis mental health settings

Abstract

Background: Team case formulation is recommended clinical practice for managing patients' challenging behaviour in acute psychiatric settings. There are limited standardised protocols for case formulation and research lacks insights from facilitators. This predominantly qualitative study aimed to explore facilitators' experience of team case formulation in acute psychiatric settings to understand this practice and inform future approaches. Methodology: Clinicians with experience of facilitating team case formulation were recruited. Quantitative data was collected using visual analogue scales. Qualitative data was collected through in-depth semi-structured interviews and analysed using thematic analysis. Results: Participants were ten clinical psychologists. Findings highlighted benefits of team case formulation, including increasing staff understanding of patients' challenging behaviour and support for staff. Participants reported that a variety of models and approaches are used, which provide different ways of understanding complex presentations and challenging behaviour. Challenges to delivering case formulation included disruptions to sessions, unclear roles and expectations, and limited attendance, preparation time, and patient involvement. Challenges with dissemination and follow-ups to case formulation included lack of communication and agreement amongst staff and difficulties putting intervention plans into practice due to lack of resources. Conclusion: Team case formulation has benefits for staff and patients. While case formulation appears to enhance psychological-mindedness of staff, promote a person-centred approach, improve ward-culture, and reduce patients' challenging behaviours, there is a need to increase resources, consistency in approaches, collaboration between staff, and evaluation of outcomes. Findings from this study have the potential to inform frameworks for team case formulation.