Abstract

OBJECTIVES
Team formulation is expected to support multidisciplinary team members to work effectively with their clients, meet their clients’ needs and broaden their psychological knowledge. There remains a lack of research evidence regarding the perceptions of team formulation among Community Mental Health Team (CMHT) members. This study addressed the following research questions; (1) what are considered helpful or unhelpful aspects of team formulation? (2) what are the processes or mechanisms that lead to unhelpful or helpful aspects of team formulation? (3) what is the impact of team formulation on professionals’ clinical practice? and (4) what are the factors that may influence these outcomes?
DESIGN An inductive qualitative design was used, utilising a contextualist, critical-realist paradigm.
METHODS 12 CMHT members who attended team formulation were recruited from three sites within the British National Health Service. In each site, an individual interview with a clinical psychologist and a focus group with three professionals were conducted. An inductive thematic analysis was used.
RESULTS Attendees across the three teams reported that although team formulation was optional, a low priority and outside of their usual way of working, this was engaged by those who perceived a value in it. Participants reported that this process required a safe environment which would not threaten attendees’ job securities; and identified factors that enable this. Although attendees predominately reported helpful aspects of engaging in team formulation, these could also be perceived as unhelpful (apart from validation). The helpful aspects of team formulation involved other professionals’ contributions. Attendees reported that team formulation impacted on their clinical practice by (1)
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providing alternative ways of working with clients and meeting their clients’ needs and (2) justifying discontinuation of clinical work.
Across all teams, participants reported that ideas derived from team formulation, integrated into care plans (CPs) were integral and that these CPs were valued outcomes/ products of team formulation. Participants reported that CPs were helpful in justifying attendees’ engagement in team formulation, prioritising ideas and making these achievable, and providing a rationale for professionals to flexibly test ideas. Participants did not report unhelpful aspects of CPs as products of team formulation. There were conflicting perceptions across the teams regarding the factors that influenced the use of CPs e.g., psychologists expected CPs to be used but also reported that this was not required as attendees adopted alternative perspectives.
CONCLUSIONS This study found that attendees reported that other professionals’ contributions enabled them to work effectively with their clients and meet their clients’ needs. Attendees did not outline broadening their psychological knowledge as suggested by the professional document published by the Division of Clinical Psychology (2011). This study’s findings suggests that each CMHT may benefit from discussing (1) clear expectations of team formulation, as this process can be perceived as different for attendees, (2) what aspects enable team formulation to be safe and ascertain how this could be achieved, (3) the unhelpful aspects of engaging in team formulation and ways of managing these, and (4) agreeing on their expectations of the outcomes or use of the products of team formulation i.e., are professionals expected to use CPs, adopt alternative perspectives, or both. If CPs are expected to be utilised then CMHTs may require support from their managers.