Bringing ‘patient voice’ into psychological formulations of in‐patients with intellectual disabilities, autism spectrum disorder and severe challenging behaviours: report of a service improvement pilot

Abstract

Accessible summary• It is important to listen to patients' views when they are in hospital.• Sometimes it is difficult for staff to understand what people with intellectual disabilities are saying.• This project tried to include the views of all the patients on an autism services ward. • Some people were easier to understand than others but we managed to listen to everybody. SummaryThis is a report of a service improvement pilot project undertaken at an inpatient autism service for adults with intellectual disabilities and severe challenging behaviours. Within the service, a key facet of the care pathway was the use of a biopsychosocial case formulation. Formulation meetings were led by psychology and involved a full multidisciplinary team and external representation. However, routine invitation of patients was not appropriate due to anxiety and complex communication difficulties. Therefore, the service was looking for alternative ways to incorporate the voices of patients into formulation. This report presents the case studies of four individual patients who were chosen because together they were indicative of the patient profile across the service. The study has demonstrated that it is possible to include patients' voices in their psychological formulation. For those with mild intellectual disabilities and mild autism spectrum disorder, this has been simple and extremely fruitful. For those with severe intellectual disability and severe autism spectrum disorder this has been more resource intensive and the results have been more tentative. Despite this, it has been demonstrated that it is possible to include the voices of all patients to some extent.

A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes

“…Two studies (Rowe & Nevin, ; Whitton et al ., ) did not specify what team formulation was and were not included in the synthesis for the review's first question. Definitions were found to be descriptions of implementation (how team formulation should be used) as opposed to offering an understanding of what team formulation meant.…”

“…Table 2 provides descriptive information for the 11 articles included in the review. Five quantitative (Berry, Barrowclough, & Wearden, 2009;Ingham, 2011;Ramsden, Lowton, & Joyes, 2014;Whitton, Small, Lyon, Barker, & Akiboh, 2016), three qualitative (Christofides et al, 2012;Murphy, Osborne, & Smith, 2013;Summers, 2006), and three descriptive (Davenport, 2002;Rowe & Nevin, 2013;Wilcox, 2013) articles were retained. From articles providing information, at least 300 staff (predominantly qualified nursing and support staff), 10 clinical psychologists, and 41 service users were represented.…”

“…How do psychologists define team formulation? Two studies (Rowe & Nevin, 2013;Whitton et al, 2016) did not specify what team formulation was and were not included in the synthesis for the review's first question.…”

“…Mirroring the definition, Christofides et al (2012) implemented team formulation as an ongoing, informal approach. The remaining articles used a meeting format either as a fixed component of usual care (Berry et al, 2009Davenport, 2002;Murphy, Osborne, et al, 2013;Rowe & Nevin, 2013;Summers, 2006;Wilcox, 2013) or contingent on the emergence of difficulties (Ingham, 2011;Ramsden et al, 2014).…”

Psychological consultancy in mental health services: A systematic review of service, staff, and patient outcomes

“…Ability in developing and sharing psychological formulations with other disciplines is a core competency for psychological therapists (Division of Clinical Psychology, 2011; Skinner & Toogood, 2010). Psychological formulations are shared during team meetings, reflective practice forums, and ward rounds (Rowe & Nevin, 2013). Studies agreed on the importance of visibility and accessibility of the consultant and so findings support the integration of psychological therapists into clinical teams (Onyett, 2007).…”