Team Formulation in Practice: A Framework Analysis of Examples From UK Clinical Psychology Practice

Background: Team formulation is an increasingly popular practice within Clinical Psychology. However, the extant literature is limited to a small body of peer-reviewed research which employs unstandardised definitions and reports varied implementation of team formulation in practice. The absence of a consistent understanding and practice of team formulation complicates both the identification and evaluation of key processes that enable workable team formulation practice. Describing practice-based instances where Clinical Psychologists have experienced workable implementation allows for identification of the key characteristics of this practice as well as an understanding of the factors that might help/hinder implementation. Aims: In the context of Clinical Psychology practice in the UK, this study aimed to: 1. Characterise the perceived forms, functions, and outcomes of team formulation 2. Understand whether/how team formulation is evaluated 3. Identify factors that may support/obstruct perceived ‘best practices’ in team formulation – based on practice-based examples of successful and unsuccessful implementation Method: We conducted an online survey of 49 UK Clinical Psychologists with experience of involvement in team formulation in practice. Participants were asked to describe two detailed examples of team formulation in practice. Further, participants answered questions regarding team formulation implementation and evaluation. Professional membership networks, social media, and snowballing were used for recruitment. Responses to free text questions were analysed using Framework Analysis. Results: Seven types of team formulation with different functions were found based on examples form practice. These had varying foci and key features. Further, evaluation was targeted at three levels: (1) Service-level indicators; (2) Team formulation indicators (quality, perceived effectiveness and staff experience); and (3) Service user-level indicators. However, issues of specificity, sensitivity and validity were noted for reported measures/methods. A number of factors perceived to support and obstruct team formulation were identified and were common across team formulation types. Managing teams’ distress within team formulation sessions was an important factor for successful implementation. Factors such as the group structure, managing difference, the level of collaboration and engagement, and linking the team formulation to meaningful changes to practice were also highlighted as factors supporting workable implementation. Conclusion: This study highlights specific team formulation functions and forms which could be used to standardise practice. Further, proposed common factors that facilitate workable implementation across team formulation types are provided. This study offers an understanding of workable team formulation in practice, however, there remains a dearth of understanding about “effective” team formulation. Future research should focus on validating and testing the identified helpful factors to further our understanding of team formulation process-outcome links.