AAP Structure and Style Guide AAP –DIRECT THERAPY CASE Type of write up Presenting Reason (examples) What would I do/what is my initial assessment strategy? Background info/history of presenting issue What sense can I make of this based on psychological theory?(Formulation) What do I suggest needs to happen next (based on psychological theory)?(Intervention) Is there anything else I need to be aware of/consider in this piece of work? Direct therapy work with individual/family Distress which has a psychological basis e.g. anxiety/ depression / low mood etc What are my initial thoughts/hypotheses about what might be happening based on the referral information/presenting reason? What does the evidence base/NICE say about this particular issue? How is this informing/ shaping my assessment strategy? What is my assessment strategy? What measures shall I use? And why? What am I planning to ask about/explore? What are my good (evidence based) reasons about asking about certain things? What adaptations might I need to think about? Brief outline of the history of the presenting issue e.g. onset. What impact is it having on life of client? Context of client’s situation e.g. family set up if relevant, social support, activities engaged in/not. Based on the background information what is your understanding of the individual/family’s situation? What theory/approach works best to explain/ make sense of their issues? Does drawing on several different theories/approaches work better i.e. an integrative formulation? Give your good (evidence based) reasons for choosing a particular approach. Based on the formulation and the evidence base what am I suggesting needs to happen next? Why is important that certain things are being recommended? Do I need to think about adaptations? Is what I am suggesting realistic/reasonable for today’s NHS context? Risk Consent Confidentiality issues Prof issues Critical perspective of work – gaps in evidence base/critique of evidence base Outcome measues
AAP – EXTENDED ASSESSMENT Type of write up Presenting Reason (examples) What would I do/what is my initial assessment strategy? Background info/history of presenting issue What sense can I make of this based on psychological theory?(Formulation) What do I suggest needs to happen next (based on psychological theory)?(Intervention) Is there anything else I need to be aware of/consider in this piece of work? Memory assessment Neuro psychological assessment Referral from GP for short term memory loss Brain trauma following an accident Possible onset of neurodegenerative process e.g. MS What do I think this might be? What are my initial hypotheses E.g. dementia/anxiety/ stress/specific area of damage? What does the literature say about these conditions? What are the best assessments available to investigate this? What does the evidence base advise? I actually carried out the following assessments (which were available in my placement service) and got the following results….. The onset of the memory loss/neurological issue was…. Shown by…….. Other issues present at the same time Family history of….? Pre-morbid functioning Based on the information in the background section what is your conclusion? Draw on neuropsychological theory Broaden out to include psychological impact on individual/family system/life change? What helps to explain the presentation? What are your recommendations? Psychoeducation? Who for? Reassessment?/Further assessment – if so what and why? Changes in persons daily routine? Referral to social care? Psychological adjustment? Group based intervention? Sign posting? Risk issues Outcome measures Professional issues e.g. confidentiality within the system? MDT working? Critical perspective on service provision? i.e. what a good service would look like
(example) strategy? on psychological theory?(Formulation) (based on psychological theory)?(Intervention) aware of/consider in this piece of work? Group intervention What was the identified need for the group? e.g. Several referrals concerning same issue? What are the presenting issues of the clients? Service identified need? How? What are my initial thoughts about a group intervention? Assess the need for the group - What does the literature/NICE say about interventions for this presenting issue? Is a group based intervention advocated? What makes for a good group intervention e.g. is it based on a particular theory/ies? What is my best recommendation about how to proceed with a group intervention? How should inclusion/invite to the group be considered – screening? What was the actual psychological basis/approach of the group? Was it a informed group? I.e. what was the content of the group sessions? How many people attended? What were their presenting issues? Thinking about the first 2-3 sessions only - what was the group like? Were there any dynamics? What happened? How well did they engage with the material? What sense have you made about the group and its processes? Draw on the dynamics in the group. What are the psychological processes which are working for people in the group? What psychological theory helps to explain the group? E.g. CAT? Is anxiety getting in the way of people attending/paying attention in the group? Based on your formulation – what next? What should be the content of the group? What psychological approach would work best? The one I suggested in my assessment stage or a different one? How does it map onto the formulation i.e. what sense I have made of the group? Any adjustments – pace/content/rules? Risk Boundaries Group rules Confidentiality Co-facilitation Management of/set up Prof issues Outcome measures Critical perspective on group based interventions e.g. are they more cost Pros/cons in the literature? AAP –GROUP INTERVENTION dynamic
Type of write up Presenting Reason (example) What would I do/what is my initial assessment strategy? Background info/history of presenting issue What sense can I make of this based on psychological theory?(Formulation) What do I suggest needs to happen next (based on psychological theory)?(Intervention) Is there anything else I need to be aware of/consider in this piece of work? Service/team Unhelpful dynamics in MDT/service What are my initial thoughts/hypotheses about the issue/dynamic? What is my good (evidence based) reason for considering this dynamic? What are my hypotheses about what the issue is? What would my strategy be to understand this dynamic/issue better? What models/frameworks does the literature suggest? What is the hoped for outcome? An outline of the what the issue(s) is (are). Historical information – changes in team/service delivery What the dynamic is creating/influencing /being experienced as What sense have I made of the dynamic? What is my psychological understanding of the issue/dynamic? What theory should I draw on to help with the sense making process? What would I be suggesting/recommending needs to happen to address the dynamic/issue? What psychological theory would I base this on? What role would I recommend psychology could take? Leadership? Risk Documenting what you have noticed/the process Confidentiality of the service Consideration of sensitivities of write up/consent Responsibility for the dynamic Prof issues Outcome Critical perspective AAP – SERVICE/TEAM DYNAMIC Your AAP
Type of write up Presenting Reason What would I do/what is my initial assessment strategy? Background info/history of presenting issue What sense can I make of this based on psychological theory?(Formulation) What do I suggest needs to happen next (based on psychological theory)?(Intervention) Is there anything else I need to be aware of/consider in this work? AAP – EXAMPLES OF TENSE
Presenting Reason What would I do/what is my assessment strategy? Background info/history of presenting issue What sense can I make of this based on psychological theory?(Formulation) What do I suggest needs to happen next (based on psychological theory)?(Intervention) Current tense i.e. Future tense i.e. Present/past tense i.e. Present tense i.e. Future tense The referral indicated that the client was experiencing short term memory loss The presenting issue as stated in the referral letter was anxiety with some obsessive features which took the form of…. My initial hypothesis is that X’s difficulties have developed as a result of … I plan to complete an assessment via a semi-structured interview, to explore… I intend to conduct the assessment with CBT principles in mind… I will explore how … During the assessment I hope to discuss … as indicated in (ref) I plan to administer the … [measure] Initially I would adopt a cognitive behavioural therapy (CBT) approach due to the evidence base (ref)… I would gather information on … I would sensitively ask about … [risk]. If these issues arose I would … I would use X theory to guide my assessment strategy, due to …. During a clinical interview, I would be aiming to… Based on the presenting information I would plan to use the following assessments…. Onset of the memory loss occurred 3 months before the referral… There were five people living in the family home…. X checked the door handles several times before leaving the house. This started when… Parents separated when X was three years old I used [theory] to aid my formulation, as … As a result of these experiences, X may have… X reports that she responds to these feelings by… X perceived his early relationships as… X avoids expressing feelings due to… In the context of X’s early experiences I think that … These early experiences led to … Following on from the formulation…. I would therefore decide to focus on …. This would take the form of ….. I would aim to …. Alongside this I would develop a risk management plan… An alternative intervention would be … I would base the intervention on [manualised approach]. However, I would implement the following adaptations on the basis of X’s formulation: • I would take into consideration…