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Team formulation, used to understand patient problems and plan care, is a growing practice in adult mental health and learning disability services. The purpose of this paper is to explore definitions applied to team formulation (as distinct to therapy formulation), its underpinning theories, and the inter-relationship between the team and the process of formulation.

A database search (main search term of team formulation) of peer-reviewed studies was conducted using PRISMA guidelines. A main and second reviewer conducted quality appraisals and thematic analysis. Data were analysed by convergent qualitative synthesis design using thematic analysis to transform evidence from quantitative and qualitative studies into qualitative findings.

Initial searching produced 4,532 papers, 10 of which were eligible for inclusion. Team formulation has no distinct definition. Theories underpinning the practice of therapy formulation emanating from general psychological theory underpin team formulation. Seven studies applied psychological theories to the examination of team formulation. No studies examined the impact of the team on the formulation. Six themes were generated regarding the impact of team formulation on the team; “increased knowledge and understanding”, “altered perceptions, leading to altered relationships, feelings and behaviours”, “space to reflect”, “useful when stuck or challenged”, “perceived increase in effectiveness” and “improved team working”.

Limited evidence and variable quality compromised the availability of review evidence.

This is the first review to examine team formulation through the context of the team. The authors argue that a conceptual framework to encompass team inputs, processes and outputs in team formulation practice should guide future research.

The SECURE STAIRS framework has promoted young person involvement as a key feature of innovative service provision. In the North East of England, Secure Children’s Homes (SCHs) have pioneered young person involvement in team formulation. Young people have also led on the development of formulation materials through a young person involvement project. Young people’s attendance at team formulation meetings has become embedded. These service developments have also begun to expand across broader SCHs, Secure Training Centres (STCs) and Young Offender Institutions (YOIs) and reflect the national impact of such pioneering developments. There is a notable lack of research examining the impact of young person involvement in formulation. The purpose of this study is to elucidate this area.

Between April and August 2019, there were 86 staff attendances at formulation meetings where young people were present across two SCHs in the North East of England.

Paired samples t-tests indicated staff-reported significant post-formulation improvements across all domains measured including knowledge [t(85) = 11.38, p < 0.001]; confidence working with the young person [t(85) = 5.87, p < 0.001]; motivation [t(85) = 3.58, p < 0.001]; understanding [t(85) = 9.03, p < 0.001]; and satisfaction with the treatment plan [t(85) = 8.63, p < 0.001].

Implications of findings are discussed and further developments outlined.

Young people attending team formulation is a new and evolving area, and to the best of the authors’ knowledge, there is no existing research evaluating this area. The current findings suggest that staff knowledge, motivation, confidence and satisfaction with the treatment plan is improved following attendance at team formulation where the young person is present and actively participating. Young people’s participation and involvement is central to planning, developing and progressing meaningful provision within children and young people secure provision.

Involving children and young people in decision-making, service development and evaluation are also key components of ensuring the voice of young people is central in our minds. It also supports empowering the young people we work with. Young people and their journey should always be at the heart of what we do.

Young people attending team formulation is a new and evolving area, and to the best of the authors’ knowledge, there is no existing research evaluating this area. This is the first study of its type evaluating formulation directions within the SECURE STAIRS framework.

The purpose of this paper is to investigate the impact of psychological case formulation meetings for staff in a secure forensic learning disability and autism service.

In total, 89 of the attendees completed a questionnaire prior to the formulation meeting and then another questionnaire following attendance at a formulation meeting.

The results indicate that staff found these to be a helpful, informative and a positive experience professionally and personally. The results suggest that the formulation meetings developed staffs’ psychological understanding about the patient and their problems, helped to increase their empathy towards the patient, increased consistency in the teams’ views, and that the staff felt listened to.

Psychological formulation meetings are established in the current service, and therefore this may be a contributing to factor to the lack of significant change found in some of the items. Therefore, it would be beneficial for future services to complete a service evaluation at a much earlier point of implementation, as this may impact the level of significance.

The findings of this service evaluation suggest that formulation is a beneficial and useful tool for teams and would be a helpful tool for psychologists to use in the clinical work with teams.

Despite the popularity of team formulation, there is a lack of knowledge about workable implementation in practice. The purpose of this paper is twofold: first, to characterise team formulation, based upon examples from practice; and second, to identify factors perceived to support or obstruct workable implementation in practice.

An online survey recruited UK Clinical Psychologists (n=49) with experience in team formulation from a range of work contexts. Examples of team formulation in practice were analysed using both deductive and inductive framework analysis.

Four novel types of team formulation with different functions and forms are described: case review, formulating behaviour experienced as challenging, formulating the staff-service user relationship and formulating with the service-user perspective. A number of factors perceived to support and obstruct team formulation were identified including team distress, facilitating change, managing difference and informing practice. These were common across team formulation types.

The team formulation types identified could be used to standardise team formulation practice. Several common factors, including managing team distress, were identified as aiding workable implementation across team formulation types. Future research should investigate the key processes and links to outcomes of team formulation in practice.

This paper presents two original, practice-based and practice-informing frameworks: describing, first, novel forms and functions of team formulation and, second, the factors supporting and obstructing facilitation in practice. This paper is the first to highlight the common factors that seem to facilitate workable implementation of team formulation in practice.

A biopsychosocial case formulation is an important tool for understanding complexity and guiding treatment for people with intellectual disabilities. It has been suggested that formulation meetings develop staff understanding of individuals they support. This study aims to explore the change processes that occur as a result of professional team formulation meetings, and the mechanisms that facilitate and hinder these events.

Eight clinicians who took part in multi-disciplinary team-based formulations in an inpatient mental health service for adults with intellectual disabilities were interviewed. Interviews were examined using thematic analysis.

The key themes identified were: “gaining information”, “altered thoughts” and “focused goals”. These themes were supported by “collaborative working” and “time for reflection” and were hindered by “poor communication and interaction” and inconsistent “staff attendance”.

Multi-disciplinary team formulation meetings may have a number of change processes that affect staff knowledge and perception of the people that they support. The facilitation of these processes should be a focus for further development.

The purpose of this paper is to understand staff experiences of cognitive analytic team formulation, within an inpatient unit for women with a diagnosis of personality disorder.

In total, 16 staff completed an online questionnaire, rating their views on how helpful formulation sessions had been in regards to ten domains. Following this, six staff participated in semi-structured interviews exploring their experiences of the process and impact of cognitive analytic team formulation. Transcripts were analysed using thematic analysis.

Responses from questionnaires indicated the general process of team formulation was helpful across each domain. Interviews highlighted benefits such as an increased capacity to think and work relationally. This was impacted upon by staff’s confidence in using the model and the practicalities of attending sessions.

Team formulation has been described as the facilitation of a group of professionals to create a shared understanding of service-users’ difficulties. Team formulation continues to demonstrate benefits for staff working within complex mental health. The challenges of this are considered, however overall, a cognitive analytic framework seems to offer staff the opportunity to integrate learning from a service-user’s history, and current relational difficulties, in a way that develops reflective capacity and informs intervention.

Limited research has explored the theoretical models underpinning team formulation, and the impact for staff learning and practice. The current study develops previous work by specifically focussing on the contribution of cognitive analytic theory to team formulation.

Team psychological formulation is an organisational intervention aimed at developing a shared understanding of a person’s mental health difficulties. There is a lack of evidence regarding the therapeutic value of this approach for older people. The purpose of this paper is to explore how older people and their carers experience a cognitive-behavioural approach to team psychological formulation, within a mental health inpatient service in the UK.

A qualitative study using interpretative phenomenological analysis was undertaken. In total, 13 participants were interviewed: five older people/carer dyads, two lone older people and one lone carer.

Three overarching themes emerged: “Emotional impact of formulation” captured the mixed emotions that the process evoked in participants. “Making sense?” reflected the therapeutic value that participants experienced and what held them back from making gains in their recovery. “Disempowered people trapped in a biomedical world” illustrated the negative aspects of ward care, which hindered recovery.

The findings provide insights into the therapeutic value of team psychological formulation and the difficulties in facilitating the process effectively. More consistency is required to ensure that team formulation is standardised. Further research into the outcomes of the approach for older people is recommended.

Recommendations are proposed for how team psychological formulation can be conducted effectively, using the mnemonic “SETUP”.

This study focussed on older people’s and their carers’ own perspectives regarding the team psychological formulation approach.

The purpose of this paper is to evaluate pre- and post-formulation findings with multi-disciplinary staff within two secure children’s homes (SCHs) in the North East of England.

Multi-disciplinary staff teams involved in formulation across two SCHs were administered pre- and post-formulation questionnaires. The pre- and post-formulation questionnaires focused on five domains: knowledge; confidence; motivation; understanding; and satisfaction with treatment plan.

A total of 338 pre- and post-formulation questionnaires were administered across 43 formulation meetings. The highest proportion of formulation attendees were: residential staff (44%); mental health staff (17%); case managers (12%); and education staff (9%). Paired samples t-tests showed significant post-formulation improvements across all domains including: knowledge [t(337) = 22.65, p < 0.001]; confidence [t(337) = 15.12, p < 0.001]; motivation [t(337) = 8.27, p < 0.001]; understanding [t(337) = 19.13, p < 0.001]; and satisfaction [t(337) = 18.81, p < 0.001].

The SECURE STAIRS framework has supported formulation developments across the Children and Young People’s Secure Estate. Preliminary findings within two SCHs suggest multi-disciplinary staff teams find psychologically informed formulation beneficial. Future directions are considered including future evaluation of young person involvement in formulation meetings.

There is a notable lack of existing research within the child and young people secure estate evaluating the impact of SECURE STAIRS trauma-informed care developments including the impact of team formulation. This paper adds to the evidence base.

The purpose of this paper is to present a case study using a systemic team formulation approach, in the context of supporting a women with intellectual disabilities with a history of trauma.

A reflective stance is used to describe the process of assessment, hypothesising, formulation and intervention in a single case study design.

Feedback from care staff suggests that they found a team formulation approach helpful to improve their understanding of the service user they support.

The paper discusses how systemic team formulation can draw on trauma-informed care principles in the context of supporting an individual with an intellectual disability. Future research should aim to replicate the approach for findings to be applied more broadly. COVID-19 has meant clinical working has had to be adapted, clinicians should carefully consider how collaborative and meaningful work can continue to be facilitated within the current parameters.

This case study contributes to the literature in the use of systemic team formulation interventions within an intellectual disability context, drawing on trauma-informed care principles and reflecting on adapted working within the COVID-19 pandemic.

The purpose of this paper is to explore the process of co-producing a formulation alongside a service user and the clinical team within a secure inpatient service. This paper has been co-authored by the service user and members of the multi-disciplinary team (MDT).

An open-ended focus group discussion was facilitated with the service user and members of her MDT. The process of thematic analysis was applied to the focus group transcript.

The following themes highlighted important outcomes of co-producing a formulation within a secure inpatient setting; “Meaningful Collaboration”, “Co-Produced Understanding” and a “Shift in Power Differential”. This paper demonstrates the importance of meaningful co-production within a secure inpatient service whilst also highlighting the challenges and tensions of working in a co-produced way within this context.

This paper explores the process of co-producing and developing a formulation from the perspective of one service user and their MDT within a secure inpatient setting. It would be unhelpful to extrapolate broad assumptions from this case study although this study does raise important considerations for future research and encourages an emphasis on a co-produced design and dissemination.

This case study highlights the importance of co-production in clinical endeavours, service delivery and development perspectives and in the dissemination of this information.

The importance of co-producing and co-authoring alongside service users have been highlighted in this paper. This approach to co-production and co-authorship is highly recommended in future research endeavours.