Formulation skills to support the co-production of mental health treatment for young people

This Bevan Exemplar project introduced training for mental health practitioners to develop formulation skills to enable treatment plans to be co-produced.

Background

Specialist Child and Adolescent Metal Health Services (S-CAMHS) provide specialist NHS Services for children and young people with mental health problems. They offer assessment and treatment for children and young people with emotional, behavioural or mental health difficulties as well as promoting emotional wellbeing. Services are offered in the community, at home, school and local clinics.

S-CAMHS services across Wales use the Choice and Partnership Model (CAPA) of need identification and treatment planning. The process begins with a Choice appointment designed to jointly identify the need and co-produce a treatment plan with the young person and their family/carers. The quality of this initial appointment is paramount and guides the young person’s future contact and treatment. Thus, an ability to jointly formulate need and identify subsequent care is a vital skill. However, few staff have received formulation training and this has led to staff across all disciplines feeling anxious and avoidant with a lack of knowledge and skill development. Formulation skills are not taught in core professional training and most will struggle to formulate the young person’s needs and thus identifying ongoing psychological treatments may be compromised. Therefore this significant gap in knowledge and skills needs urgent amelioration.

Aim

Develop and deliver formulation training for practitioners in S-CAMHS services in Aneurin Bevan University Health Board (ABUHB) to enable the joint development of treatment plans, enable an understanding of why ‘symptoms’ are present/what is maintaining symptoms and enhance therapeutic alliances by developing engagement with young persons and their family/carers.

Challenges

The project needed to undergo the following stages:

• Develop of S-CAMHS Formulation training programme.

• Pilot delivery of the training programme in ABUHB.

• Identify staff roles for inclusion in pilot training; Nurses, Psychologists, Psychiatrists.

• Administer pre-knowledge assessment to identify practitioners understanding of formulation theory, skills and knowledge.

• Administer post-knowledge assessment after delivery of the training package.

• Evaluate pilot.

Outcomes

• The training programme was delivered four times between May-June 2019, (n=13).

• 12 CPNs and 1 nurse therapist were trained (Bands 12-6 & 1-7).

The majority (n=10) had previously heard of the case formulation approach to S-CAMHS clinical provision and (n=8) had prior experience using the approach.

Next steps

The development of the case formulation and treatment pathway was successful and the pilot evaluation suggested positive impact. As such, the pilot stage should be rolled-out more widely across Wales.

The service should undergo continued evaluation to ensure its usefulness and appropriateness.

All S-CAMHS staff across Wales could be trained in a common model of formulation, using evidenced-based psychological theory and practice.

The Pre-Post Evaluation identified an improvement in both understanding and knowledge of those trained.

Knowledge increased from;
‘Little’ (n=6), ‘Reasonable’ (n=5), ‘Very’ (n=2)
To ‘Reasonable (6), ‘Very’ (n=5), ‘Extremely’ (n=2).

Understanding increased from;

‘Little’ (n=8), ‘Reasonable’ (n=4), ‘Much’ (n=1)
to ‘Reasonable’ (n=5), ‘Much’ (n=6), ‘Excellent’ (n=2).

Application to practice;

(n=13) would use it in their practice.
Rated ‘Very’ (n=6) and ‘Extremely’ (n=7) applicable.

Usefulness of training;

‘Very’ (n=9) and ‘Extremely’ (n=4).

Part of cohort Bevan Exemplar Projects 2018-19