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Considering the Team in Team Formulation : a Systematic Review This is a repository copy of Considering the team in team formulation : a systematic review. White Rose Research Online URL for this paper: https://eprints.whiterose.ac.uk/145648/ Version: Accepted Version Article: Short, Valentina, Covey, Judith A., Webster, Lisa A. et al. (4 more authors) (2019) Considering the team in team formulation : a systematic review. Mental Health Review Journal. pp. 11-29. ISSN 1361-9322 https://doi.org/10.1108/MHRJ-12-2017-0055 Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ Mental Health Review Journal Mental Health Review Journal Considering the team in team formulation: A systematic review Journal: Mental Health Review Journal Manuscript ID MHRJ-12-2017-0055.R1 Manuscript Type: Research Paper Evidence based team formulation, Team formulation definition, Team eywords: formulation theory, Team conte)t and team formulation, Team formulation impact, Team formulation Page 1 of 44 Mental Health Review Journal 1 1 2 3 Considering the team in team formulation: a systematic review 4 5 6 Abstract 7 8 9 Purpose: Team formulation, used to understand patient problems and plan care is a growing 10 Mental Health Review Journal 11 practice in adult mental health and learning disability services. This paper explores 12 13 definitions applied to team formulation (as distinct to therapy formulation), its underpinning 14 15 theories, and the inter relationship between the team and the process of formulation. 16 17 18 Design/Methodology/approach: A database search (main search term of team formulation) 19 20 of peer-reviewed studies was conducted using RISMA guidelines. A main and second 21 22 reviewer conducted quality appraisals and thematic analysis. Data were analysed by 23 24 convergent qualitative synthesis design using thematic analysis to transform evidence from 25 26 quantitative and qualitative studies into qualitative findings. 27 28 29 Findings: Initial searching produced 4532 papers, 10 of which were eligible for inclusion. 30 31 Team formulation has no distinct definition. Theories underpinning the practice of therapy 32 33 formulation emanating from general psychological theory underpin team formulation. Seven 34 35 studies applied psychological theories to the examination of team formulation. No studies 36 37 38 examined the impact of the team on the formulation. Six themes were generated regarding the 39 40 impact of team formulation on the team; /increased 0nowledge and understanding1, /altered 41 42 perceptions, leading to altered relationships, feelings and behaviours1, /space to reflect1, 43 44 /useful when stuc0 or challenged1, /perceived increase in effectiveness1, and /improved team 45 46 wor0ing1. 47 48 49 Research limitations/implications: 2imited evidence and variable quality compromised 50 51 availability of review evidence. 52 53 54 55 56 57 58 59 60 Mental Health Review Journal Page 2 of 44 2 1 2 3 Originality/value: This is the first review to examine team formulation through the context 4 5 of the team. The authors argue that a conceptual framewor0 to encompass team inputs, 6 7 processes and outputs in team formulation practice should guide future research. 8 9 10 KeywordsMental: Team formulation. Health Evidence based Review team formulation. Journal Team formulation 11 12 definition. Team formulation theory. Team context and team formulation. Team formulation 13 14 impact. 15 16 17 Paper type: 2iterature review 18 19 Declaration of Interest: None 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 3 of 44 Mental Health Review Journal 3 1 2 3 Introduction 4 5 Multi-disciplinary mental health and learning disability clinical teams, wor0ing together to 6 7 8 develop individual patient case formulations is an increasing practice within the 4nited 9 10 5ingdomMental (6ohnstone., 2011).Health 5nown as /teamReview formulation1, theJournal purpose is to develop a 11 12 shared understanding of the patient to determine the interventions (6ohnstone, 2014). 13 14 Research underpinning team formulation is of relevance to clinical practice globally. National 15 16 guidelines indicate that care that should be provided based on diagnosis (for example see 17 18 NICE, 2014a, 2014b. NIM8, 2019), however individualised care is also required (8M:/D8, 19 20 21 2011. World 8ealth Organization, 2015). Team formulation guides the design of individual 22 23 care for patients experiencing a range of mental health problems, some of which are 24 25 considered complex (for example see Berry, Barrowclough, & Wearden, 200A). Therefore, 26 27 determining a patient1s unique needs through the lens of team formulation may afford this 28 29 individualised focus. 4nderstanding the evidence base for this practice is of critical 30 31 importance in supporting teams to use evidence based practice. 32 33 34 Individual psychological case formulation (therapy formulation) emanated from behaviour 35 36 therapy in the 1A501s when it was developed as a central component for understanding the 37 38 problematic behaviours of individual patients (Bruch, 2015). Now it is recognised as a central 39 40 41 tenet of most one-to-one psychological therapies where a single therapist wor0s with a single 42 43 patient to develop a collaborative formulation (Sturmey, 200A). Studies examining therapy 44 45 formulation report a wea0 evidence base. For example, a recent systematic review examining 46 47 the inter-rater and testCretest reliability of therapy formulations across various therapeutic 48 49 modalities reported considerable differences in reliability. This ranged from slight to 50 51 substantial, depending on practitioner experience and therapy modality (Flinn, Braham, & das 52 53 54 Nair, 2015). Furthermore, there is limited evidence for impact on patient outcomes (Bieling 55 56 & 5uy0en, 2003. 5uy0en, 2009). Researchers examining formulation within the Cognitive 57 58 59 60 Mental Health Review Journal Page 4 of 44 4 1 2 3 Behavioural Therapy (CBT) model challenge whether the scientific constructs underpinning 4 5 formulation are evidence based and able to demonstrate a valid framewor0 for understanding 6 7 patient problems. Research has not yet comprehensively examined the descriptive and 8 9 explanatory elements of therapy formulation, particularly in relation to outcome prediction 10 Mental Health Review Journal 11 12 (Bieling & 5uy0en, 2003). 13 14 Despite these uncertain foundations, formulation has continued to evolve, from one-to-one 15 16 application in individual psychological therapy, to its most recent application by teams. The 17 18 earliest published report of formulation being used by teams was in 1AA7, when a practice 19 20 account of the use of Cognitive Analytic Therapy (CAT) formulation was described as a team 21 22 endeavour, used to understand patients diagnosed with personality disorder. This descriptive 23 24 account, published in a non-peer reviewed professional forum magazine (Dunn, 1AA7) has 25 26 27 preceded further descriptive accounts (for example see Davenport, 2002. Robson & Euayle, 28 29 200A. Shirley, 2010. Whomsley, 2010), and the suggested evidence for the benefits of team 30 31 fomulation continues to expand. 8owever, evidence is originating from a small research base 32 33 accompanied by a greater number of practice accounts and opinion pieces, published in non- 34 35 peer reviewed publications, which attest to the benefits of team formualtion. This is evident 36 37 from a succinct summary of team formulation offered by 6ohnstone, which highlights the 38 39 40 benefits of team formualtion as supporting increased team functioning and well-being (for 41 42 example using the expertise of all team memebrs, increasing team ability to reflect), and 43 44 bringing a more balanced and effective approach to interventions (6ohnstone, 2014). This 45 46 evidence base poses several problems. Rather than evidence-based practice, team formulation 47 48 is developing from a basis of untested and poorly collated, practice-based experience. As the 49 50 practice spreads, the degree to which team formulation can be considered a separate 51 52 53 phenomenon to therapy formulation, with its own unique definition and underpinning theory, 54 55 is not clear. Furthermore, researchers have examined the impact of the clinician on the 56 57 58 59 60 Page 5 of 44 Mental Health Review Journal 5 1 2 3 therapy formulation, scrutinising the level of practitioner s0ill and experience on the 4 5 formulation produced (Dudley, ar0, 6ames, & Dodgson, 2010. T. D. Eells, 2ombart, 6 7 5endjelic, Turner, & 2ucas, 2005), however, it is unclear whether studies on team 8 9 formulation are similarly accounting for the team context. 10 Mental Health Review Journal 11 12 The impact of team processes on the execution of specific team tas0s is well documented. A 13 14 large study of over 400 4nited 5ingdom National 8ealth Service health care teams, including 15 16 teams from physical and mental health care, concluded that team processes such as 17 18 participation, reflexivity, decision ma0ing, leadership and communication impacted on team 19 20 levels of effectiveness and innovative practice (Borrill et al., 2013). Teamwor0 is also 21 22 essential for team reliability and patient safety (Ba0er, Day, & Salas, 2009) and professional 23 24 differences in teams impact on joint wor0ing and 0nowledge sharing (Baxter & Brumfitt, 25 26 27 2008).
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