Clinical Interview with a Parent in Primary Care Psychology Service: Formulation, Assessment, and Tr

Please read the below clinical interview with a parent in a primary care psychology service and develop a formulation of the child as well as an action plan for any further assessment necessary as well as a treatment plan. We recommend you approach this exam as a continuation of the work completed for your continuous assessment. The treatment plan can utilise one specific therapeutic approach or incorporate aspects of more than one. Please note how you would know at the end of the intervention whether it has been successful or not (be specific). Feel free to use tables or figures to support your work if necessary, however these must be included in the word count. Please refer to the guidelines below as to how to frame your response. Please note the below client details are based on several different clients with all identifying information changed.

1. An initial formulation, which consists of a brief statement about how the problem was understood after the clinical interview. Such an initial formulation could be wrong but  should lead coherently to the initial intervention.

A formulation should help to provide a coherent framework to better understand a client’s presenting difficulties. It usually contains informed "best guesses", about causal or functional relationships between variables/events and the central clinical problem, set within the framework of a sound theoretical psychological model (for example a specific model within psychodynamic or cognitive behavioural theories). It should cover psychological (behavioural, affective, cognitive), socio-economic and biological aspects of the problem and take into account the individual’s age, developmental stage and life stage.

This formulation is based on the hypothesis that emerges most strongly from your assessment. The formulation should be holistic i.e. not just explain an isolated part of the problem. Normally the formulation will include information such as:

• Presenting Problems
• Vulnerability factors
• Precipitating factors
• Maintaining factors
• Ameliorating factors

A diagram is often helpful in illustrating the formulation. A formulation is not just a description; it follows a description and can best be regarded as an explanatory hypothesis (or set of interconnected hypotheses) about the nature of the clinical problem. The formulation hastwo main functions: (a) it tells you what to do, i.e. it guides your clinical action, and (b) helps you to set up criteria for evaluating your intervention.

Clear expression of your formulation helps the examiners understand your ability to think clinically about a case in a logical and systematic manner.

A formulation is not expected to be static. It may well change in the light of new information and so a formulation does not have to turn out to be correct. It is in essence a Working Hypothesis and it is common to find that a formulation has been incomplete, or even wrong; it must however have been derived coherently, with reference to current theory and knowledge and from specific information and observations you have made.

Action Plan

2. An action plan following logically from the clinical interview and formulation of the problem. This action plan might involve further detailed  assessment, and/or outline of therapeutic intervention. Where relevant it should refer to the professional and ethical issues raised.

The action plan is implicitly contained within the formulation but now needs to be explicitly stated. Support for the choice of action plan also needs to be provided: e.g.clinical guidelines (e.g. NICE) and research evidence regarding efficacy of intervention type, suitability of that intervention with that particular client, their stated goals, their age, developmental stage and motivation. In addition the plan needs to take into account implications in relation to carers (impacts on them, attitudes towards the problems) and service providers (limitations imposed by resources and operational policies). The intervention need not necessarily be focused on the individual client, but may be aimed at systemic change. It may be helpful to use sub-headings for different aspects of the Action Plan. At this stage, especially in a complex case, it may be decided that further more detailed assessment is necessary in which case the modes of assessment should be the basis of the Action Plan.

3. A description of how you will measure the efficacy of the intervention. This mayinclude parental report, child report or formal assessment.

Measuring progress, effectiveness, or outcomes, and using the information to help guide or adjust treatment, has been shown to significantly improve therapy outcomes. Measuring progress or effectiveness during the course of treatment allows a client and psychologist to discuss what seems to be working, what doesn't seem to be working, and any need for adjustments to the treatment (e.g., different approach, different focus, different therapist, or even an intervention other than therapy) if it is not helping. Measuring progress, effectiveness, and outcomes also helps determine when treatment is complete, i.e., when a person has achieved what they wanted from therapy and the intervention can end.

There are many ways in which progress or effectiveness of therapy can be measured. Goals and objectives are discussed throughout the course of intervention to determine progress and completion of treatment. Various outcome scales and checklists have been developed to track progress, effectiveness, and outcomes in an even more quantitative and concrete manner. These measures range from brief (e.g., one to two minutes) rating scales completed by a client every session, to much more comprehensive and lengthy measures incorporating both client andpsychologist perspectives which can take 20 minutes or more to complete at various intervals throughout treatment. Any approach to measuring therapy progress, effectiveness, and outcomes is not likely to be appropriate for all people in all situations.