Clinical Risk Assessment and Management: The Critical Role of Formulation

I wanted to share the really positive experience I had at the recent BPS CPD day on Clinical Risk Assessment and Management: The Critical Role of Formulation delivered by an effervescent and very informed Dr Caroline Logan. 

Well it was always going to be a risk - navigating the perpetual roadworks of the M62 in order to get to Manchester by 10.  So I ustilised the 5 -Ps...

 

the Problem - getting to Manchester before the start of the programme at 10

Precipitating factors = Traffic and roadworks

Perpetuating factors = Traffic and roadworks worsened by a broken down lorry that resulted in a lane closure and even more traffic.

Predisposing factors = vulnerability factors = the drivers - literally

Protective factors  = I left home at 7.15 to ensure I arrived in  plenty of time (TomTom said 2 hours - tops!)

then I encountered the remaining 3Ps in a continuous revolution...

 

When I eventually got there - 10.30 I was met with "why didn't you get the train?"

Wish I had...

The day was exciting and informative, with Caroline connecting with each one of us as she picked up on comments we had made about our work and interpretation. 

The day provided  

1. An overview of the most recent thinking on the structured professional judgement approach to clinical risk assessment and management. 
2.  An understanding of the critical role of formulation as the bridge between risk assessment and risk management.
3. Skills in risk formulation
4. A framework for evaluating risk formulations
5. Skills in the communication of risk formulations

 

The HCR-20 version 3 was discussed in detail. We even talked about the current DSM-V debate!  A very interesting and fulfilling day with a very fulfilling lunch!

 

Campaign for a Royal College of Psychologists

At the time of writing, 449 out of a required 500 BPS Members, Associate Fellows and Fellows have signed up to the campaign for the establishment of a Royal College of Psychologists (RCPsychol). 

As reported by the Campaign group:

"With the new RCPsychol, the professional interests of all psychologists will be seen to be substantively protected by psychologists. The BPS has all the infrastructure in place to do this, but the campaign feels that this is not being given the recognition it deserves by government, business stakeholders, international organisations and authorities, as the BPS is not perceived to be of the same status as other chartered institutions who have adopted a royal institutional title.

The aim of the campaign is to petition the BPS to work towards the status of becoming (or creating) a Royal College, such as “The Royal College of Psychologists” or “The Royal College of Chartered Psychologists”. The choice of name and associated membership grades, their privileges and responsibilities would ultimately be a matter for Council. 

The principal reason for the BPS operating under the name of a Royal College is to bring the BPS in line with other Royal Colleges in the UK, e.g. Royal College of Physicians, Royal College of Speech and Language Therapists, etc.

The BPS has had a Royal Charter since 1965, BPS Royal Charter and is already doing what other Royal Colleges do but without the visible authority of a Royal College per se. The status of a Royal College of Psychologists will give the present BPS a well-deserved place among sister Royal Colleges, and raise it to the status of a definitive authority in the eyes of the public, both at home and internationally. It will also give visible regard to the Royal Charter granted to the Society 45 years ago."

This is a very important step and one I urge other BPS Members to sign up to before 26th March 2013. We have a long established professionsl career and need to move forward with a sense of our history alongside a determination to develop further and take us into the future. Read about the past and the future and then decide what action you may be able to take that is relevant to you.

Please feel free to leave your comments below.

not a neuropsychologist but a clinical psychologist interested in neuropsychology

I am a clinical psychologist and have a  particular interest in neuropsychology and am experienced in conducting neuropsychological assessments.  When working in Australia I was a member of the (4-person) organizing committee, and also presented at, Novita Children’s Services (formerly the Crippled Children’s Association) inaugural Acquired Brain Injury conference - the first Australian ABI conference that focused on children.  The conference has become a biannual event. 

At the same time I established (with another psychologist and two social workers) a Brain Injury Support Service for children and adolescents with acquired brain injuries.  We received referrals for neuropsychological assessments, rehabilitation programmes, and for the education and support of schools in reintegrating children back into the learning environment.  Individual therapy and family support was included.

Building upon my interest, my current research involves looking at the role of memory in the development of post traumatic stress disorder in adult patients who have spent time in Intensive Care. 

From a therapist's perspective I have looked at the therapeutic environments of people living with dementia in enabling them to feel emotionally secure and therefore less distressed.  This thesis was completed as part of a Diploma in Disability Psychotherapy run by Frankish Training.  This work has been presented and published at the 2012  British Psychological Society Faculty of Psychology of Older People (FPoP), formerly PSIGE, conference in Bristol, UK: “Application of the Frankish Model of emotional development in the therapeutic holding of people with dementia: A pilot study”.  For more information about helping older people to age well see http:www.psige.org/info/home

Counselling Psychologists

Counselling psychologist: Job description

Counselling psychologists use psychological theory and research in their therapeutic work with clients, staff groups and organisations. Clients may present with a variety of problems ranging from anxiety and depression arising from difficult life issues to more serious mental health problems.

Life issues could include bereavement, relationship difficulties, domestic violence or the aftereffects of childhood sexual abuse, while mental health problems could include eating disorders, post-traumatic stress disorder (PTSD) or psychosis. Some individuals may have simply come to a point in their life, where they feel the need to take stock and consider options for moving forward.

Staff teams may need assistance to develop Support Plans for individuals; may need assistance in understanding the meaning behind behaviours that challenge; or may need to find a support mechanism to aid them in avoiding burnout issues.

Organisations can utilise the therapeutic understanding and expertise of Counselling Psychologists to understand system dynamics; to create new and therapeutic environments; and to develop new therapeutic models of care and support.

Practising as a counselling psychologist requires a high level of training and self-awareness, achieved through personal therapy, as well as the ability to work collaboratively with the client in a holistic, insightful and facilitative way to enable them to consider change.

Counselling psychologists work with diverse client groups, including children, adults, students and young people, families and couples, and older people. They work in many different settings, such as health and care services, hospitals, prisons, probation services, consultancy, and in private or public organisations.

Typical tasks include:

• undertaking assessments, including assessment of mental health need, risk assessment and psychometric testing;
• formulating a psychological explanation of the client’s issues;
• planning and implementing therapy;
• evaluating the outcome of therapy;
• establishing a collaborative working relationship with the client based on trust and respect;
• writing reports and record-keeping;
• training and supervision of other psychologists;
• management, audit and development of services and organisation;
• multidisciplinary teamworking;
• continuing personal and professional development (CPD);
• undertaking research, either individually or as part of a team

Empathy & Compassion in Society Conference

Speakers

Tomorrow marks a unique opportunity for those involved in the fields of policy, education, health and social care to come together to hear internationally acclaimed scientists, leaders and change makers in a series of presentations and workshops focused on Empathy & Compassion in Society. The Conference actually begins with a free event for young people, an encouraging sign that the focus of empathy and compassion will begin with hope for the future and the encouragement of our young people to award status to these ideas.
The conference is being supported by a range of organisations dedicated to making a diference in the daily lives of individuals and the overarching consideration of national and international peoples.
As a group of psychologists we are committed to active investment in cutting edge science and provision of services to enable as many individuals as possible to achieve their potential. As a result we are endeavouring to stay abreast of such movements and to incorporate these ideas into our work with individuals and organisations.
The publication of the Winterbourne report, after the revelations of the dreadful treatment of those within the care system at Winterbourne, gave particular emphasis to the importance of compassion in the care and support of vulnerable people. We will attend the conference and hopefully let you have feedback on how it goes and what outcomes there may be. Watch this space....

CPD, who has responsibility?

We all know the rules and requirements of CPD for Practioner Psychologists. We also know that it is in the interests of our practice and the support we offer to others, to stay up to date with professional development. For those of us who are employed there is an expectation that our employer will provide CPD or foot the bill. For those of us who are self-employed there is obviously a need to source and pay for our own. Is there a point at which the two cross over? Is there some form of CPD that would benefit you directly in your practice, that would make little or no difference in business or efficiency terms for your employer. Are there just things you are plain interested in? Are there things you could be doing to help yourself?

We need to bear in mind that many daily activities count towards CPD. None of us can practice without supervision and this counts. Teaching individuals, managing provisions, reading articles, networking with other professionals - all of these things count towards the maintenance of CPD. In a climate of fiscal austerity, take responsibility for some of your own CPD and find training or interests that inspire and motivate you to take ownership of your own CPD. Tackle the issue head on and gain a sense of choice and autonomy in where you place your attention. Both you and the individuals you support will make greater gains than attendance at perfunctory training in areas that hold little professional passion for you.

Frustration with the lack of psychotherapy for adolescent sex offenders.

Over the last few years I have been asked to assess adolescent sex offenders either pre-trial or pre-sentencing.  More often than not these adolescents have experienced trauma that predates their offences and often I recommended psychodynamic therapy in addition to the traditional sex offender treatment programme.  I recommend this not just because it would be beneficial to the psychological development of the individual, but also because if (as is also common) the adolescent is emotionally under-developed as a result of their trauma, the psychotherapy will enable them to develop to such a point that they would be able to fully engage with sex offender treatment.

So last week I was asked to reassess an adolescent who was applying for parole whom I had recommended the above with concern that his mental health would deteriorate.  I was saddened to discover that his mental health had worsened and I considered him to be of greater risk than two years previously.  He had not received psychodynamic psychotherapy, but had been accessing sex offender treatment but had not completed it, in my opinion due to an inability as a result of his emotional incapacity.  This left me feeling frustrated, but ready to improve awareness and try to change this.

Nigel organises a good congress!

Well it has taken a little while to post this, but still worth a little read:

Joint Congress of the European Association for Mental Health and Intellectual Disability and IASSID Challenging Behaviour and Mental Health SIRG

1-3 September 2011, Palace Hotel, Manchester.

Well, it was always going to be a good conference with Nigel Beail organising it… and I am not just talking about the Social Programme (although the Casablanca Steps were rather fabulous!).

It was a conference where I could not find a slot in the programme to have a break, so I attended throughout, despite my weariness (noting the good social programme again!).

My highlights were hearing: Noelle Blackman presenting a case study of an eight year psychotherapy with a woman with learning disabilities who initially displayed some very disturbed and dangerous (self-injurious) behaviour; Valerie Sinason raising our awareness of the presence of Dissociative Identity Disorder in people with intellectual disability in her wonderful expressive and heartfelt style (which prompted me to buy the new edition of her book Mental Handicap and the Human Condition); and overall, Pat Frankish giving her keynote speech considering the Paradigm Shift that has happened over the last thirty years from a position where psychological therapies were not considered appropriate for people with intellectual disabilities, whereas now they are widely used, and this was reflected in the congress programme.

Pat has worked hard over the last thirty years… I guess it’s time for us to keep the momentum going!

Happy opening ceremony day everyone.  I rang my school bell with many of my neighbours this morning to celebrate the countdown to the beginning.  It was a beautiful 3 minutes, shared across the country with many many people and car drivers tooting and ringing away.  It was beautiful for the soul and three minutes of connection at a very spiritual level.  Enjoy!

Thoughts from the Annual Institute of Psychotherapy and Disability Conference in Dublin, June 2012

I was lucky enough a couple of weeks ago to travel to the Annual IPD Conference in Dublin with a colleague from PFP&PC.  The conference was entitled What about me: Psychotherapeutic Applications to Disability.  Professor Nigel Beail presented the keynote address about setting up psychotherapy services for people with learning disabilities where he outlined the areas for consideration including the available outcome research and the importance of evaluating services to provide data to commissioners about the value of the service. 

After the break, we presented our paper “Providing Support within the Private sector: a UK experience” on behalf of Dr Pat Frankish, which described the development of our service model with case examples of the model in practice.  We were followed by Patty Van Belle-Krusse from the Netherlands, who described her project in Arduin which provided support to people with intellectual disabilities in an environment that is therapeutic. 

In the lunch break, Irish author Jack Harte read from his novel Reflections in a Tar-Barrel which tells the story of a man who is considered to be a “half-wit”; he also believes this to be true.  The story describes how he grapples with life and the spiritual and arrives at his own world view.  Harte uses a tragic humour in his story-telling, which characterised both the pain and wonder of hero’s journey.

Following lunch there were a series of parallel seminars, of which only two could be attended. I chose Angelina Veiga’s Who Framed Sigmund Freud? On protecting patient and therapist from attack and Grania Clarke’s Working with Systems within Systems: the value of systemic approaches in working with people with disabilities and the systems designed to support them. These two seminars reminded me of the huge variations in approaches to working with people with intellectual disabilities, and the vital importance of the presence of all of them as there are large variations in our clients and their needs will be different requiring different forms of therapy and support at different times.  Angelina’s psychoanalytical presentation raised the blocks to therapy that are even more damaging of the therapy for people with intellectual disabilities and the importance of the therapist to be aware of these attacks and be ready to address them.  Grania described the complexities in the systems of people with intellectual disabilities and the varied perspectives of individual’s within the system.  She used case examples to highlight the importance of using a systemic perspective in working with people with intellectual disabilities.

Well worth the whistle-stop tour!!



Statement of Equivalence (SoE) – the old fashioned way

As an Australian-trained Clinical Psychologist I began the SoE process in 2007, and, after four years was last year awarded Chartered status by the British Psychological Society (BPS) and registered by the Health Professions Council (HPC).  What a process!  It would have been quicker to undertake the doctoral program from beginning to end.

There are inherent difficulties in gaining the now defunct SoE and practitioner status via the international route with the HPC.  The biggest, yet most important, was, as an international applicant, circumnavigating the ‘system’ to find

a)     placements and supervisors in order to meet the required competencies

b)     a university to support you if you need to undertake doctoral level research

c)      an establishment that supports candidates through the process.

My experience has been “Well, this is what you need to do, go do it”, but without documented links to Trusts or private practices that are willing to take on overseas clinicians. 

Of greatest disappointment is the as yet unaddressed issue of candidates undertaking doctoral level research, being examined as if a doctoral final year student, but not getting the qualification at the end of it.  While equivalence was always the goal, surely the next step for the profession is recognition and reward for those candidates who complete this process?

Any thoughts from other SoE candidates or from those who applied to the HPC via the international route are welcome.

Yorkshire PQT training day: Teaching psychology to non-psychologists

Two of the team from PFP&PC attended a one day workshop run by The Yorkshire Psychologists’ Post Qualification Training group, at University of Leeds. The day covered ideas around teaching psychological thinking to other professions. Interestingly, three of the speakers were non-psychologists which gave a good all round feel to the day, acknowledging areas of expertise amongst professionals willing to share.

The first sessions was run by Gary Latchford, a research director at University of Leeds. He introduced us to the amazing Dr Fox and we discovered that it’s not what people try and teach us that aids recall, but the dynamism of the person teaching us. He also gave us hints and tips from the famous, Steve Jobs, founder of the Apple company, and his approach to public speaking and selling his products. It is well worth noting that the need to physically practise cannot be over emphasised.

Jason Heppell, academic support officer, University of Leeds, gave us a more theoretical background on recent research in the literature on higher education. It would be worth your while to investigate some of the findings on e-learning, seminars, and self-directed learning followed by student teaching. Seems the work students put into preparing presentations and teaching projects, gains them valuable deep learning. Also interesting to note that in spite of all the evidence in support of learning styles, these have little bearing on how we might teach effectively. What matters is that the method of teaching is suited to the content of the material.

Rebecca Dearden, from the staff and departmental development unit, University of Leeds, blew us all away with her grasp of electronic availability and manipulation of material. She came up with some amazing suggestions for use of technology from instant video uploading, to tweeting, to texting questions within seminars. All worth some serious investigation for gaining and maintaining audiences.

Claire Dowzer then announced and facilitated some understanding of the new Sharepoint system between the University and the NHS to facilitate collaborative working. A small area of the site is available to PQT members too. The Sharepoint system is a Microsoft system available to all for the sharing of info between teams and across organisations.

After lunch, a consultant psychiatrist, Dr James Johnston, gave a fascinating talk on facilitating reflective practice groups for those working in acute psychiatric settings.

More to follow in a future blog.

New sign up for Twitter

Finally beginning to coordinate our social media and networking to bring some of our thoughts and experiences to you from The Psychology Team. So you can follow us on our new Twitter feed @psydaily and we hope to bring you up to date information, comment and reflection. You can check out the work we do and who we are at http://www.patfrankish.com/or http://www.patfrankish.co.uk/