Putting the team into Team Formulation in adult mental health and learning disability services: Conceptual foundations.

Abstract

Team formulation is considered central to care delivery by mental health and learning disability multi-disciplinary teams. A systematic review completed as part of the thesis indicated team formulation research is scarce, of variable quality, and mainly explores practice acceptability. Team formulation lacks distinct definition and is based on psychological case formulation theory, a central tenet of one-to-one psychological therapy which does not include team theory. While there is emerging research on the impact of team formulation on the team, the systematic review found no reports of the impact of the team on the formulation. The development of a definition and model of team formulation, based on both team and case formulation theories was central to this thesis. The model proposed the role of team factors as critical to team formulation. The model guided the choice of two empirical studies, examining team factors and their relationship with the knowledge sharing required for team formulation.
Participants for both studies were recruited from clinical teams in a National Health Service organisation. Results of Study One showed perceived team communication quality (CQ) was a significant predictor of the level of a knowledge sharing system known as the transactive memory system (TMS), used for the task of team formulation. This relationship was not mediated by team identification (TI) or moderated by the effect of professional identification (PI) on team identification. However, there were significant correlations between CQ and TI, CQ and TMS, and TI and TMS. Study Two focussed on TI and TMS, to explore this relationship in depth and understand its relevance to the model of team formulation. It found that TI and the TMS for team formulation were closely related in a reciprocal manner, enhancing conditions for team formulation. Synthesis and discussion of both studies support the inclusion of team factors in the model of team formulation, highlighting application of the model for future research and clinical practice.
The thesis makes a novel contribution to team formulation theory, by uniting team and case formulation research. It provides a model to guide future team formulation research. The utility of the model is demonstrated by the two studies conducted for the thesis. Both studies advance understanding of team conditions and their relevance to the knowledge sharing required in team formulation. Furthermore, the thesis provides opportunities for teams to develop or enhance team formulation practice by suggesting the theory based core components and flow of team formulation practice.