A Thematic Analysis of the Multidisciplinary Team Understanding of the 5P Team Formulation Model and Its Evaluation on a Psychosis Rehabilitation Unit.

There is a dearth of research investigating team formulation in mental health services. This research investigated the multidisciplinary team understanding of the 5P team formulation model and its evaluation on a psychosis rehabilitation unit. Six participants were individually interviewed from one multidisciplinary team. The data was analysed using thematic analysis and this resulted in three main themes: The configuration of 5P team formulation on a psychosis rehabilitation unit, team formulation has multiple functions and team formulation does not require transformational change. Participants evidently understood the 5P model. Team formulation functioned as a cognitive learning process that enabled broader knowledge and a deeper understanding of individual clients. It also facilitated staff to have a space to discuss client cases whilst reinforcing team support and working. It was an informal process that was not directly linked to intervention. However, it indirectly influenced clinical practice both at a team and on an individual level. There were no reported drawbacks to team formulation, and it did not require change. Further research in psychosis services is required in order to generalize the findings. It will also be necessary to link team formulation to psychological intervention if it is to achieve its aim.

Using the Newcastle Model to understand people whose behaviour challenges in dementia care.

National guidance for working with people whose behaviour challenges in dementia care suggests that a psychosocial approach should be the first-line intervention. However, there is little guidance for nurses about how to assess and manage behaviour that challenges in people with dementia. Nurses across specialties who work with older people might be asked to contribute to an assessment or provide advice to care home staff or families. This article presents one psychosocial model--the Newcastle Model--that provides a framework and process in which to understand behaviour that challenges in terms of needs which are unmet, and suggests a structure in which to develop effective interventions that keep people with dementia central to their care.

Legal implications of restrictive physical interventions in people with dementia.

Dementia care environments are now home to thousands of people who have complex mental and physical health needs. Many of these people have lost capacity or have fluctuating capacity to make decisions about their care. There can be times when restrictive physical interventions are necessary to protect a person's wellbeing and to administer required treatment and care. However, nurses working in care settings may not be aware of their rights and liabilities, and those of care staff, when such interventions are used for therapeutic purposes. This article seeks to address areas of uncertainty and clarify the legal responsibilities of care teams by exploring the issues raised through a fictitious case vignette.

Extending the Newcastle Model: how therapeutic communication can reduce distress in people with dementia.

This article identifies the importance of effective communication in delivering care to people living with dementia when their understanding of the situation may differ to ours. The Newcastle Model's biopsychosocial framework is revisited to understand the context in which caregiving takes place, and the article goes on to consider the importance of communication to person-centred care delivery. The special case of lie telling or 'therapeutic untruths' as a communication tool is considered as an often essential way to join with the person's reality, and the practical and ethical dilemmas this poses are considered.

'Speaking about the unspeakable': Clinical psychologists views on the role of the profession regarding 'forced care' of older adults without capacity.

'Forced care' describes the provision of personal care to an individual who does not have the capacity to make a decision about that care and resists receiving that care. This study explored the views of clinical psychologists on supporting staff involved with forced care and considered the following question: Do clinical psychologists feel that they have a role in guiding decisions around forced care, and if so, what? Interview data were gathered from five clinical psychologists experienced in the field of Older Adult psychology in the UK. This study concludes that the environment in which psychologists work influences the psychologist's beliefs about whether psychologists should be involved with making recommendations about forced care, and how they should be involved.

Micro-skills of group formulations in care settings: Working with expressions of staff distress.

The help of specialist clinicians is often sought to advise staff in residential and nursing care homes about how to work with people with dementia whose behaviour is challenging. The Newcastle Model ( James, 2011 ) is a framework and a process developed to help care staff understand and improve their care of this group. The model emphasises the use of sharing information with staff to develop effective care plans. In the Shared Formulation Sessions characteristic of the Newcastle Model, clinicians take the role of a group facilitator, helping the staff reach a consensus about what needs to change. These sessions can be difficult to manage as intra and inter-group processes emerge and the group express their anxieties. This paper aims to explore the processes that might be in play Shared Formulation Sessions and to suggest ways in which the facilitator might approach this to manage effective collaborative working.

Micro-skills of group formulations in care settings.

This study examines some of the micro-skills associated with the moment-to-moment decisions and actions involved in delivering group formulation sessions in dementia care settings. We discuss the therapeutic framework used by therapists from a number of Challenging Behaviour Services in the UK (Newcastle, Northumberland, South Tyneside, Teesside, Sutton and Merton, Northern Ireland) which is frequently referred to as the Newcastle or Colombo approach. Through a theoretical review and practice illustration, the study pays particular attention to the role of therapists' questions and questioning styles in group formulation sessions, providing a framework which aims to facilitate care staffs' understanding, reflection and empathy regarding their residents who are displaying 'challenging behaviours'. The study also provides a potential guide to the training of therapists working in this area and thereby attempts to benefit clinical practices in an area where pharmacological approaches are usually the treatment of choice.