Formulation and Formulation Meetings at Red Kite View: A Guide for Young People and Families

What is Formulation?

A formulation is just a way of describing problems and ways out of them. Formulations start with the idea that a Young Person has good reasons for having difficulties, being distressed or feeling stuck. These good reasons may be difficult to understand or accept (if they were easier to understand or accept, a formulation wouldn’t be needed).

These good reasons may include:

• past difficulties and experiences that have affected you;
• changes in relationships in your family and friends;
• people having left, become ill or died;
• conflict at home, at school or with your friends;
• difficult changes in life (e.g. starting a new school).

Working out how different aspects of life fit together can help you begin to make sense of why you are having difficulties.

A good formulation also:

• recognises the positive things, for example, your own strengths and resources and people you can call on to help;
• points the way forward to positive change.

There is quite a bit of evidence that making sense of your difficulties in this way can be helpful.

How Formulations are developed at Red Kite View

Developing a formulation is a bit like doing a jigsaw – you work together to find the different pieces of the puzzle and put it together in the way you both think it fits. A formulation is developed together between the inpatient team and the Young Person, and any other people they trust to help solve the puzzle, both in services and in their family. This is usually led by a Psychologist or Psychological Therapist.

The pieces of the ‘jigsaw’ are pieces of information, like:

• how you feel at the moment;
• what’s going on in your life now;
• what’s going on with family, friends and school;
• when the difficulties or distress started;
• key experiences and relationships in your life;
• what these experiences and relationships mean to you.

When doing a formulation, we understand that the most likely explanation is that a Young Person is trying to cope with a situation, a history or some really difficult experiences in the only way they know how, even if this is inadvertently keeping them trapped in distress and difficulty. This is why we make efforts to work out not only the good reasons why someone is in difficulty, but also what has kept them there, and what might help them move forwards.

Like with a jigsaw, how long it takes to complete a formulation depends on how many pieces there are and how complicated the ‘picture’ is. Once the pieces are put together, the formulation can be used to explore the best way forward.

Formulation meetings

When a young person is admitted to Red Kite View, we aim to arrange a formulation meeting to take place within 21 days of admission.

The aim of the formulation meeting is to bring together all the professionals who are involved in the Young Person’s care and treatment, both from inpatient and community services, to develop this shared understanding of the young person’s difficulties.

Young people and their families are not invited to attend the formulation meetings as the meeting is a chance for the team and other professionals to develop more positive understandings of young people’s difficulties and to exclude inaccurate or inappropriate ideas. It is not considered helpful to subject a Young Person or their families to listening to “guesses” about their history that might not be accurate. However the views of the Young Person and their family about their experiences will be included from discussions, reports and observations made by the Young Person and their families prior to the formulation meeting.

What happens next?

The ideas generated at the formulation meeting will be typed up into a diagram or letter and discussed with the Young Person and their family. These discussions may lead to further changes or additions so that we have a shared and agreed written formulation.

Agreement will be reached with the Young Person about who the formulation would be most usefully shared with (in addition to the inpatient team and the community team(s) who will be supporting them following discharge from Red Kite View, and how it will be shared.

A formulation that is not understood by, or acceptable to, the Young Person is not a useful formulation, and implies, at the very least, the need for further collaborative discussion in order to develop a shared perspective. Complete agreement may not be achieved, or may be the subject of negotiation throughout the intervention.

Reformulation

A formulation is not a solution but provides hypotheses or “best guesses” to be tested out over time. Young People’s difficulties and needs may change significantly whilst they are at Red Kite View and formulations should be reviewed and amended regularly. Formulations are reviewed regularly within MDT discussions, CPA meetings and reformulation meetings.

The formulation will guide the intervention/treatment that is offered to the Young Person and their family whilst they are at Red Kite View, but will also inform post-discharge intervention/ treatment planning.

Acknowledgements

This document has been developed from the “Understanding Formulation” leaflet written by the Division of Clinical Psychology (DCP), and from the Formulation Meeting guidance at the Inspire Unit in Hull.