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A Pilot Study Evaluating Care Staffs' Perceptions of their Experience of Psychological Consultation within a Mental Health Setting
Abstract
The aim of this study was to conduct a preliminary evaluation of a mental health consultation process provided to staff working in residential care settings for young people. Using a semi-structured interview approach, qualitative information was gathered from six participants about their experiences of the consultation. A thematic analysis of the interviews generated four key themes, which appear to reflect the different stages of consultation. These included: initiating consultation; building the consultative relationship; overcoming obstacles; and seeing the value of consultation. These themes, along with prevalent sub-themes, are discussed with reference to the effectiveness of the consultation process and the implications for use of psychological consultation in clinical practice. Implications for future practice include providing information to potential consultees before the consultation process, being accessible informally to the consultee and adopting a variety of approaches based on the consultee's needs. The limitations of this study and recommendations for future research are also discussed.
... At the time of writing, the majority of identified studies focused on Children's Services (e.g. Bostock et al., 2017;Cameron et al., 2016;Dimaro et al., 2014;Dixon & Ward, 2017;Evans et al., 2011;Luckock et al., 2017;Lushey et al., 2017), with several also including consultees from Child and Adolescent Mental Health Services (CAMHS) (e.g. Hibbert & Frankl, 2011) and Adult Social Care (e.g. ...
... The majority of studies assessing the impact of consultations within social care have focused on staff views. Several recent studies employed semi-structured interviews to ascertain the views of Social Workers on the consultation process, and their perceived impact on practice (Cameron et al., 2016;Evans et al., 2011;Hibbert & Frankl, 2011;Mattan & Isherwood, 2009). These studies found that consultations were well received by both staff and families within social care. ...
... These studies found that consultations were well received by both staff and families within social care. Social Workers and residential care support staff reported numerous positive outcomes stemming from consultations, including having a clearer formulation of cases, and feeling that their competency and skills were validated (Evans et al., 2011). In addition, they valued being offered an alternative perspective on cases, learning and improving therapeutic skills, and being supported with decision making and planning (Hibbert & Frankl, 2011). ...
It’s widely acknowledged that Social Work requires a more psychological approach when working with families. However, social care settings are under increased financial constraints and creative solutions are necessary. The provision of psychological consultations may be one way to meet this identified need; however, practice-based research is in its infancy. Using a mixed-methods approach, this service evaluation aimed to evaluate the provision of psychological consultations across community Social Care, and Residential Edge of Care teams. Quantitative analysis revealed that psychological consultations significantly improved consultees’ knowledge, confidence, motivation, and understanding – factors associated with best practice. Thematic analysis of the consultees’ qualitative feedback resulted in four key themes pertaining to areas of benefit: ‘enriching assessments’, ‘developing formulations’, ‘improving interventions’, and ‘supporting reflective professional practice’. Three key themes emerged in relation to what staff viewed as areas for improvement; that is: ‘changes to the process of consultation’, ‘changes to the content of consultation’, and ‘no improvement necessary’. These findings further evidence the beneficial impact of psychological consultations when provided across a range of Children’s Social Care settings. Psychology consultations therefore offer a promising means of promoting psychologically informed Social Care practice, contributing to best practice standards within the context of financial constraints.
... A strength of the present study is the independence of the research team from consulting clinicians, which contrasts with some of the literature (e.g. Durka & Hacker, 2015;Evans et al., 2011). Data were coded and themes conceptualised before the literature review, meaning the consistency with previous investigations is not attributable to simply coding for ideas that researchers had been previously exposed to. ...
Psychological consultation is one way of reaching a greater number of families with limited resources, yet little is known about the benefits and challenges of this intervention in adoption. We qualitatively explored consultations provided to adoption social workers by clinical psychologists. Six social workers and four clinical psychologists participated in semi-structured interviews. Five themes with supporting sub-themes were identified: (1) A context of highly emotive work with scarce resources; (2) consultations draw on Dyadic Developmental Practice and systemic thinking and involve goal-oriented and interpersonal processes; (3) consultations experienced as valuable despite challenges; (4) consultations facilitate learning for both social workers and psychologists; and (5) a collaborative focus and the ‘expert role’. Our findings suggest consultation is experienced positively by social workers and psychologists, that it successfully facilitates the transfer of psychological knowledge, and has the potential to enhance multi-agency working. Future research needs to better understand the impact of consultation on adoptive families.
... One model designed to support staff and develop their skills has been to provide external consultancy from a mental health practitioner. Evans et al (2011) describe the complexities of trying to do this in one unit. Possible barriers include staff feeling under-confident, being put off by the use of 'jargon', and practical problems such as the availability of the consultant or a lack of 'peace and quiet' in which to talk. ...
Team formulation can provide opportunities for integrating interprofessional perspectives, leading to a rich consensus of how to support someone. Such an approach can be particularly important when working in complex environments, where it is essential that a range of professional perspectives inform a trans-professional approach to care. Youth Forensic Services are one such setting, supporting young people who face intersectional vulnerabilities and have often experienced multi-type traumas. A trauma-informed approach to team formulation facilitates a compassionate perspective to inform decision-making and care planning, encapsulating an understanding of how a young person’s past experiences of trauma may be influencing how they interact with their environment and in relationships in the here-and-now. Additionally, some therapeutic modalities may feature more dominantly within trauma-informed formulation, which may reinforce a greater theoretical basis to the formulation process, offering further opportunities for tailored, evidence-based, person-centred care.
Purpose
The purpose of this paper is to evaluate pre- and post-formulation findings with multi-disciplinary staff within two secure children’s homes (SCHs) in the North East of England.
Design/methodology/approach
Multi-disciplinary staff teams involved in formulation across two SCHs were administered pre- and post-formulation questionnaires. The pre- and post-formulation questionnaires focused on five domains: knowledge; confidence; motivation; understanding; and satisfaction with treatment plan.
Findings
A total of 338 pre- and post-formulation questionnaires were administered across 43 formulation meetings. The highest proportion of formulation attendees were: residential staff (44%); mental health staff (17%); case managers (12%); and education staff (9%). Paired samples t -tests showed significant post-formulation improvements across all domains including: knowledge [ t (337) = 22.65, p < 0.001]; confidence [ t (337) = 15.12, p < 0.001]; motivation [ t (337) = 8.27, p < 0.001]; understanding [ t (337) = 19.13, p < 0.001]; and satisfaction [ t (337) = 18.81, p < 0.001].
Research limitations/implications
The SECURE STAIRS framework has supported formulation developments across the Children and Young People’s Secure Estate. Preliminary findings within two SCHs suggest multi-disciplinary staff teams find psychologically informed formulation beneficial. Future directions are considered including future evaluation of young person involvement in formulation meetings.
Originality/value
There is a notable lack of existing research within the child and young people secure estate evaluating the impact of SECURE STAIRS trauma-informed care developments including the impact of team formulation. This paper adds to the evidence base.
Psychological consultation is a key means of informing care and practice with psychological theory and evidence. The current paper sought to investigate what elements of psychological consultation are useful for social workers when consulting on high-risk youth, due to the current gap in the literature. Seven social workers shared their experiences during one-to-one interviews. The data was analysed through thematic analysis and the emerging themes were organised into three categories: Helpful elements, such as a safe space, independent expertise, and a shared understanding; Unhelpful elements, including consultee anxiety and the unheard young person; A Mediating element in the form of feasible recommendations. The implications of these findings are discussed, as well as the limitations of this paper and recommendations for future research.
Objectives:
Psychological consultation in mental health is an organizational intervention aiming to enable mental health care to be delivered in a more efficient manner. This review sought to: (1) clarify what theoretical models underpin consultancy, (2) define how consultancy is implemented, (3) assess the methodological rigour of the evidence base, and (4) define the outcomes achieved for services, staff, and patients. The review was focal to direct and indirect forms of consultation.
Method:
PRISMA guidelines were followed. Three databases were searched identifying N = 17 studies, and these were quality assessed using the QualSyst quality ratings checklist. Studies were grouped by model of consultation and outcome. A thematic analysis then clustered the patient, staff, and service outcomes into either discrepant or confirmatory evidence.
Results:
The most frequently adopted theoretical models underpinning psychological consultation are cognitive-behavioural and cognitive-analytic. Method of consultancy implementation is typically via case formulation meetings. Study quality varied from limited to strong. The main confirmatory and positive outcomes for staff are an increase in understanding and also more positive feelings towards patients, and for the service, there is a reduced need for other interventions.
Conclusions:
Psychological consultation appears a useful and worthwhile aspect of leadership by psychological therapists. Training in delivering consultancy needs to be well integrated into the core curricula of clinical training programmes. The evidence base is still in its infancy, and further well-controlled research is required.
This chapter aims to provide an overview of an emerging therapeutic approach for working with adolescents in secure settings who present with high vulnerability and high-risk behaviour towards both themselves and/or others. The approach has evolved over the past ten years through clinical experience and clinical practice within a variety of secure settings in the UK. The overarching framework is defined as the developmentally informed attachment, risk and trauma (DART) approach. The DART approach is unique because it brings together an understanding of complex presentations, and makes real and pragmatic links between theory and practice, pitching the interventions in a developmentally congruent way, while maintaining an awareness of the importance of understanding and managing risk. Rather than more traditional approaches in secure settings for young people, which are often drawn from adult practice that may have a particular focus on offending behaviour and risk, this approach understands high-risk behaviours as being driven by adaptive attachment strategies. The framework proposes that these are strategies that need to be understood within the broader developmental context, traumatic experience, and emotional and mental well-being of the young person and their system.
Looked-after and accommodated children are at higher risk of poor mental health and behavioural difficulties and experience high levels of emotional and psychological distress. Consultation plays a pivotal role in providing indirect support to vulnerable children and young people. The aim of this study was to explore the experience of consultation in three residential childcare settings. A mixed-methods sequential exploratory design was used. In the initial phase, a questionnaire survey exploring consultees' experience of the consultation process was conducted in three residential care establishments (N = 30). In the second phase, focus groups were conducted with both staff groups and consultants (N = 15). Results from the first phase identified themes around the interpersonal skills of the consultant, the helpfulness and the limitations of consultation. Using a thematic analysis approach in this second phase, three consultee themes emerged: the value of consultation, a new way of working, and the consultation relationship. The three consultant themes identified were: understanding roles, challenges, and building the consultation relationship. Results are discussed with reference to the current literature. These findings may impact on service development and clinical practice to improve the quality of care for looked-after and accommodated children.
Purpose
– The purpose of this paper is to conduct a preliminary evaluation of psychological-based supervision and consultation provided by a clinical psychologist to nursing staff working in a low-secure Learning Disability Forensic Service.
Design/methodology/approach
– A questionnaire was completed by 22 staff members, to gather information about their experiences of receiving this service and its impact on the motivation, stress and the care they provide for patients within the service.
Findings
– The most common reasons for staff to attend were to discuss patient issues ( n =10), needing space to reflect ( n =10) and wanting to discuss service issues ( n =9). Staff found these sessions to be supportive ( n =13), useful ( n =11), helpful ( n =11) and informative ( n =11). A majority of staff reported an increase in positive interactions (60 per cent, n =9) and in motivation (60 per cent, n =9) and a reduction in stress (43.7 per cent, n =7). Of staff answering the question 87.5 per cent ( n =16) would recommend these sessions to others.
Practical implications
– The findings suggest that staff benefitted from having this opportunity to discuss patient and service issues and that this had a positive impact on their role and the care they provide.
Originality/value
– Therefore, the paper suggests that by offering psychological supervision and consultation will provide support to nurses working in Learning Disability Forensic Service, increase motivation and reduce stress. These findings could also be used by management in service development, for example to reduce staff sickness and subsequently reduce costs within the service.
As the use of qualitative methods in health research proliferates, it becomes increasingly necessary to consider how the value of a piece of qualitative research should be assessed. This article discusses the problem posed by the novelty and diversity of qualitative approaches within health psychology and considers the question of what criteria are appropriate for assessing the validity of a qualitative analysis. In keeping with the ethos of much qualitative research, some open-ended, flexible principles are suggested as a guide to the quality of a qualitative study: sensitivity to context; commitment and rigour; transparency and coherence; impact and importance. Examples are given of the very different ways in which various forms of qualitative research can meet these criteria.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Traces the historical roots of Caplanian mental health consultation and lists 9 aspects of the model that have proven valuable over time. A relatively new development, mental health collaboration, is discussed with reference to the internal consultant. The role of mental health consultation in primary prevention is briefly reviewed, and it is argued that consulting psychologists who conduct organization development would do well to consider explicitly the preventive aspects of their work. The paper concludes with some thoughts regarding potential problems of working through intermediary caregivers to achieve the goals of primary prevention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated the causal attribution made by consultants with regard to successful and unsuccessful consultation experiences. 164 school psychologists (mean age 32.1 yrs) were asked to consider their consultation experiences with teachers, select the most and least successful cases they could remember, and then state why they felt each case succeeded or failed. Consultants attributed both success and failure experiences more to characteristics of the consultee than to any other cause, with consultee characteristics considered a greater contributing factor to the failure rather than the success experiences. (14 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The consulting process seems to work similarly regardless of whether the consultant is internal or external or is doing individual or group consultation. Some differences may occur depending on whether the consultant is a process helper or content helper, although good content‐focused consultants often possess excellent process skills and use them as a regular part of the consulting process. Several consultation processes were reviewed, and from this a six‐step approach is presented.
Gerald Caplan's (1970) classic text, "The Theory and Practice of Mental Health Consultation" was first issued more than 30 years ago. In it, he outlined the use of consultation as an indirect means to promote mental health in clients through the practice of four basic forms of consultation to professionals. Of the four varieties of mental health consultation that he outlined in the text, one variety, consultee-centered consultation, has received considerable attention and has been the most closely associated with Caplan. Consultee-centered consultation emphasizes a non-hierarchical helping role relationship between a resource (consultant) and a person or group (consultee) who seeks professional help with a work problem involving a third party (client). The primary task of the consultant is to help the consultee pinpoint critical information and then consider multiple views about well-being, development, intrapersonal, interpersonal, and organizational effectiveness appropriate to the consultee's work setting. The goal of the consultation process is the joint development of a new way of conceptualizing the work problem so that the repertoire of the consultee is expanded and the professional relationship between the consultee and the client is restored or improved. This special issue will address the three core issues of theoretical base, the consultant's line of responsibility, and application in educational settings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this article, we trace the historical roots of Caplartian mental health consultation and list nine aspects of the model that have proved valuable over time. Mental health consultation and a relatively new development, mental health collaboration, are discussed with reference to the school-based consultant. We argue that mental health collaboration must replace mental health consultation as the most frequent mode of interprofessional communication used by mental health specialists who are staff members of an institution. We conclude with a reminder that consultation is one piece of a much larger conceptual framework designed to prevent mental illness and promote mental health in the population at large.
Traces the historical roots of Caplanian mental health consultation and lists 9 aspects of the model that have proven valuable over time. A relatively new development, mental health collaboration, is discussed with reference to the internal consultant. The role of mental health consultation in primary prevention is briefly reviewed, and it is argued that consulting psychologists who conduct organization development would do well to consider explicitly the preventive aspects of their work. The paper concludes with some thoughts regarding potential problems of working through intermediary caregivers to achieve the goals of primary prevention.
Attempts to put consultation research trends into a broad research-development context. The authors consider the recommendations of many consultation research reviewers and address first-order changes needed to energize consultation research. Several key areas for consultation research are defined, and several potentially useful directions in methodology are presented, including qualitative research, single-case research designs, and alternative techniques for data analysis. Some important criteria for evaluating consultation research are considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Conducted a review of the professional literature, including the 1st 19 volumes of the present journal, to identify research articles in which elementary school counselors provided consulting services. Consultation is defined as a helping relationship between the counselor and one or more persons who are responsible for providing care and training for children. Of 21 studies identified, 18 (86%) provided outcome data indicating the positive effects of consultation (e.g., improvements in students' grades and/or attention, parental confidence, parent–child communication). The predominant consulting model used was Adlerian, with behavioral models occurring the 2nd most frequently. Groups were used more often than individual interventions with parents. (38 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
As a novice qualitative researcher, the author had little idea of the significant and vital role of transcription in the qualitative research process until she undertook her own transcription tasks. The questions she asked herself during that work led her to insights on transcription both as product and as methodological process. Her purpose in writing this article is to enter into the discussion of the nature and role of transcription in qualitative research by contributing an experiential context created when the transcription process is regarded as a key phase of data analysis within interpretive qualitative methodology. The structure of this article parallels the sequence of her learning experiences. The findings generate an enhanced view of transcription and transcriber as methodological components, provide a clearer vision for researcher positioning on the intersecting landscapes of transcription and qualitative methodology, and illuminate some implications for the training of qualitative researchers.
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